Are E-Cigarettes Gateway to Cocaine?

Elegant woman smoking e-cigarette wearing suit

E-cigarettes are powered devices that deliver a nicotine-containing aerosol mist into the lungs. While proponents of these devices point to their potential for reducing the risks associated with consuming nicotine-containing cigarette smoke, critics point to a range of possible problems stemming from their use. In a report published in September 2014 in The New England Journal of Medicine, researchers from Columbia University Medical Center explored the role that e-cigarette use may play in promoting a transition to the use of the powerful stimulant drug cocaine.


E-cigarettes contain a liquefied, purified version of the same nicotine that naturally occurs in commercial tobacco. Just like the nicotine in tobacco, this addictive substance produces mind alteration and other changes in normal central nervous system function when its enters the brain. Every e-cigarette contains a battery-powered heat source; when activated, this source vaporizes the nicotine contained in the cigarette’s main chamber and creates a mist that’s inhaled into the lungs. Additional substances commonly included in an e-cigarette’s main chamber include propylene glycol (an anti-freeze ingredient) and various types of flavorings. Most e-cigarette manufacturers create products that roughly approximate the size and shape of tobacco cigarettes, although their products may also take other forms.

E-cigarette proponents generally claim two main benefits for users: avoidance of the toxic and cancer-causing substances found in commercial tobacco and a reduction of the odds that people who don’t currently smoke tobacco cigarettes will start smoking these products in the future. However, additives contained in e-cigarettes may carry their own risks for toxic exposure; in addition, credible research indicates that e-cigarette use increases the odds for tobacco cigarette use rather than diminishing them. As of 2014, the U.S. Food and Drug Administration is seeking to broadly expand its ability to regulate e-cigarettes on the American market. Current guidelines largely prevent the FDA from effectively regulating these products.

Nicotine and Drug Use

Statistically speaking, people who regularly smoke tobacco cigarettes are substantially more likely than non-smokers to eventually consume two illicit/illegal drugs: cocaine and marijuana. Two possible explanations for this fact exist. On one hand, nicotine consumption may act as a “gateway” activity that chemically primes the brain for subsequent involvement in drug use. On the other hand, a person who consumes nicotine may already have a mental/chemical bias toward substance use that makes drug intake in general more likely to occur. Increasingly, scientific findings support the gateway hypothesis. For example, in a study published in 2013 in the journal Science Translational Medicine, Columbia University researchers used laboratory experiments on rats to demonstrate that exposure to nicotine makes the brain temporarily more susceptible to the pleasure-producing effects of cocaine.

Potential Impact of E-Cigarette Use

In the report published in The New England Journal of Medicine, the Columbia University Medical Center researchers reviewed the evidence that points toward e-cigarettes’ potential to function as a gateway for cocaine use. The foundation of this evidence is nicotine’s impact on the brain. The researchers concluded that the nicotine in tobacco heightens cocaine’s drug effects when the two substances are used together; they also concluded that the use of nicotine-containing tobacco increases the odds that a first-time cocaine user will eventually develop a cocaine addiction. Results drawn from a small sample of U.S. teens and young adults indicate that fully three-quarters (75.2 percent) of these individuals smoked conventional cigarettes at the time of their initial introduction to cocaine. In addition, results drawn from a much larger, nationally representative sample indicate that the highest overall rate for cocaine addiction (20.2 percent) occurs among people who start using the drug only after establishing a pattern of tobacco cigarette use.

The report’s authors note that the nicotine contained in e-cigarettes produces the same changes in brain function as those produced by the nicotine contained in commercial tobacco. This means that, logically, e-cigarettes and conventional cigarettes have the same ability to increase the risks for cocaine use, as well as the same ability to increase the risks for cocaine addiction. Furthermore, e-cigarette’s effects on the brain may be substantially heightened in teenagers, since people in this age group have not fully completed the normal course of brain development. The report’s authors note that their work does not definitively indicate that e-cigarette use contributes to future risks for cocaine use and cocaine addiction. However, they point out the obvious possibility that e-cigarettes may play such a role for large segments of the population.

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