Is Vaping Safe? Everything You Need to Know About Nicotine Vaporizers

Nicotine vaporizers—commonly known as vapes or e-cigarettes—are electronic devices that deliver nicotine in the form of vapor instead of smoke. This method avoids the combustion of tobacco and thereby reduces exposure to the over 7K chemicals found in cigarette smoke.

As of May 2024, the FDA considers nicotine vaporizers to be potentially lower-risk alternatives to traditional cigarettes. However, these devices are not without risks, including exposure to harmful substances and potential lung issues.

This guide covers the essential aspects of nicotine vaporizers, including:

• How nicotine vaporizers work to deliver nicotine

• The different types of nicotine vaporizers available

• The ingredients commonly found in nicotine e-liquids

• The safety concerns and health risks associated with vaping

• Regulatory actions and quality control measures in place to ensure user safety

In this guide, we will also explore the role of nicotine vaporizers in smoking cessation, comparing them with other methods like nicotine gum and patches, and discuss strategies to manage side effects and ensure safe use.

What Are Nicotine Vaporizers (Vapes)?

Nicotine vaporizers are electronic devices designed to deliver nicotine in the form of vapor rather than smoke. Unlike traditional cigarettes that burn tobacco to release nicotine, vaporizers heat a liquid (often called e-liquid or vape juice) containing nicotine, flavorings, and other chemicals to create an aerosol. This aerosol is then inhaled by the user, providing a similar experience to smoking but without the combustion of tobacco.

A nicotine vaporizer typically consists of (1) a battery; (2) an atomizer (i. e. heating element); and (3) a reservoir or cartridge that holds the e-liquid. When the device is activated, the battery powers the heating element, which heats the e-liquid and converts it into vapor. Users inhale this vapor through a mouthpiece, delivering nicotine into their lungs.

Types of Nicotine Vaporizers

There are several types of nicotine vaporizers, varying in design, functionality, and user experience:

• E-cigarettes: Often resembling traditional cigarettes, e-cigarettes are compact and easy to use. They are typically disposable or come with replaceable cartridges.

• Vape Pens: These are cylindrical devices that are slightly larger than e-cigarettes. Vape pens often offer more customization options, including refillable tanks and adjustable power settings.

• Mods: Short for "modifications," mods are advanced vaporizers that allow users to modify various aspects such as wattage, temperature, and coil type. They usually have larger batteries and tanks, providing longer usage between charges and refills.

• Pod Systems: Pod systems use pre-filled or refillable pods containing e-liquid. They are convenient and often favored by beginners for their simplicity and ease of use.

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Source: DSHS

How Do Nicotine Vaporizers Work?

The primary components of a nicotine vaporizer include:

• Battery: Provides the power needed to heat the atomizer. Batteries can be internal or replaceable.

• Atomizer: The heating element that converts the e-liquid into vapor. It often consists of a coil and a wick.

• E-liquid: The liquid solution used in vaporizers, which is vaporized to produce the inhalable aerosol. It usually contains nicotine, flavorings, propylene glycol (PG), and vegetable glycerin (VG).

When activated, the battery heats the atomizer, which in turn heats the e-liquid. This process creates a vapor that the user inhales through the mouthpiece.

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Source: DSHS

Types of Nicotine E-liquids

E-liquids come in various compositions and strengths, tailored to meet different preferences and needs:

Ingredients: Common ingredients in e-liquids include nicotine and flavorings, propylene glycol (PG), and vegetable glycerin (VG). PG is a colorless, odorless liquid that serves as a carrier for flavoring and nicotine. It provides a stronger throat hit, which mimics the sensation of smoking tobacco. VG is a thicker, sweet-tasting liquid that produces more vapor. It is used to create the “clouds” associated with vaping. VG is also a carrier for flavors and nicotine but in a higher VG ratio, it results in a smoother throat hit.

In addition to these main components, some e-liquids might contain distilled water and ethanol to adjust the viscosity and improve the mixability of the other ingredients. Most e-liquids on the market today consist of these four primary ingredients in varying ratios, which determine the overall experience, such as the intensity of the throat hit and the volume of vapor produced

Nicotine Levels: E-liquids are available in various nicotine strengths, ranging from 0 mg/mL (nicotine-free) to 50 mg/mL or higher. The choice of nicotine level depends on the user's previous smoking habits and nicotine dependency.

Flavor Varieties: E-liquids come in a wide range of flavors, from traditional tobacco and menthol to fruit, dessert, and beverage flavors.

In both the United States and Europe, there has been significant regulatory action towards banning flavored nicotine e-liquids to curb their appeal to youth. In the US, several states including Massachusetts, New York, New Jersey, and California have implemented comprehensive or are in the process of implementing bans on all flavored vaping products, excluding tobacco and sometimes menthol flavors. These restrictions are aimed at reducing youth access and use.

Similarly, the European Union has also moved towards stricter regulations, with some countries like Latvia and Slovenia banning all vape flavors except tobacco and menthol. As of 2021, over 30 countries had implemented some form of ban or regulation on vaping products. The EU’s Tobacco Products Directive allows member states to enforce their own regulations, leading to a varied regulatory landscape across Europe, but with a common trend towards limiting flavors to protect public health.

Are Nicotine Vaporizers Safe?

As of May 2024, the FDA considers nicotine vaporizers (vapes) to be potentially lower-risk alternatives to combustible cigarettes for adult smokers who switch completely from smoking, as they can reduce exposure to harmful chemicals found in traditional cigarettes. However, the FDA also emphasizes that these products are not without risks.

Lung Issues: Vaping can cause lung inflammation, irritation, and other respiratory problems. Chemicals in e-liquids, such as diacetyl and formaldehyde, can lead to conditions like "popcorn lung" and other severe lung injuries, such as EVALI (e-cigarette or vaping product use-associated lung injury).

“Popcorn lung,” or bronchiolitis obliterans (BO), is a lung condition characterized by inflammation that leads to wheezing, coughing, and shortness of breath. The term “popcorn lung” originates from cases of the illness among workers in a microwave popcorn factory who were exposed to diacetyl. Over time, it can cause scarring of the tiny air sacs in the lungs and the narrowing of the airways. This condition is associated with diacetyl, a chemical found in many e-cigarette flavors.

According to the CDC, by February 2020, more than 2.8K e-cigarette users were hospitalized due to EVALI, with 68 deaths, mostly among teens and young adults. Symptoms typically started gradually with shortness of breath or chest pain before worsening. Experts suspect that contamination with vitamin E acetate in some THC-containing e-cigarettes is the primary cause of EVALI, though other contaminants and pre-existing lung conditions may also contribute. The number of new EVALI cases has decreased significantly since September 2019, likely due to public health warnings about THC and vitamin E acetate in e-cigarettes. However, some cases may be missed or misattributed to infections, leading to incomplete tracking.

Exposure to Harmful Substances: Vaporizers can expose users to various harmful substances, including heavy metals, volatile organic compounds, and carcinogens. The heating elements in some devices can also release metal nanoparticles into the vapor. There have also been reports of lung illnesses and deaths associated with inhaling certain vaping oils, as the lungs cannot filter out toxic ingredients.

The FDA stresses that there is no safe tobacco product as of May 2024. Youth and adults who do not use tobacco products should not start using e-cigarettes. Nicotine is highly addictive, and vaping can lead to nicotine dependency among youth and non-smokers.

For more information, visit the FDA’s “Facts about E-Cigarettes” webpage.

Can Nicotine Vaporizers Help You Quit Smoking?

As of May 2024, the FDA has approved no e-cigarette or nicotine vaporizer as a smoking cessation device. Some e-cigarettes may help adults transition away from, or reduce their use of traditional cigarettes, according to a 2023 Cochrane review. Nicotine vaporizers can provide immediate relief from nicotine cravings, similar to the sensation of smoking a cigarette. Vaping also mimics the hand-to-mouth action of smoking, which can help address the behavioral and psychological aspects of nicotine addiction.

However, adults must utilize vaporizers to quit smoking and make the switch completely. According to a 2021 study, many smokers who vape tend to continue to utilize both cigarettes and e-cigarettes. This ‘dual use’ exposes users to the risks of tobacco smoking, and the potential risks of e-cigarette smoking simultaneously.

According to the NIH, a study of adult smokers in Europe found that those who vaped nicotine were less likely to quit smoking than those who didn’t. Additionally, e-cigarette users smoked more cigarettes than non-users. Another study involving over 800 people who vaped to quit smoking found that only nine percent had quit after a year.

Side Effects of Nicotine Vaporizers and How to Manage Them

Common Side Effects

While nicotine vaporizers are considered potentially less harmful than traditional cigarettes, they can still cause side effects. Common side effects include:

• Dry Mouth: The propylene glycol in e-liquids can cause dryness in the mouth and throat.

• Throat Irritation: Inhaling vapor can irritate the throat, especially for new users or those using higher nicotine concentrations.

• Coughing: The transition from smoking to vaping or the use of certain e-liquid ingredients can trigger coughing.

• Nicotine Overdose Symptoms: Symptoms of consuming too much nicotine include dizziness, nausea, headaches, rapid heartbeat, and, in severe cases, vomiting and confusion.

Managing Side Effects

To minimize and manage these side effects, consider the following:

• Stay Hydrated: Drink plenty of water to combat dry mouth and throat irritation. Keeping hydrated helps mitigate the drying effects of propylene glycol.

• Adjust Nicotine Levels: If you experience nicotine overdose symptoms, reduce the nicotine strength of your e-liquid. Gradually decreasing nicotine levels can help your body adjust without overwhelming it.

• Use Quality E-liquids: Choose high-quality, reputable e-liquids that use safe ingredients. Avoid those with excessive additives and artificial flavors.

• Pace Your Vaping: Avoid chain vaping or taking deep, prolonged puffs. Give your body time to adjust, especially if you are new to vaping.

• Switch Devices or E-liquids: If irritation persists, try switching to a different device or e-liquid. Some people react differently to various components in e-liquids.

Nicotine Vaporizers: Regulations and Quality Control

The regulatory landscape for nicotine vaporizers varies significantly across different regions. In the United States, the FDA regulates e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS). The FDA’s oversight includes product standards, labeling, marketing, and manufacturing practices to ensure public safety.

As of May 2024, the FDA has authorized 23 e-cigarette products and devices. These have undergone thorough review, including toxicologic reviews, and “have been found by FDA to meet the statutory public health standard.”

In the US, several states including Massachusetts, New York, New Jersey, and California have implemented or and in the process of implementing comprehensive bans on all flavored vaping products, excluding tobacco and sometimes menthol flavors to reduce youth access and use.

Vaping Among Teens

According to the NIH, as of June 2024, vaping devices are the most commonly used nicotine product among US teens, with many unaware that their cartridges contain nicotine and not just flavoring. The accessibility of these devices, their appealing advertisements, various e-liquid flavors, and the belief that they’re safer than cigarettes contribute to their popularity. They are also easy to conceal and often resemble flash drives.

A study found that one in four high school students used e-cigarettes for “dripping,” a practice in which people produce and inhale vapors by placing e-liquid drops directly onto heated atomizer coils. Teens reportedly used dripping to produce thicker vapor (63.5%), improve flavors (38.7%), and get a stronger throat hit (27.7%). Research also indicates that vaping may lead teens to start smoking cigarettes, with students who vaped being more likely to begin smoking within a year compared to non-vapers. Another study showed that high school students who used e-cigarettes were about seven times more likely to start smoking cigarettes within six months.

Alternatives to Nicotine Vaporizers

Nicotine Gum

Nicotine gum is a chewable form of nicotine replacement therapy (NRT) that releases nicotine as you chew. To use, chew the gum slowly until you feel a tingling sensation, then park it between your cheek and gum. Repeat this process until the tingling sensation fades, typically over 30 minutes. Avoid eating or drinking 15 minutes before and during use to ensure proper nicotine absorption.

Nicotine gum provides quick relief from cravings and can be used discreetly. It offers oral stimulation, which can help with the behavioral aspects of quitting smoking. Common side effects include mouth and throat irritation, hiccups, jaw discomfort, and gastrointestinal issues such as heartburn and nausea.

Nicotine Patches

Nicotine patches are adhesive patches that release nicotine through the skin. To use, apply a patch to a clean, dry, hairless area on the upper body or arm each morning. Patches are typically worn for 16-24 hours, depending on the brand and dosage.

Patches provide a steady, controlled release of nicotine throughout the day, reducing the need for frequent dosing. They are easy to use and discreet. Side effects may include skin irritation, dizziness, headaches, nausea, and sleep disturbances, particularly with 24-hour patches.

Nicotine Inhalers

Nicotine inhalers deliver nicotine vapor to the mouth and throat, mimicking the hand-to-mouth action of smoking. To use, puff on the inhaler as needed to manage cravings. Each cartridge provides a specific number of puffs and is typically used for about 20 minutes of continuous puffing.

Inhalers can help with the physical habit of smoking and provide quick relief from cravings. They are particularly useful for those who miss the act of smoking. Common side effects include throat irritation, coughing, and a runny nose.

Nicotine Nasal Spray

Nicotine nasal sprays deliver nicotine through the nasal mucosa, providing rapid absorption into the bloodstream. To use, administer one spray into each nostril to control cravings. The spray is typically used up to 40 times a day, depending on the prescribed dosage.

The nasal spray offers the fastest relief from cravings among NRTs, making it effective for sudden, intense cravings. Common side effects include nasal irritation, runny nose, watery eyes, throat irritation, and coughing.

Nicotine Lozenges

Nicotine lozenges are small oral tablets that dissolve slowly in the mouth, releasing nicotine. Lozenges are available in 2mg and 4mg strengths. To use, place the lozenge in your mouth and allow it to dissolve slowly. Do not chew or swallow the lozenge.

Lozenges are discreet and can be used anytime and anywhere without drawing attention. They provide quick relief from cravings by releasing nicotine gradually as they dissolve. Common side effects of nicotine lozenges include mouth irritation, sore throat, hiccups, heartburn, and nausea.

Other Quit Smoking Medication

As of June 2024, there are two primary drugs approved by the FDA to help individuals quit smoking: bupropion and varenicline.

Bupropion: Bupropion is an antidepressant that also helps reduce symptoms of nicotine withdrawal and the urge to smoke. It works by affecting brain neurotransmitters, including dopamine and norepinephrine, which are involved in nicotine addiction.

• Dosage and Use: Bupropion is usually started one to two weeks before the quit date, beginning with 150 mg once daily for three days and then increasing to 150 mg twice daily.

• Possible Side Effects: Common side effects include insomnia, dry mouth, and dizziness. Some users may also experience mood changes, increased blood pressure, and, in rare cases, seizures. Caution is advised for individuals with a history of seizures, eating disorders, or heavy alcohol use.

Varenicline: Varenicline targets nicotine receptors in the brain, reducing both the pleasure from smoking and withdrawal symptoms. It partially stimulates these receptors while blocking nicotine from binding to them.

• Dosage and Use: Varenicline is typically started one week before the quit date. The regimen begins with 0.5 mg once daily for the first three days, then 0.5 mg twice daily for four days, followed by 1 mg twice daily for the rest of the treatment.

• Possible Side Effects: Common side effects include nausea, vivid dreams, insomnia, and headaches. There have been reports of mood and behavior changes, depression, and suicidal thoughts, especially in those with a history of mental health issues.

Frequently Asked Questions

What should I tell my care team before I use a nicotine vaporizer?

Before using a nicotine vaporizer, inform your healthcare provider about any existing health conditions, medications you are taking, and your smoking history. This information helps them determine whether vaping is a suitable option for you and allows them to monitor for potential interactions or side effects.

What should I watch for while using a nicotine vaporizer?

Monitor for any adverse effects such as chest pain, breathing difficulties, severe throat irritation, dizziness, or symptoms of nicotine overdose like nausea and rapid heartbeat. If you experience any severe or persistent symptoms, seek medical attention immediately.

Can I smoke while using a nicotine vaporizer?

It is not recommended to smoke while using a vaporizer. Doing so increases the risk of nicotine overdose, undermines your efforts to quit smoking, and nullifies the health benefits of switching from cigarettes to vaporizers. Combining smoking with vaping can lead to an excessive intake of nicotine, which can be harmful to your health.

How do I choose the right nicotine strength for my vaporizer?

The appropriate nicotine strength depends on your previous smoking habits. Heavy smokers (more than a pack a day) might start with higher nicotine levels (18-24 mg/mL), while lighter smokers might opt for lower strengths (6-12 mg/mL). Gradually reducing the nicotine strength over time can help decrease dependency.

Can nicotine vaporizers explode or catch fire?

While rare, there have been instances of vaporizers malfunctioning and causing burns or fires. To minimize risk, use devices from reputable manufacturers, follow the manufacturer’s instructions, avoid overcharging batteries, and do not modify the device. Additionally, the FDA has a webpage with trips to help avoid vape fires or explosions.

Are there any long-term health effects of vaping?

The long-term health effects of vaping are still not fully understood, as it is a relatively new practice. While as of May 2024, the FDA considers vaping generally less harmful than smoking traditional cigarettes, ongoing research is needed to determine the full impact of prolonged vaping on health.

Conclusion

Nicotine vaporizers, or vapes, deliver nicotine through vapor instead of smoke, which reduces exposure to the harmful chemicals found in traditional cigarette smoke. These devices come in various forms, including e-cigarettes, vape pens, mods, and pod systems, each offering different features and user experiences. E-liquids used in these devices typically contain nicotine, flavorings, propylene glycol (PG), and vegetable glycerin (VG), with the composition and strength of these ingredients affecting the overall vaping experience.

Despite being considered potentially lower-risk alternatives to smoking by the FDA, nicotine vaporizers are not without risks. They can cause lung issues such as "popcorn lung" and EVALI, both linked to specific chemicals like diacetyl and vitamin E acetate. Furthermore, regulatory actions in both the US and Europe are increasingly aimed at banning flavored e-liquids to reduce their appeal to youth.

As of May 2024, the FDA does not recognize any e-cigarette or nicotine vaporizer as an approved smoking cessation device, although some studies suggest they might help adults transition away from traditional cigarettes if used exclusively. While vaping may offer a less harmful alternative to smoking for some, it remains important to consider the potential health risks and the evolving regulatory landscape surrounding these devices.

Resources to Quit Smoking

• Smokefree.gov - Provides tools, tips, and support that can help you quit smoking.

• Centers for Disease Control and Prevention (CDC) - Quit Smoking - Offers resources on how to quit smoking, including tips on quitting, benefits of quitting, and quit plans.

• American Cancer Society - How to Quit Using Tobacco - Provides detailed information on why to quit, how to quit, and dealing with the emotional and physical aspects of quitting.

• Mayo Clinic - Quit Smoking - Features articles, tools, and tips on quitting smoking and overcoming addiction.

• Truth Initiative - Provides innovative tools and resources for young people, including a text-to-quit program.

Glossary

• Nicotine Vaporizers (Vapes): Electronic devices that deliver nicotine in vapor form rather than smoke.

• E-liquid/Vape Juice: The liquid solution used in vaporizers, containing nicotine, flavorings, propylene glycol (PG), and vegetable glycerin (VG).

• EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury): A severe lung condition linked to vaping, often associated with vitamin E acetate in THC-containing e-cigarettes.

• Popcorn Lung (Bronchiolitis Obliterans): A lung condition caused by inhaling diacetyl, characterized by wheezing, coughing, and shortness of breath.

• Propylene Glycol (PG): A colorless, odorless liquid in e-liquids that carries flavor and nicotine, providing a stronger throat hit.

• Vegetable Glycerin (VG): A thick, sweet-tasting liquid in e-liquids that produces vapor clouds and provides a smoother throat hit.

• Mods: Advanced vaporizers allowing users to modify settings like wattage and temperature for a customized vaping experience.

• Pod Systems: Vaping devices using pre-filled or refillable pods, known for their simplicity and ease of use.

• Diacetyl: A chemical used in some e-liquid flavors, linked to the development of popcorn lung.

• Vitamin E Acetate: An additive found in some THC-containing e-cigarettes, linked to EVALI.

• FDA (Food and Drug Administration): The US regulatory body overseeing the safety, manufacturing, and marketing of e-cigarettes and other tobacco products.

• Nicotine Replacement Therapy (NRT): FDA-approved products like gum, patches, inhalers, nasal sprays, and lozenges designed to help individuals quit smoking.

• Dual Use: The concurrent use of both traditional cigarettes and e-cigarettes, which can undermine the benefits of switching to vaping.

• Dripping: A vaping practice where users place e-liquid drops directly onto the heated atomizer coil to produce thicker vapor and enhance flavor.