title: Successful Nicotine Intake in Medical Assisted Use of E-Cigarettes: A Pilot Study.
abstract: The electronic cigarette (e-cig) has gained popularity as an aid in smoking cessation programs mainly because it maintains the gestures and rituals of tobacco smoking. However, it has been shown in inexperienced e-cig users that ineffective nicotine delivery can cause tobacco craving that could be responsible for unsuccessful smoking reduction/cessation. Moreover, the incorrect use of an e-cig could also led to potential nicotine overdosage and intoxication. Medically assisted training on the proper use of an e-cig plus behavioral support for tobacco dependence could be a pivotal step in avoiding both issues. We performed an eight-month pilot study of adult smokers who started e-cig use after receiving a multi-component medically assisted training program with monitoring of nicotine intake as a biomarker of correct e-cig use. Participants were tested during follow-up for breath carbon monoxide (CO), plasma cotinine and trans-3'-hydroxycotinine, and number of tobacco cigarettes smoked. At the end of the first, fourth, and eighth month of follow-up, 91.1, 73.5, and 76.5% of participants respectively were e-cig users ('only e-cig' and 'dual users'). They showed no significant variation in plasma cotinine and trans-3'-hydroxycotinine with respect to the start of the study when they smoked only tobacco cigarettes, but a significant reduction in breath CO. The proposed medically assisted training program of e-cig use led to a successful nicotine intake, lack of typical cigarette craving and overdosage symptoms and a significant decrease in the biomarker of cigarette combustion products.
authors.affiliation: Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161, Italy. roberta.pacifici@iss.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Pacifici
authors.affiliation: Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161, Italy. simona.pichini@iss.it.
authors.forename: Simona
authors.initials: S
authors.lastname: Pichini
authors.affiliation: Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161, Italy. silviagrzn@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Graziano
authors.affiliation: Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161, Italy. manuela.pellegrini@iss.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pellegrini
authors.affiliation: Ospedale San Giovanni Bosco, ASL TO2 Torino 10154, Italy. massaro.giuseppina@yahoo.it.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Massaro
authors.affiliation: Ospedale San Giovanni Bosco, ASL TO2 Torino 10154, Italy. fabio.beatrice@tin.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Beatrice
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D002248:Carbon Monoxide; D003367:Cotinine / Q000031:analogs & derivatives; D066249:Craving; D066300:Electronic Nicotine Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D010865:Pilot Projects; D012907:Smoking; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder; D055815:Young Adult
chemical_list: D015415:Biomarkers; C001381:hydroxycotinine; D009538:Nicotine; D002248:Carbon Monoxide; D003367:Cotinine
keywords: cotinine; electronic cigarette; smoking cigarette; tobacco harm reduction; trans-3’-hydroxycotinine