E-Cigarettes, Vapes, or Vape Pens

E-cigarettes, short for electronic cigarettes, are electronic devices designed to simulate the experience of smoking tobacco. Also called e-cigs, vape pens, vapes, e-hookahs, JUUL pods (a popular brand), and electronic nicotine delivery systems (ENDS), most e-cigarettes have a battery, a heating element, and a place to hold a liquid. The liquid usually contains nicotine, but some users also use e-cigarettes for marijuana extracts and other drugs. The vape fluids may also contain flavorings and other chemicals. Inside the e-cigarette, the liquid is heated, producing an aerosol that users inhale.

E-cigs may resemble regular cigarettes, cigars, or pipes. Some may look like pens or USB flash drives. Others like tank systems or “mods,” are much larger devices and may not resemble traditional cigarettes at all.

Using an e-cigarette is called vaping. When the liquid (also sometimes called “vape juice”) is heated inside the e-cigarette it produces an aerosol that takes the form of a vapor for inhalation, which is where the term vaping comes from.

Most e-cigarettes have a battery, a heating element, and a place to hold a liquid cartridge that typically contains nicotine or THC (the psychoactive part of marijuana), chemical flavoring, and other chemicals. When a person takes a drag from an e-cigarette, some of the liquid moves into the vaporization chamber/atomizer where it is heated and then vaporized to be inhaled into the lungs.

How much nicotine is in e-cigarettes?Nicotine levels in e-cigarettes vary and are usually 2-5%, but studies have shown mislabeling is a common issue for vape pens. JUUL, the top-selling e-cigarette (67.2% of the market as of 2019) has pods that contain 5% nicotine strength.

Some concentrations are very low and some are nearly as high as conventional cigarettes. The delivery of nicotine is affected by the way an e-cigarette is used or modified. Some brands of e-cigs deliver nicotine much more quickly than regular cigarettes, which can increase the chances of addiction.

Some vape products contain THC, the main psychotropic ingredient in marijuana. In other cases, the vape cartridge contains CBD oil, a concentrated type of cannabidiol in a liquid form.

E-cigarettes were initially touted as being safer than conventional cigarettes, but it is not known how safe or unsafe these products may be. The Centers for Disease Control (CDC) had identified certain symptoms associated with vaping as EVALI, which stand for “E-cigarette, or Vaping, product use Associated Lung Injury.” Characteristics of EVALI include respiratory symptoms such as cough, chest pain, and shortness of breath, and gastrointestinal symptoms, including abdominal pain, nausea, vomiting, and diarrhea. Other symptoms may include fever, chills, and weight loss. Death from lung injury may also result.

Even though e-cigarettes don’t contain the same toxins as combustible tobacco products like cigarettes and cigars, they still may contain a number of harmful chemicals including diacetyl (a chemical linked to serious lung disease), 2,3 pentanedione, and acetoin, along with other cancer-causing chemicals, and heavy metals such as nickel, tin, and lead. And though many of the flavorings and humectants in vape pen fluids are approved by the U.S. Food and Drug Administration (FDA) for oral consumption, there is a lack of research on the safety of these substances when inhaled, and they have not been approved for use by inhalation.

E-cigarette use has caused thousands of cases of respiratory illness and lung injury, and even several deaths. Side effects of vaping may include cough, chest pain, nausea, shortness of breath, vomiting, and diarrhea. Nicotine can be addictive and may cause side effects such as nausea, vomiting, abdominal pain, and eye irritation in low doses. In higher doses, nicotine can cause fast heart rate, high blood pressure, seizures, coma, and even death.

E-cigarettes are often touted by manufacturers as an effective way to help smokers quit, though research has not shown this to be the case. In some instances, users continue to smoke tobacco products in addition to vaping. The FDA does not recognize e-cigarettes as a method to help quit smoking.

Some e-cigarettes may contain a chemical called diacetyl that was once used to provide flavor to microwave popcorn. When inhaled, diacetyl may cause “popcorn lung” (bronchiolitis obliterans), a disease that results in scarring of the air sacs in the lung and narrowing of the airways. Popcorn lung is a serious lung disease that causes symptoms similar to those of chronic obstructive pulmonary disease (COPD), such as coughing, wheezing, and shortness of breath.

Most e-cigarettes contain nicotine, which is an addictive substance. The most addictive form of nicotine is that which comes from tobacco combustion, or traditional smoking products such as cigarettes and cigars. However, many nicotine vapes deliver the same levels of nicotine as combustible tobacco products. Young people may be more susceptible to nicotine exposure, as it has a significant effect on essential brain receptors.