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Self-titration by experienced e-cigarette users: Blood nicotine delivery and subjective effects

Self-titration by experienced e-cigarette users: Blood nicotine delivery and subjective effects. Lynne Dawkins (LSBU), Catherine Kimber (UEL), Mira Doig (ABS labs), Colin Feyerabend (ABS labs) and Olivia Corcoran (UEL ). Declarations.

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Self-titration by experienced e-cigarette users: Blood nicotine delivery and subjective effects

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  1. Self-titration by experienced e-cigarette users: Blood nicotine delivery and subjective effects Lynne Dawkins (LSBU), Catherine Kimber (UEL), Mira Doig (ABS labs), Colin Feyerabend (ABS labs) and Olivia Corcoran (UEL)

  2. Declarations • Conducted research for e-cigarette companies (2010-2013) • Consultant for pharmaceutical industry (2014) • Expert witness in e-cigarette patent infringement case (2014) • No funding from tobacco industry

  3. Blood nicotine delivery: cigarette smoking Smoking one cigarette (5 mins): Cmax 15-30ng/mL Tmax: 5-8 mins Hukkanen, Jacob & Benowitz, (2005), Pharmacological Reviews

  4. Self-Titration Hypothesis Smokers adjust their nicotine intake to maintain a personal optimal level. Smokers compensated for about 2/3 of the difference in nicotine yields (Ashton et al., 1979, BMJ)

  5. Compensatory Puffing 12% 40% Usual brand Low Yield Switch at Trial 3 Hammond et al. (2005) Cancer Epidemiol Biomarkers Prev

  6. Smokers can achieve approx. 60-80% of the nicotine yield via compensatory puffing behaviour (Scherer & Lee, 2014) • Mainly via taking longer, harder drags and more frequent puffs • Switching to ‘light’ or reduced nicotine containing cigs doesn’t appear to reduce toxicant exposure and may even increase it.

  7. E-cigs and nicotine delivery Bullen et al. (2010) Eissenberg (2010)

  8. E-cigs and nicotine delivery Error bars = 1SE Nicotine boost of 4.7ng/mL after 10 mins (10 puffs). Cmax = 13.9ng/mL at 60 mins. Dawkins & Corcoran (2014)

  9. Individual nicotine levels

  10. TPD Article 20 • Limit on nicotine concentrations > 20mg/mL • 9% use above 20mg/mL (ASH, 2016) • 1/5th of e-cig users initiated vaping with >20mg/mL nicotine concentration (Farsalinos et al., 2013)

  11. Aims To explore: • the extent to which e-cigaretteusers self-titrate when given a lower nicotine concentration liquid • subjective effects (craving, withdrawal symptoms, positive and negative effects) and plasma nicotine concentrations between conditions (high vs. low nicotine concentration liquid)

  12. Methods • Participants: 11 male experienced e-cig users • E-cigarette: eVic Supreme (Joyetech) with Aspire tank (Nautilus) • E-liquid: 6 & 24mg/mL tobacco flavour (Halo Smokers’ Angels) • Double-blind, counterbalanced

  13. Measures • Puffing topography: puff number, puff duration, mL consumed • Mood & Physical Symptoms & Urge to Vape (West & Hajek, 2004) • Positive Effects (e.g. hit, satisfaction on VAS) • Negative Effects (e.g. nausea, dry mouth on VAS)

  14. Procedure Ad lib vaping Pre-study Screening Overnight abstinence 60 mins baseline 30 mins 10 mins Blood Craving Withdrawal symptoms Puffing topography Positive & negative effects Salivary cotinine > 100ng/mL Blood Craving Withdrawal symptoms Blood Craving Withdrawal symptoms Puffing topography Blood Craving Withdrawal symptoms Puffing topography Repeated under high and low nicotine concentration conditions

  15. Puffing topography More puffs, longer puffs and more liquid consumed in the low (6mg/mL condition (p < 0.05)

  16. Blood nicotine delivery Incomplete self-titration from compensatory puffing

  17. Blood nicotine/puffing topography correlations High: r = 0.85**; Low: r = 0.75** High: r = 0.56*; Low: r = 0.22 ** p < 0.01; * p < 0.05 High: r = 0.85**; Low: r = 0.75**

  18. Subjective effects No significant differences between conditions in urge to vape or withdrawal symptoms

  19. Positive Effects Trend for higher ratings of hit and satisfaction in the high nicotine condition (p = 0.11 & p = 0.09)

  20. Negative Effects Rated on percentage scale: 0-100%; All ps > 0.09

  21. Conclusions • Clear evidence of compensatory puffing with lower nicotine concentration e-liquid • Self-titration was partially effective… • … equivalent reduction in urge to vape and withdrawal symptoms across conditions… • …but significantly higher levels of blood nicotine in the high condition • Very high levels of nicotine can be achieved very quickly (equivalent to smoking) under certain conditions

  22. Implications • Self-titration – another attractive feature of vaping? • More e-liquid consumed = higher cost(Kimber et al., 2016) • Advise smokers to use a higher nicotine strength liquid? • Limiting nicotine concentrations in e-liquid (TPD; May 2016) not necessarily the best option. • Blood nicotine levels akin to smoking may improve smoking cessation rates but prolong nicotine addiction

  23. Acknowledgements • Catherine Kimber • Olivia Corcoran • Mira Doig • Colin Feyerabend • Sarah Jakes • Pooja Shah • Neil Chauhan • Lowell Edio • Paul Boakes • Rory Butterworth • Participants

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