They wanted the best…
Less nicotine means less harm to health... but not always?
The desire to do "the best way" again led to the result "as always": nicotine-depleted vaping liquids can eventually lead to an increase in nicotine consumption. Let's try to figure out why it happened.
The word "nicotine" itself came into the focus of public attention in a "bad" context: in 1850, the pure form of this compound was used as a poison, and it was then that this substance became known to someone other than chemists. Further, the image of the substance remained consistently low: "a drop of nicotine kills a horse" and, as many jokers added to this phrase, blows the hamster to pieces.
Well, he could actually be dangerous. If, in small doses, a compound with the general formula C10H14N2 accelerates the passage of nerve impulses through synapses (contact points of two neurons), then if dangerous doses are exceeded, it can greatly complicate the work of the synapses themselves – and it is in this case that an organism that has received an extremely high dose can die.
Visar do Bokarne kills his half-brother to take possession of the inheritance, around 1850. The count forced his brother to swallow a liquid containing nicotine, which was the first crime of its kind. Despite the novelty of the poison, local chemists were able to bring Bokarne to light / Wikimedia Commons.
Sensitivity to the dose is the reason why the content of this substance is being severely restricted. Before the advent of electronic cigarettes and tobacco heating systems, there was no particular problem here: factory-made tobacco products had a historically well-established range of nicotine content, and this did not cause serious disputes.
Less is better, isn't it better?
But in the XXI century, everything has changed. Electronic cigarettes appeared, evaporating liquid by heating without gorenje. It would seem an indisputable plus: there is no gorenje – so there are no dangerous by-products of conventional cigarettes, including formaldehyde and other carcinogens.
Although nicotine itself acts on synapses, it has not demonstrated a carcinogenic effect in animal studies. Meanwhile, smoking – with all the unpleasant aspects of nicotine addiction – is dangerous primarily for its carcinogenic effect, reliably proven by a huge array of medical statistics.
There is another unpleasant side to the by-products of combustion: when gorenje cigarettes (800-900 ° C) inevitably formed microparticles of 10 micrometers in diameter or less. They negatively affect the work of blood vessels: through the lungs, such particles enter the blood, where they stimulate the formation of blood clots. It is clear that gorenje does not occur in electronic cigarettes as such (heating is limited to 350 °C), so the risks from PM 2.5 and PM 10 microparticles or carcinogenic substances in electronic cigarettes are noticeably lower.
However, there was another side to e-cigarettes: it was also a technical new phenomenon, the pros and cons of which were unknown to the public. Therefore, when introducing technical regulations on the composition of liquids for such devices, errors were possible. And in 2014 they happened: the EU authorities adopted a technical regulation according to which the nicotine content in vaping liquids cannot exceed 20 milligrams per milliliter. It seems to be a good thing: the less nicotine, the weaker the dependence will be formed.
Unfortunately, as noted by cardiologist Konstantinos Farsalinos from the Onassis Cardiac Surgery Center (Greece), this concentration was included in the regulations by mistake, and based on the interpretation of one of the works of the same Farsalinos. Despite the fact that he, along with a number of his colleagues, tried to send letters to the authorities explaining that such concentration was not entirely correct, this did not correct the situation.
What is wrong with these 20 milligrams per milliliter and where exactly were the European authorities able to make a mistake in interpreting the results of the European scientist? Farsalinos has been investigating the effect of electronic nicotine delivery systems since 2011 and in a number of papers cited figures of nicotine entering the human body when using such systems. To assess the effect of nicotine on the central nervous system, this is logical: the number of milligrams that reached the human synapses is important.
However, European officials, when deciding on the permissible amount of nicotine per milliliter of vape liquid, considered that the milligrams that got into the body are equal to those milligrams that are contained in the liquid. This is the same as calculating that all the energy during the combustion of gasoline is converted into the energy of the rotation of the wheels of the car: the reality is extremely far from such a scheme. Up to three quarters of nicotine from vaping liquids does not enter the body, but instead goes into the surrounding space together with steam.
In general, there is nothing new here. When smoking a regular cigarette, too, not all 100% of the nicotine contained in it reaches our nervous system. However, the nicotine content in cigarettes will no longer be touched by the European authorities: the product has settled. But the new phenomenon got, and quite badly.
What is wrong with the lack of a harmful substance
The main problem associated with nicotine in today's world is smoking ordinary cigarettes, and not electronic ones at all – containing several times less extraneous dangerous substances. Therefore, the developers of new nicotine delivery systems assumed that their systems would be able to compete directly with cigarettes and gradually displace those from circulation.
At first glance, vaping has all the objective prerequisites for this: "steam" does not smell so sharply, it has a better image in the eyes of the public, after all, vaping is more fashionable.
But there is one big "but": in order to compete with cigarettes, vape systems need to replace as much nicotine as an ordinary smoker with experience gets from cigarettes. Studies show that while smoking a strong regular cigarette (red Marlboros), the concentration of nicotine in the smoker's blood is 3.86 times higher than when vaping with liquid according to European technical regulations.
It would seem that we should be happy: less nicotine means less addiction. But maybe it's too early. In 2019, The New England Journal of Medicine published an article that tried to find out what is the probability of a regular smoker switching to electronic cigarettes with a "European" nicotine content (up to 20 milligrams per milliliter). Exactly such liquids are rarely used in Europe, usually used with a slightly lower threshold content – so as not to accidentally exceed the limit due to deviations from the production process.
Therefore, the system was tested with a nicotine concentration of 18 milligrams per milliliter (or 1.7%, since the mass and volume fractions are somewhat different here). Despite attempts of up to three months, up to 18% of smokers were able to switch to vaping.
Maybe the problem is not in nicotine, but in the fact that people who are used to regular cigarettes cannot switch to electronic ones? This myth was dispelled by data from the USA: they conducted an experiment on liquids with 5% nicotine content (approximately 59 milligrams per milliliter).
It turned out that after six months, 54% of smokers gave up cigarettes by switching to a new product, and if we take the results for the first three months, the number of those who switched was 47%. For comparison, it can be pointed out that nicotine replacement therapy based on patches and the like gave smoking cessation only in 10% of cases – that is, several times less often.
It follows from this that the increase in nicotine content by almost three times caused an approximately three-fold increase in "transitions" from conventional, more dangerous cigarettes to electronic, somewhat less dangerous ones.
Endless hovering: another example of turning a plus into a minus
Interestingly, even those 18% who still switched from cigarettes to vaping, when using liquids with 1.7% nicotine, could not significantly change their level of consumption of this substance. The thing is that a cigarette burns for several minutes, and not many people smoke them one by one.
But the total vaping time in minutes can be noticeably longer. A number of studies have found that when using liquids with a concentration of up to 20 milligrams per milliliter, the time of continuous "vaping" increases to tens of minutes. The concentration of nicotine in the blood at the same time can reach the same level as from a regular strong cigarette – only not after 5, but after 35 minutes.
Meanwhile, the user continues the process of consuming the product for a reason: it is nicotine that causes addiction, and not the components of the vaping liquid that hold it. That is, the body is trying to get the right amount of nicotine by increasing the inhalation time.
As Farsalinos notes, the problem is that a significant amount of concomitant substances is inhaled. Even if they are not as dangerous as when smoking ordinary cigarettes with their formaldehyde-containing components, but in any case, the consumption of heated vapors of foreign substances obviously does not bring any benefit to the body.
"Our studies have shown that when the concentration of nicotine was reduced to 20 milligrams per milliliter, vapers consumed three times more liquid than at higher concentrations of nicotine. By reducing the concentration, we force people to use more aerosol, and this is the real danger," says the researcher,
Of course, vaping with nicotine-containing liquids did not show such a danger as when "vaping" with liquids containing tetrahydrocannabinol (the active component of marijuana). The latter type of liquids used vitamin E, which was previously considered harmless. However, as it turned out, when heated in the aerosol, it acquired extremely unpleasant properties and caused damage to the respiratory tract of vapers.
But even for those who consume liquids with nicotine, an unreasonable increase in inhalation of aerosols is undesirable. For cigarettes, there are more than a hundred years of experience in their use – and for vapers there is no such long tradition. Therefore, it makes sense to minimize the use of "non-targeted" related products that enter the lungs when using electronic cigarettes.
How will it all end
The EU plans to revise the legislative norms on the topic of 20 milligrams per milliliter by May 20, 2021 (although who knows if coronavirus will not be knocked out of the usual schedule there). In the USA and some other countries, there is no limit on nicotine in vaping liquids at all, and liquids with a content of up to 60 milligrams per milliliter (approximately 5% by volume) are available on the market.
In Canada, the limit is set, but at the level of 66 milligrams per milliliter – there legislators did not make an elementary mistake by confusing milligrams of nicotine in the body with milligrams in vape liquid. Therefore, for Western countries, most likely, the "Pharsalinos name mistake" will be a temporary, transient phenomenon.
But in our country, the situation may be slightly different. As you know, the Russian parliament often focuses on European, not American or other legislative norms. According to the Parliamentary Newspaper, Russian deputies considered that in order to reduce the damage from new electronic cigarettes, it is necessary to introduce European restrictions – even ignoring the fact that they will be canceled in the European Union tomorrow.
However, while the bill with such norms is still only passing the State Duma, and it is quite difficult to say for sure whether vape liquids with a nicotine content above 1.9% will be banned in Russia. If this does happen, then our country risks repeating the mistakes that have already been realized in Europe.
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