The Harm Reduction Role of High-Nicotine Vaping

    Many people who quit cigarettes say that vaping at higher nicotine levels was key to their ability to make the switch. Meanwhile, the United Kingdom is considering taxing vape products at higher rates if they have higher nicotine strength. In this context, a new study found that higher-nicotine vaping has risen significantly in the UK.

    The study, conducted by researchers at University College London (UCL) and published in the Addiction journal, looked at 7,314 adults in England who vape, and changes in the nicotine levels they used between July 2016 and January 2024. It showed a sharp rise in people using e-liquids at or above the UK’s highest legally available nicotine level of 20 milligrams/milliliter.

    In June 2021, 6.6 percent of the group were vaping high strengths—mostly exactly 20 mg/ml, in accordance with the law. By January 2024, the proportion was much higher, at 32.5 percent.

    What prompted this? Dr. Sarah Jackson, a behavioral scientist at UCL and lead author of the study, told Filter that the increase “coincided with the introduction of new disposable vapes, many which contain e-liquids with nicotine strengths at the upper end of the legal limit.”

    “Studies suggest e-cigarettes containing higher nicotine strengths may be more effective for helping people to stop smoking.”

    These products tend to use nicotine salts e-liquids, she elaborated, which allow higher strengths to be inhaled without the harshness people may experience with higher-strength freebase nicotine e-liquids.

    The rise in higher-nicotine vaping occurred disproportionately among younger adults, and among people who currently smoked, had recently quit smoking, or had never smoked (as opposed to older adults, or people who quit smoking over a year prior).

    Vaping in some of those groups has been the focus of media alarm. But Jackson identifies crucial harm reduction benefits in higher nicotine levels. “Studies suggest e-cigarettes containing higher nicotine strengths may be more effective for helping people to stop smoking than those with lower levels of nicotine,” she said.

    One such study, for instance, suggested that availability of vapes “in nicotine concentrations greater than 20 mg/ml may be associated with increased switching among adult smokers.” If so, the UK could be reducing vapes’ harm reduction impact by capping the strength; the United States, in contrast, has no federal maximum.

    Higher-nicotine vapes can “provide better relief from withdrawal symptoms and satisfy cravings,” Jackson said. And many people who switched attest to that.

    “David,” who asked to remain anonymous, told Filter that he was a “heavy smoker,” beginning in 1982 at the age of 14. He rolled tobacco as well as smoking popular cigarette brands. After smoking restrictions were introduced in the UK, he discovered vapes, which helped him get nicotine in places where he wasn’t allowed to smoke. This ultimately led to him switching entirely.

    “When I went to 18 mg, it worked. The hit was strong enough for me to stay on vape.”

    But he found that the 12 mg nicotine he initially vaped was “too little” to stop his cravings to smoke. “DIY-ing” with e-liquids, he experimented with 15 mg, but that still wasn’t enough. “One gets nostalgic” when surrounded by people smoking, he recalled.

    However, “when I went to 18 mg, it worked,” he continued. “The hit was strong enough for me to stay on vape and to be able to ignore smelling the smokes of others.”

    In the years since, David has chosen to gradually drop down to vaping 6 mg, and now he finds he “can still ignore the craving” when others smoke around him.

    Janine Timmons, in Canada, also said high-nicotine vapes were “necessary” for her when she quit smoking after 40 years. “I would think the amount smoked and length of time is a factor in high nicotine use to quit smoking,” she told Filter.

    Marc Slis lives in the United States and, until recently, owned a vape store. He quit smoking after 41 years by vaping 24 mg freebase, though he rapidly cut it down to 3 mg.

    “Most folks, myself included, need a much higher nicotine level to quit initially, but tend to reduce it over time.”

    “In my experience, as a vaper and from many years of helping folks to become and remain smoke-free, high-strength nicotine is important,” he told Filter. “Most folks, myself included, need a much higher nicotine level/intake to quit initially, but tend to reduce it over time.”

    However, people might also need to increase nicotine levels at times “to avoid returning to smoking,” Slis noted. He himself initially returned to 24 mg, and is currently using 50 mg, due to stress, he said, including from the situation of having to close down his shop.

    But nicotine, at any level humans would realistically use, is not a significant driver of harm. Vaping at any nicotine strength is vastly safer than smoking.

    Strength preferences and needs vary person-to-person. Henry Heldner, who lives in Germany, told Filter that he began smoking at the age of 16 and continued for 44 years. He then started vaping at a moderate 12 mg, and this was enough for him to quit his 30-a-day cigarette habit in 2019.

    “I know everyone is different, and I know people who would need higher levels of nicotine, especially in the beginning to overcome their addiction to cigarettes,” said Heldner, now 65. He’s more recently reduced his nicotine level to 3-6 mg.

    “It would make more sense from a public health perspective for the proposed tax on vapes to be implemented as a flat rate.”

    If higher-nicotine vaping products are taxed more heavily, this will “likely encourage people to use lower-strength e-liquids to reduce the cost of vaping,” Jackson said, which “could potentially undermine the effectiveness of e-cigarettes for helping people to stop smoking.”

    A related possible downside, she continued, is that “it could result in some people vaping more [at lower nicotine levels] to get their desired dose of nicotine, which would increase their exposure to potential toxicants.” It would also make it financially harder for people to migrate between different nicotine levels, as they often do to meet their changing needs.

    Heldner said that higher tax on his former 12 mg vaping product would not necessarily have stopped him buying it, but might have opened up the possibility of “getting it somewhere cheaper” on the illicit market. For now, “I’m celebrating each smoke-free milestone with my life-saving tool: vapes.”

    The planned UK vape tax is deeply controversial among consumers and harm reductionists. But if enacted, Jackson said, “it would make more sense from a public health perspective for the proposed tax on vapes to be implemented as a flat rate, rather than taxing higher nicotine strengths at higher rates.”



    Correction, July 10: This article has been updated to remove an inaccurate reference to the UK Tobacco and Vapes Bill.

    Photograph by Lindsay Fox via Flickr/Creative Commons 2.0

    • Kiran is a tobacco harm reduction fellow for Filter. She is a writer and journalist who has written for publications including the Guardian, the Telegraph, I Paper and the Times, among many others. Her book, I Can Hear the Cuckoo, was published by Gaia in 2023. She lives in Wales.

      Kiran’s fellowship is supported by an independently administered tobacco harm reduction scholarship from Knowledge-Action-Change—an organization that has separately provided restricted grants and donations to Filter.

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