What are in these pens? Generally, a combination of nicotine, flavoring — which is made up of chemicals — and a solvent of glycerin or propylene glycol. A battery heats the solution to vapor, which is then inhaled. There are approximately 7700 different flavors available, making ENDS attractive to people, particularly to adolescents.
The substances contained in ENDS, however, are far from benign since some of their byproducts are potential carcinogens.
Many people, including adolescents, are frequently under the impression that they are just inhaling water vapor and nicotine; this is not the case. There are no good studies available to support the safety or efficacy of ENDS as an option for smoking cessation.
There is good data, however, that nicotine replacement and varenicline together are effective in smoking cessation. Bupropion is another potential option, and is better than just nicotine replacement alone. Can e-cigarettes be used here? Possibly. However, other delivery methods, such as the patch, lozenges, or gum, when used as directed or prescribed, have a more proven safety record.
On the other end of the spectrum, it is important to screen adolescents at their visits for any form of nicotine use, including vaping, due to the staggering numbers of adolescents using ENDS that I mentioned. While adults may use e-cigarettes to aid in smoking cessation, adolescents may start with vaping, become dependent on nicotine, and then move to combustible nicotine.
They are often under the impression that there is no risk to them from using these vapor products. There is some evidence, also, that vaping may increase their risk for substance use down the line.
In 2016, the US Food and Drug Administration (FDA) ruled that ENDS could not be sold to individuals younger than 18. Now, there is actually a black market for selling vape pens in high schools.
Whatever the reasons our patients start vaping, whether it is an adolescent trying to be cool, or an adult working on smoking cessation, one thing is for sure: vaping is likely here to stay as this is a rapidly growing market.