1. 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

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

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

4. First Generation EC

5. Second Generation EC

6. Third Generation EC (‘mods’)

7. 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 (0mg nicotine) EC (1 st gen) also associated with decline in craving after 5 mins. (Dawkins et al., 2012, Add Beh, 37)

8. 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

9. 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)

10. 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)

11. EC: Blood nicotine delivery Effective nicotine delivery with 1 st generation cartomiser device in 14 regular users Dawkins & Corcoran (2014), Psychopharmacology, vol. 231

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

13. 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)

14. 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

15. Economic demand for EC vs. TC Vapers had a lower unit price than smokers at breakpoint – i.e. smokers will pay more for their puffs Campbell, Dawkins et al., in prep

16. 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) A ddiction, 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

17. Randomised Controlled Trials (RCTs): ‘Categoria’ 23mg/ml nicotine EC vs. 17mg/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’ 16mg/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)

18. 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)

19. 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

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