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Strong evidence exists that e-cigarette use suppresses nicotine withdrawal symptoms, although it is possible this may be a conditioned rather than a pharmacological effect. However, products that deliver physiologically active doses of nicotine would be expected to suppress withdrawal by both pharmacological and non-pharmacological mechanisms.

The ability of e-cigarettes to assist in smoking cessation is likely to depend on two principal factors: their ability to alleviate withdrawal symptoms following cessation of cigarette use, and the capacity to deliver nicotine to the brain swiftly.

Several well-designed and conducted randomized cross-over trials have investigated the pharmacokinetic characteristics of a number of e-cigarette brands in smokers naive to e-cigarette use, with regard to nicotine and the nicotine withdrawal syndrome, compared with cigarettes (Vansickel et al., 2010; Eissenberg, 2010) and with cigarettes and the nicotine inhaler (Bullen et al., 2010).  In these studies, e-cigarette use attenuated withdrawal symptoms despite negligible or very low levels of nicotine delivery, and  less swiftly and effectively than tobacco cigarettes,.  The low nicotine delivery in these studies suggests the effect may have been in some part to conditioned smoking-related cues.

In a study of eight experienced e-cigarette users who had been using the products for at least three months, Vansickel and Eissenberg (2013) found increases in nicotine and decreases in abstinence symptoms, relative to baseline. In a larger (n=86) randomized three-arm trial conducted by Dawkins et al. (2012), smokers who used e-cigarettes for 5 minutes in different doses and ways (ad lib 18 mg vs. 0 mg nicotine vs. ‘just holding without inhaling’), experienced relief of desire to smoke and withdrawal symptoms (using the Mood and Physical Symptoms Scale) within 20 minutes of use in both 18 mg and 0 mg groups but not in the ‘just holding’ group, suggesting that conditioned smoking cues play an important role.

These studies together suggest that the active use of e-cigarettes can relieve desire to smoke and withdrawal symptoms. Withdrawal symptoms and urges to smoke may be mitigated by smoking-related stimuli, such as those e-cigarettes provide through both behavioral replacement and throat stimulation effects (Buchhalter et al., 2005).

Buchhalter AR, Acosta MC, Evans SE, Breland AB, Eissenberg T. Tobacco abstinence symptom suppression: the role played by the smoking-related stimuli that are delivered by denicotinized cigarettes. Addiction. 2005 Apr;100(4):550-9.

Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control. 2010 Apr;19(2):98-103.

Dawkins L, Turner J, Hasna S, Soar K. The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition. Addict Behav. 2012 Aug;37(8):970-3.

Eissenberg T. Electronic nicotine delivery devices: ineffective nicotine delivery and craving suppression after acute administration. Tob Control. 2010 Feb;19(1):87-8.

Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE. A clinical laboratory model for evaluating the acute effects of electronic "cigarettes": nicotine delivery profile and cardiovascular and subjective effects. Cancer Epidemiol Biomarkers Prev. 2010 Aug;19(8):1945-53.

Vansickel AR, Eissenberg T. Electronic cigarettes: effective nicotine delivery after acute administration. Nicotine Tob Res. 2013 Jan;15(1):267-70. logo
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