Confession: I am an ex-smoker who consistently falls of the abstinence wagon, I am an addict. As far as I’m concerned, when it comes to addiction, there are no “safe” cigarettes. Yet e-cigarettes are marketed as products that can help smokers quit. And what about toxicity? We all know that tobacco is toxic, causes cancer, heart disease, lung disease, and makes pretty much every minor illness worse or last longer. You can imagine I met the thought of a safe alternative to tobacco with a good deal of suspicion. To that end, I decided to look into both the toxicity of e-cigarettes and their capacity to help smokers quit the habit.

First, some background for the uninitiated: an e-cigarette is an electronic device that delivers nicotine not by burning tobacco, but by aerosolizing liquid nicotine from a small container. The omission of actual smoke supposedly reduces the bodily harm normally associated with cigarettes.

So what can science tell us about the risks of e-cigarettes? A 2014 paper reviewed 82 articles on the subject, and came up with some interesting answers to this question. First of all, levels of toxins other than nicotine were considerably lower in e-cigarettes than in tobacco based products. For example, formaldehyde levels from e-cigarettes were between 0.2 and 5.61 μg per cigarette equivalent, fading in comparison to formaldehyde levels in a regular cigarette (1.6 to 52 μg). Similarly, acetyldehyde levels were between 0.11 μg and 1.36 μg in e-cigarettes, compared to between 52 μg and 140 μg in a tobacco cigarette. Both chemicals are known carcinogens. Other chemicals were also studied, and all were present in orders of magnitude lower than in tobacco products.

Sound too good to be true? Maybe. I next looked into the effectiveness of e-cigarettes in helping smokers quit. Was there any evidence adorning e-cigarettes with this magical power? The short answer to this question is no. Several clinical trials have found no evidence that switching to e-cigarettes contributes to a user quitting the smoking habit. This is not surprising, nicotine is still a substance with addictive properties similar to cocaine and morphine.

A puff from a cigarette, electronic or otherwise, sends a blast of nicotine across the blood-brain barrier, causing a wide range of increased activity across the brain. Attention, planning, memory and even skilled movements are raised to a higher level. Furthermore, a complex interplay of chemicals in the brain cause association of nicotine with environmental cues, mood and arousal. Brain circuitry adapts to these associations, strengthening them and causing cravings when nicotine is withheld, especially when cued by the environment. Combining these effects with a subjective sense of wellbeing causes a nicotine user to become addicted.

So e-cigarettes are a nicotine delivery device that substantially reduces the number of toxic chemicals to which a user is exposed when compared to a tobacco cigarette. On the other hand they still contain a highly addictive substance and in no way contribute to smokers quitting the habit, begging the question of whether e-cigarettes are producing a new generation of smokers.

So are e-cigarettes a safe alternative to tobacco? SaFER, maybe, but is appears that as long as nicotine is involved, there is no safety in smoking.