Vaping is a lot safer than cigarettes, right? It involves nicotine, but at least people aren’t infusing their lungs with carcinogen-laced smoke. Plus, vaping seems to help smokers wean themselves off cancer sticks.
Not so fast, says Dr. Frank Leone, director of Penn Medicine’s comprehensive smoking treatment programs. Medical evidence is sorely lacking on the long-term effects of vaping—or e-cigarettes, the term Leone uses so no one forgets what they are. “We know that cigarettes are unsafe after 40 years of exposure,” he says. “We don’t have 40 years of exposure to e-cigarettes to know what the danger is. We don’t know the safety profile, so we can’t say that e-cigarettes are safer than traditional cigarettes.”
How dangerous can water vapor be? “It’s not water vapor,” Leone says. “And it’s not a nicotine delivery device. It’s a nicotine, glycol, formaldehyde and propylene delivery device. Those chemicals have deleterious effects on the body that may be completely different from the carcinogens in regular cigarettes. We just don’t know.”
But there is plenty of anecdotal evidence that cigarette smokers who switch to e-cigarettes wheeze less, have improved circulation, and generally feel better. Yes, Leone concedes, but the long-term effect could be worse or the same as lung cancer.
The only proven path to health is ending the nicotine addiction itself. Vaping doesn’t always do that. “The number of people for whom e-cigarettes prolong their addiction is higher than the number of people for whom it ends their addiction to cigarettes,” Leone says. “There is a subset of people for whom e-cigarettes are helpful. That’s a great thing. We have to figure out why it works for them and not everyone.”
One thing is indisputable: Ending nicotine addiction is tremendously difficult. The pharmacological effects of nicotine embed themselves into the brain, as do habits associated with smoking. “We’ve recently come to identify that biologic changes often manifest in behavioral routines,” Leone says. “You eat and want to smoke. It’s an irrelevant connection, but over time it becomes relevant to the survival circuitry in the brain. If you don’t smoke, there’s a sense of incompleteness and uneasiness. The only way to resolve that is to smoke a cigarette. The continuation of routines takes on importance to the brain.”
The earlier those routines get instilled, the harder they are to break. That’s why vaping is so dangerous for teenagers. And they are already “dripping,” manually operating vapes to get more nicotine out of them. “Studies show that nicotine-naïve adolescents who begin their exposure through e-cigarettes are more likely to move on to regular cigarettes,” Leone says.
He wants manufacturers to refine vapes so that the level of nicotine delivery doesn’t vary. That would help smokers use them to quit cigarettes, then help them quit vaping. Of course, that’s not in the best interest of the booming vape business.
In the meantime, Leone hopes that people who seriously want to end their nicotine addictions will turn to medically based programs like those at Penn Medicine.