DÄ internationalArchive17/2020Not a Smoking Cessation Aid
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The authors did not mention how much nicotine is inhaled when e-cigarettes are used purportedly in order to stop smoking (1).

With each cigarette, smokers take in 1 mg of nicotine. According to the tobacco guideline, the components/ingredients of smoking one cigarette are defined as follows: nicotine content 1.0 mg, carbon monoxide 10 mg, tar 10 mg per cigarette. The nicotine content of the cigarette itself is much higher. Swallowing tobacco or drinking an infusion of a few cigarettes is fatal. Tar has an unpleasant effect and prevents smokers from increasing the amount of cigarettes smoked ad infinitum. “Chain smokers” admit to smoking between 35 and 40 cigarettes or two packs per day; their intake is therefore 35–40 mg nicotine; more than that is mostly not tolerated.

Since nicotine does not burn up in e-cigarettes but is vaporized, the nicotine contained in the vaping liquids is almost completely inhaled. In the EU, e-cigarette liquids usually contain up to 20 mg/mL, diluted with flavorings to the ready solution of 10 mg/mL: mango or cucumber flavor are tolerated better than tar.

I ask my “vaping” patients regularly for concrete amounts. On average they report that 10 ml vape juice at 10 mg/mL—that is, 100 mg nicotine—lasts them about a day and a half. The nicotine intake is almost twice that of chain smokers, but all of them subjectively expressed the opinion that they smoked less. Fruit esters do not scratch in the throat in the way tar does.

In conclusion: the key statement of the article, that e-cigarettes constitute a form of smoking cessation support, is untenable.

DOI: 10.3238/arztebl.2020.0298a

Dr. med. Ralf Cüppers

Medical psychotherapist, addiction psychiatrist

Flensburg, Germany

ralf@psychotherapeutische-medizin.net

Conflict of interest statement

The author declares that no conflict of interest exists

1.
Kotz D, Batra A, Kastaun S: Smoking cessation attempts and common strategies employed—a Germany-wide representative survey conducted in 19 waves from 2016 to 2019 (The DEBRA Study) and analyzed by socioeconomic status. Dtsch Arztebl Int 2020; 117: 7–13 VOLLTEXT
1.Kotz D, Batra A, Kastaun S: Smoking cessation attempts and common strategies employed—a Germany-wide representative survey conducted in 19 waves from 2016 to 2019 (The DEBRA Study) and analyzed by socioeconomic status. Dtsch Arztebl Int 2020; 117: 7–13 VOLLTEXT

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