The effects of alcohol-containing e-cigarettes on young adult smokers

Abstract

Background The liquids (e-liquids) used in an electronic cigarette (e-cigarette) contain myriad chemicals without adequate human inhalation safety data. Furthermore, the absence of e-liquid labeling requirements poses a formidable challenge to understanding how e-liquid constituents may promote nicotine addiction and / or have independent or synergistic biological effects when combined with nicotine. Ethyl alcohol is such a constituent, but has received little scientific interest in this context. Methods Using a randomized, double blind, crossover design, acute changes in subjective drug effects, motor performance and biochemical measures of alcohol and nicotine intake were evaluated after directed and ad lib puffing from two commercially available e-liquids containing nicotine (8 mg/ml), vanilla flavor and either 23.5% (high) or 0.4% (trace) alcohol. Results While no differences in subjective drug effects were observed between alcohol conditions, performance on the Purdue Pegboard Dexterity Test (PPDT) improved under the trace, but not under the 23.5% alcohol condition. Although plasma alcohol levels remained undetectable during testing, urine ethyl glucuronide (EtG), an alcohol metabolite, became measurable in three participants after puffing from the 23.5% alcohol e-cigarette. Conclusions Brief use of a widely available type of e-cigarette containing an e-liquid purchased from an Internet vendor can negatively impact psychomotor performance and in some instances, produce detectable levels of a urine alcohol metabolite. Given the widespread and unregulated use of e-cigarettes, especially by youth and other vulnerable populations, further studies are needed to evaluate both the acute safety and long-term health risks of using alcohol-containing e-cigarettes.

Ethanol concentration in 56 refillable electronic cigarettes liquid formulations determined by headspace gas chromatography with flame ionization detector (HS‐GC‐FID)

“…Ethanol was determined in 53 of the 56 e-liquid. Varlet et al reported ethanol concentrations in 42 brand name e-liquids from 14 manufactures purchased in 2013(8). All but five of these samples were reported to contain nicotine as the active drug, and 30 of the 42 e-liquid samples were reported as positive for ethanol with concentrations > 3.70 mg/mL.…”

A call to end the epidemic of adolescent E-cigarette use

“…E-liquids also contain varying concentrations of nicotine, water, and flavorings. Some e-liquids also contain other solvents like ethyl alcohol, sometimes in high enough levels to negatively impact psychomotor performance (Valentine et al, 2016). E-liquids are currently available in over 7000 flavors (Zhu et al, 2014) and each flavor is made up of a mixture of chemicals, which are primarily aldehydes and vanillins, as well as maltol, ethyl maltol, benzyl and ethyl alcohol, ethyl butyrate and ethyl acetate, and other confectionary flavor chemicals (Tierney et al, 2015).…”

“Essentially, All Models Are Wrong, but Some Are Useful”: A Preliminary Conceptual Model of Co-occurring E-cig and Alcohol Use

“…Research using human lung fibroblasts (i.e., cells of connective tissues) exposed to e-cig liquid has demonstrated the release Interleuken-8 (IL-8) [4], a pro-inflammatory protein that contributes to chronic inflammation in the lungs [34]. Also, many commercial e-cig liquids contain ethyl alcohol, with recent research finding detectible levels of urine ethyl glucuronide in individuals exposed to such e-liquids, which was associated with impaired psychomotor performance following e-cig exposure [35]. Taken together, it appears that e-cigs have direct negative health effects that, although are arguably less harmful than traditional cigarettes, should not be dismissed.…”

“…On the other hand, the drug content of cigarettes and e-cigs differs quite markedly, which might lead to differential effects in some cases. For example, one unique pattern can be found in e-cig liquids that contain alcohol, which might not affect subjective drug effects, but can affect psychomotor performance [35]. Second, processes linking impulsive personality traits to the development of positive drug expectancies (see Figure 1, box A and B) and motives, as well as how these beliefs influence subsequent use, may generalize between cigarette and e-cig use, as expectancy processes apply to a wide range of behaviors [17, 50–51].…”