E-Cigarettes and Vaping

full update September 2025

Question	Answer/Pertinent Information
What are e-cigarettes and vaping devices?	E-cigarette is a common term for “electronic nicotine delivery systems (ENDS).” Other terms used include vapes, vape pens, dab pens or rigs, tanks, mods, pod-mods, e-cigs, electronic vapor products (EVPs), e-cigars, and e-hookah. These devices (of various shapes and sizes) heat a liquid to produce an aerosol which is inhaled.¹⁹ The use of these devices may be called vaping, juuling, or dabbing.^4,19 Devices may be “open” (allowing refilling) or “closed” (i.e., disposable cartridges or pods).⁶
Do these devices contain nicotine?	Most e-cigarettes contain nicotine; however, some are nicotine-free and others contain cannabis. Nicotine concentrations vary from zero to more than is found in tobacco cigarettes (max is 20 mg/mL in Canada).⁶ For example, in the US, a 5% (by weight and ~59 mg/mL) Juul pod contains ~40 mg of nicotine (the equivalent of ~20 cigarettes); this is one of the highest concentrations on the market.^2,3 Note that nicotine salts (e.g., used in Juul, Suorin) have a lower pH compared to free-base nicotine, which allows inhalation of higher levels of nicotine with less throat irritation.^3,19
How are e-cigarettes used?	E-cigarettes are marketed for smoking cessation; however, they are not FDA- or Health Canada-approved for this.^11,14 Recreational use of these devices is common, often in users who have never smoked cigarettes (particularly youth).²⁸ Used for smoke tricks and competitions, or inhalation of other substances (e.g., cannabis). Social media promotes many uses and manipulations of these devices.¹² With “dripping,” the e-liquid is dripped directly onto the device’s heating coil and inhaled quickly. These higher temperature exposures may increase the release of toxins (e.g., formaldehyde, acetaldehyde, acetone) and nicotine. “Dripping” may produce thicker clouds of vapor, improved flavor, and a stronger “hit.”^12,19 One of the hazards of e-cigarettes is their ease of use, which may increase the frequency of their use. Their design makes them accessible and easy to puff on constantly throughout the day.
What are the risks of nicotine in e-cigarettes?	Nicotine inhaled via e-cigarettes and absorbed through the lungs can be expected to have similar risks compared to nicotine exposure from smoking tobacco cigarettes.⁹ There are limited data about cardiac effects with e-cigarette use suggesting the possibility of increased heart rate, blood pressure, and arterial stiffness.¹⁶ Nicotine is highly addictive (more in youth) and use of e-cigarettes can cause addiction to nicotine.^3,23 Nicotine alters brain development, affecting cognitive function, memory, and attention into the mid-20s.³ E-cigarettes are a source of secondhand exposure to nicotine and other chemicals. Caution is recommended around nonusers, youth, pregnant women, and people with cardiovascular conditions.¹⁸
What are the risks of the chemicals found in e-cigarettes?	Chemicals found in e-cigarettes include propylene glycol, glycerol, glycerin, flavorings (e.g., diacetyl), diethylene glycol, ethylene glycol, ethanol, formaldehyde, and acrolein. Effects of chronic exposure to these chemicals is not known.²⁷ Some of these ingredients are generally regarded as safe (e.g., propylene glycol, vegetable glycerin) when used orally; however, their long-term safety when inhaled is unknown.^23,27 When propylene glycol and glycerin are heated, toxic aldehydes are formed. Inhaling these toxins has unknown effects.²⁷ Acrolein (used as an herbicide) can cause acute lung injury, COPD, and may cause asthma and lung cancer.⁷ Bronchiolitis obliterans (also called “popcorn lung”) is associated with exposure to diacetyl (a flavoring).²³ The release of chemicals and contaminants (e.g., nickel, tin, aluminum, lead) varies between devices and how they are used. More chemicals are released (e.g., formaldehyde [a known carcinogen]) at higher temperatures (e.g., with “dripping” [described in the “How e-cigarettes are used” section above]).^12,23
What are the risks of severe lung disease from e-cigarette use?	Lung diseases associated with vaping include mild respiratory symptoms (cough, wheezing), acute lipoid pneumonia (due to inhalation of fatty acids in e-liquids), primary spontaneous pneumothorax (i.e., collapsed lung), hypersensitivity pneumonitis,and bronchiolitis obliterans (also known as “popcorn lung,” due to the inhalation of diacetyl [a common flavoring]).^22,23 E-cigarette- or vaping product-use-associated lung injury (EVALI), a severe lung disease, has caused almost 3,000 hospitalizations and almost 70 deaths, as of early 2020.²⁴ Symptoms include cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fever, and weight loss.²⁴ There is a strong link between tetrahydrocannabinol (THC)-containing products, especially those that contain vitamin E acetate, and cases of EVALI.^24,26
What other risks may be associated with e-cigarette use?	Long-term effects of e-cigarettes and vaping are unknown.¹¹ Preliminary evidence suggests that youth who use e-cigarettes are more likely to smoke tobacco cigarettes and use cannabis at a later age than youth who don’t use e-cigarettes.^25,27
Are e-cigarettes effective for smoking cessation?	Some evidence supports the use of e-cigarettes to help patients quit smoking.¹⁴ However, no e-cigarette product is currently FDA- or Health Canada-approved for smoking cessation. The US Preventative Services Task Force concluded that evidence is lacking to determine if the benefits of e-cigarettes for smoking cessation outweigh the risks.¹⁴ Some evidence suggests that among people who are dual users (users of tobacco cigarettes and e-cigarettes), daily e-cigarette use may be associated with an increased chance of becoming smoke free.¹⁰ Patients who want to quit smoking should be advised to use proven smoking cessation methods. See our chart, Smoking Cessation Drug Therapy, for information. If patients have failed multiple attempts with approved nicotine replacement/smoking cessation products, some healthcare professionals suggest they could try e-cigarettes.¹³ Switching completely from smoking cigarettes to use of e-cigarettes/vaping appears to be less harmful compared to continued smoking; however, these products are not considered safe and should not be promoted as safe.^11,29
Are there poisonings with e-cigarettes?	Keep e-cigarettes and vaping devices in a safe place, out of reach of children and pets.⁵ There are thousands of poison control center cases related to e-cigarettes and liquid nicotine each year, including from ingestion, skin contact, or by inhalation.¹⁷ Commercially available e-liquids may contain up to 60 mg/mL (max of 20 mg/mL in Canada) of nicotine, and the volume of e-liquid refill containers varies (30 mL to 100 mL or more). The estimated fatal dose is 6.5 to 13 mg/kg in young children. So, for example, as little as 3.5 mL to 7 mL of a 20 mg/mL nicotine liquid can be fatal to a child weighing about 25 pounds (~11 kg).²⁰
How are e-cigarettes regulated?	FDA and Health Canada regulate all aspects of e-cigarettes and vaping products including packaging, promotion, and banning of ingredients or devices.^1,6 E-cigarettes are not able to be purchased by those younger than 21 years of age (18 years of age in Canada).^8,21 FDA authorization (e.g., Vuse Solo, Juul products) does not mean they are effective for smoking cessation or are safe.
What information is available to help educate patients about the risks of e-cigarettes?	Most smoking cessation programs now include strategies to stop vaping and use of e-cigarettes, providing information on risks, quitting, and strategies to communicate with patients (particularly youth). CDC and Health Canada offer information sheets to help parents talk with their teenagers about e-cigarettes and vaping (https://www.cdc.gov/tobacco/e-cigarettes/protecting-youth.html and https://www.canada.ca/en/services/health/publications/healthy-living/talking-teen-vaping-tip-sheet-parents.html). FDA has expanded its Youth Tobacco Prevention Plan to include tools to help prevent vaping in youth with The Real Cost of Vaping (https://radarcart.boisestate.edu/library/files/woocommerce_uploads/2021/09/Scholastic-Teacher-Resource-Packet-6-8-vrcmlc.pdf). The Truth Initiative (developed by the Mayo Clinic Nicotine Dependence Center) (https://truthinitiative.org/sites/default/files/media/files/2019/03/Free-E-Cigarette-Quit-Program-Now-Available-to-Young-Vapers.pdf and https://join.exprogram.com/?cid=thetruthdotcomfooter) provides education about the risks of e-cigarettes and programs to help with quitting. Dual use is common.^13,15 For example, in some states, data suggest that up to ~40% of adults who use e-cigarettes also smoke tobacco cigarettes.¹⁵ There are little data on effective strategies to quit e-cigarettes. Patients can consider traditional smoking cessation strategies, but keep in mind that even data for smoking cessation in teenagers are limited. See our chart, Smoking Cessation Drug Therapy, for information on approved medications.

References

FDA. E-cigarettes, vapes, and other electronic nicotine delivery systems (ENDS). July 17, 2025. https://www.fda.gov/tobacco-products/products-ingredients-components/e-cigarettes-vapes-and-other-electronic-nicotine-delivery-systems-ends.
Juul. How much nicotine is in a JUULpod? January 30, 2025. http://www.juul.com. (Accessed August 17, 2025).
Truth initiative. How much nicotine is in JUUL? February 2019. https://truthinitiative.org/research-resources/emerging-tobacco-products/how-much-nicotine-juul#:~:text=JUUL%20packs%20a%20potent%20dose,a%20youth%20e%2Dcigarette%20epidemic. (Accessed August 17, 2025).
Huang J, Duan Z, Kwok J, et al. Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tob Control. 2019 Mar;28(2):146-151.
Government of Canada. Risks of vaping. July 29, 2025. https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/risks.html. (Accessed August 17, 2025).
Government of Canada. About vaping. May 9, 2025. https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html. (Accessed August 17, 2025).
American Lung Association. The impact of e-cigarettes on the lung. April 8, 2025. https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung. (Accessed August 17, 2025).
Government of Canada. Preventing kids and teens from smoking and vaping. November 7, 2024. https://www.canada.ca/en/health-canada/services/smoking-tobacco/preventing-kids-teens.html. (Accessed August 17, 2025).
Rose JJ, Krishnan-Sarin S, Exil VJ, et al. Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products: A Scientific Statement From the American Heart Association. Circulation. 2023 Aug 22;148(8):703-728.
Miller CR, Smith DM, Goniewicz ML. Changes in Nicotine Product Use among Dual Users of Tobacco and Electronic Cigarettes: Findings from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015. Subst Use Misuse. 2020;55(6):909-913.
Health Canada. Vaping and quitting smoking. February 17, 2023. https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/quit-smoking.html. (Accessed August 19, 2025).
Krishnan-Sarin S, Morean M, Kong G, et al. E-Cigarettes and "Dripping" Among High-School Youth. Pediatrics. 2017 Mar;139(3):e20163224.
Mayo Clinic. Quit-smoking products: boost your chance of success. February 25, 2025. https://www.mayoclinic.org/diseases-conditions/nicotine-dependence/in-depth/quit-smoking-products/art-20045599. (Accessed August 19, 2025).
CDC. Vaping and quitting. May 15, 2024. https://www.cdc.gov/tobacco/e-cigarettes/quitting.html. (Accessed August 18, 2025).
Minnesota Department of Health. E-cigarettes and vaping. Updated February 8, 2021. https://www.health.mn.gov/communities/tobacco/ecigarettes/docs/ecigarettes.pdf. (Accessed August 19, 2025).
D'Amario D, Migliaro S, Borovac JA, et al. Electronic Cigarettes and Cardiovascular Risk: Caution Waiting for Evidence. Eur Cardiol. 2019 Dec 18;14(3):151-158.
America’s Poison Centers. E-cigarettes and liquid nicotine. https://poisoncenters.org/track/ecigarettes-liquid-nicotine#:~:text=Keep%20nicotine%20products%20out%20of,report%20made%20to%20member%20centers. (Accessed August 18, 2025).
Government of Alberta. Smoking and vaping exposures (second-hand and third-hand smoke and aerosol). February 3, 2023. https://myhealth.alberta.ca/Alberta/Pages/Second-Hand-and-Third-Hand-Smoke-and-Vapour.aspx#:~:text=Nicotine%2C%20the%20addictive%20drug%20in,hand%20aerosol%20can%20cause%20harm. (Accessed August 17, 2025).
CDC. E-cigarette, or vaping, products visual dictionary. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/ecigarette-or-vaping-products-visual-dictionary-508.pdf. (Accessed August 18, 2025).
Olivas M, Hays HL, Kistamgari S, et al. Nicotine Ingestions Among Young Children: 2010-2023. Pediatrics. 2025 Aug 1;156(2):e2024070522
CDC. State tobacco activities tracking and evaluation (STATE) system. December 30, 2024. https://www.cdc.gov/statesystem/factsheets/ecigarette/ECigarette.html. (Accessed August 18, 2025).
John Hopkins Medicine. What does vaping do to your lungs? https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-does-vaping-do-to-your-lungs. (Accessed August 18, 2025).
Government of Canada. Risks of vaping. July 29, 2025. https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/risks.html. (Accessed August 18, 2025).
Cleveland Clinic. EVALI. https://my.clevelandclinic.org/health/diseases/24948-evali. (Accessed August 18, 2025).
Soneji S, Barrington-Trimis JL, Wills TA, et al. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA Pediatr 2017;171:788-97.
Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report. N Engl J Med. 2020 Mar 5;382(10):903-916.
Fadus MC, Smith TT, Squeglia LM. The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug Alcohol Depend. 2019 Aug 1;201:85-93.
Al-Hamdani M, McKay C, Carter-Rogers K, Smith S. Ex-Vapers' Perspectives on Helpful and Unhelpful Influences During Their Quit Journeys. Int J Environ Res Public Health. 2025 Jul 4;22(7):1073.
American Heart Association. Is vaping better than smoking. January 5, 2024. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/is-vaping-safer-than-smoking. (Accessed August 20, 2025).

Cite this document as follows: Clinical Resource, E-cigarettes and Vaping. Pharmacist’s Letter/Pharmacy Technician’s Letter/Prescriber Insights. September 2025. [410965]

E-Cigarettes and Vaping

Related Articles