Ecigarettes Craving Quitting Addictive Potential keeping up with

E-cigarettes: Craving, Quitting & Addictive Potential - keeping up with a rapidly evolving phenomena Dr. Lynne Dawkins Drugs and Addictive Behaviours Research Group (DABRG), School of Psychology http: //www. uel. ac. uk/psychology/research/drugs SSA, York, November 2014

Disclosures • E-cigarette Industry: – Research funding – Conference funding – Received products for research • Tobacco Industry: – No conflict of interest • Pharmaceutical Industry: – No conflict of interest

Overview • • • Introduction to E-cigarettes (EC) Effects on craving & withdrawal symptoms Blood nicotine delivery Addictiveness Effectiveness for smoking cessation

First Generation EC

Second Generation EC

Third Generation EC (‘mods’)

Effects on Craving & Withdrawal Symptoms (WS) • EC (1 st gen) can reduce craving & WS in deprived smokers; not as effective as tobacco cigarettes (Bullen et al. , 2010, Tob Con, 19; Vansickel et al. , 2010, Can Epid Bio Prev, 19) • Placebo (0 mg nicotine) EC (1 st gen) also associated with decline in craving after 5 mins. (Dawkins et al. , 2012, Add Beh, 37)

Novice users’ experiences of EC use over one week • ‘. . . I nearly fell out of a tree about 60 foot up and it was a real adrenaline boost and I needed something to take that away. . . that was the only time it really didn’t kick, you know, the craving away. ’ • ‘I was sat in this French cafe and there’s just people all around me smoking and it’s like, nah, I just need to get out of here now. . . It (the EC) just wasn’t taking the edge off it’ Lawson, Cahill & Dawkins (2013); UKNSCC poster

Craving and WS: 2 nd generation (refillable) devices • Lower craving & WS after using nicotine vs. placebo (2 nd gen) EC (Dawkins, Turner & Crowe, 2013; ). • Disposable cigalike vs. refillable device: both equally effective at reducing craving and WS (Dawkins et al. , under review)

1 st vs. 3 rd generation devices • 23 experienced EC users used a 1 st gen cartomiser and 3 rd gen device • In 3 rd generation condition: – ‘Craving to vape’ lower (p<0. 001) – Satisfaction and hit higher (p<0. 01) – Plasma nicotine levels higher at all time points (p<0. 001) (Farsalinos et al. , 2014)

EC: Blood nicotine delivery 18 16 Effective nicotine delivery with 1 st generation cartomiser device in 14 regular users nicotine ng/ml in plasma 14 12 10 8 6 4 2 0 Baseline 10 mins after 15 mins ad lib 30 45 60 60 mins rest 10 puffs vaping mins/vaping Dawkins & Corcoran (2014), Psychopharmacology, vol. 231

Nicotine delivery: 1 st vs. 3 rd generation device Farsalinos et al. (2014), Scientific Reports, vol. 4

EC addictiveness • EC: slower speed of nicotine delivery • Tobacco contains additives to increase addiction • Vapers reported longer time to first vape vs. time to first cigarette • 30% had tried to quit vaping; mostly ‘not very successful’ (Dawkins et al. , 2013; Addiction, 106)

EC vs tobacco cigarettes (TC) in a multiple choice procedure (MCP) Crossover value was significantly higher for 10 TC puffs ($1. 50) compared with 10 EC puffs ($1. 06). Vansickel, Weaver & Eissenberg, 2012, Addiction, 107

Economic demand for EC vs. TC Demand curve Smokers log C Vapers log C 1, 000 1, 500 2, 000 Log consumption Vapers had a lower unit price than smokers at breakpoint – i. e. smokers will pay more for their puffs 1, 500 1, 000 0, 500 0, 000 0, 500 Log Price per puff Campbell , Dawkins et al. , in prep 2, 000 2, 500

Smoking Cessation • In 8 cross-sectional studies of vapers: • 42 -99% of ex-smokers stated that EC had helped them to quit smoking • 60 -86% of smokers stated that EC had helped them to reduce no. of cigs per day. Dawkins (2013) Addiction, 108; Etter (2010) BMC Public Health, 10; Etter (2011) Addiction, 106; Farsalinos (2013) Int J Envir Res & Pub Health; Foulds (2011) Int J Clin Pract, 65; Goniewicz (2013) Drug Alc Rev, 32; Kralikova (2013), Chest, 144; Siegel (2011) Am J Prev Med, 40

Randomised Controlled Trials (RCTs): • ‘Categoria’ 23 mg/ml nicotine EC vs. 17 mg/ml nicotine EC vs. no nicotine EC • 300 smokers (not intending to quit) • 1 year abstinence rates: 13%, 9% and 4% (Caponnetto et al. , 2013) • ‘Elusion’ 16 mg/ml nicotine EC vs. no nicotine EC vs. nicotine patch • 657 smokers followed up over 6 months • 6 month abstinence rates: 7. 3%, 4. 1% and 5. 8% (Bullen et al. , 2014)

Issues with RCTs: • Expensive • Time-consuming • Out of date quickly in a rapidly changing market with fast moving technology • Ecologically valid? Not reflective of what actually happens (EC users do not stick to a single product and liquid)

Conclusions • EC can help to alleviate craving and WS. . . • . . . and raise blood nicotine levels • Craving relief, nicotine delivery & addictiveness all lower in EC vs TC • RCTs suggest e-cigs at least as effective as NRT. . . • . . . but trials with newer products needed • Effectiveness for cessation will depend on a host of political, regulatory, technological and sociocultural factors

Acknowledgements • • John Turner Kirstie Soar Catherine Kimber Victoria Lawson Sharon Cahill Eaodine Crowe Olivia Corcoran Maya Campbell