Introduction
The major aim of this study was to test whether abstinence from e-cigarettes causes withdrawal symptoms.
Methods
We conducted an unblinded, within-participants pre-post clinical trial in which 109 former smokers who were current daily e-cigarette users used their own e-cigarette for 7 days followed by 6 days of biologically confirmed abstinence engendered via an escalating contingency payment system. Participants monitored symptoms of nicotine withdrawal daily via an Interactive Voice Response system. They also attended three lab visits/week for carbon monoxide and cotinine testing to verify abstinence.
Results
Half of participants completely abstained for a week. All the DSM-5 tobacco withdrawal symptoms, craving for e-cigarettes, craving for tobacco cigarettes, and the four possible new withdrawal symptoms (anhedonia, impulsivity, mood swings and positive affect) increased during abstinence. Weight increased and heart rate decreased with abstinence. Symptoms showed the prototypical inverted U time pattern of a withdrawal state. The magnitude of withdrawal appeared to be somewhat less than that in a prior study of abstinent daily tobacco cigarette smokers. More severe withdrawal on the first two days of abstinence did not predict abstinence on the last day of the study.
Conclusions
Former smokers who are daily e-cigarette users transfer physical dependence on tobacco cigarettes to dependence on e-cigarettes. The severity of withdrawal from e-cigarettes appears to be only somewhat less than that from daily tobacco cigarette use. Replication tests that include placebo controls, testing for pharmacological specificity, and including never-smokers, non-daily e-cigarette users and dual users are indicated.
Implications
Our results indicate e-cigarettes can maintain physical dependence. This adverse effect should be included in any risk/benefit calculation. Also, potential and current e-cigarette users should be informed that abrupt cessation of e-cigarettes can cause withdrawal symptoms.
