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new report claims that using electronic cigarettes may encourage conventional cigarette smoking and increase the likelihood of illicit drug use and addiction

Study author Denise Kandel, PhD, of the Mailman School of Public Health at Columbia University Medical Center (CUMC), and colleague Dr. Eric Kandel recently published their findings in The New England Journal of Medicine.

The safety of electronic cigarettes (e-cigarettes) continues to be under much debate. Although many researchers claim the devices do not promote the health problems linked to conventional cigarettes, others suggest this may not be the case.

Last year, Medical News Today reported on a study suggesting e-cigarettes can harm the lungs, while researchers of a more recent study claimed to find high levels of toxic metals in secondhand e-cigarette smoke, some at even higher levels than what are found in standard cigarettes.

Some researchers also claim that e-cigarettes do not reduce use of conventional cigarettes. However, a recent study from University College London in the UK argued that among smokers who are trying to quit without professional help, those who use e-cigarettes are 60% more likely to succeed.

The gateway hypothesis

In this latest report, the CUMC duo reviewed a study conducted by Denise Kandel in 1975, which investigated the "gateway hypothesis" - the idea that less deleterious substances can lead to use and addiction of more harmful drugs. In particular, Denise Kandel looked at the role of nicotine as a gateway drug.

The team also reviewed a study in which they tested the gateway hypothesis in a mouse model. They discovered that when the mice were exposed to nicotine, the substance triggered biochemical alteration in the brain and activated a gene linked to reward response.

In particular, the researchers found that this process enhanced a subsequent response to cocaine in the mice, suggesting that nicotine may be a gateway drug for cocaine.

A similar result was seen in a human study the team conducted in 2004. The study revealed that participants who smoked cigarettes had higher subsequent cocaine dependence than those who had not smoked cigarettes.

"Our findings provided a biologic basis for the sequence of drug use observed in people," says Dr. Eric Kandel. "One drug alters the brain's circuitry in a way that enhances the effects of a subsequent drug."

It is 'certainly a possibility' that e-cigarettes encourage illicit drug use, tobacco smoking

Use of e-cigarettes has boomed in recent years, particularly among adolescents. Last year, a study from the Centers for Disease Control and Prevention (CDC) found that e-cigarette use more than doubled among middle and high school students in 2011-12.

A more recent report from the CDC found that more than 250,000 youths who had never smoked a cigarette in 2011 reported using e-cigarettes last year.

The researchers note that e-cigarettes have been promoted as smoking cessation aids that help limit the harmful effects caused by standard cigarettes. But they argue that the products are still pure nicotine-delivery devices that can have implications for health.

"E-cigarettes have the same physiological effects on the brain and may pose the same risk of addiction to other drugs as regular cigarettes, especially in adolescence during a critical period of brain development," says Dr. Eric Kandel.

"We don't yet know whether e-cigarettes will prove to be a gateway to the use of conventional cigarettes and illicit drugs, but that's certainly a possibility. Nicotine clearly acts as a gateway drug on the brain, and this effect is likely to occur whether the exposure comes from smoking cigarettes, passive tobacco smoke or e-cigarettes."

Given these findings and the increasing popularity of e-cigarettes, the researchers say there need to be more effective prevention programs put in place for all nicotine-containing products.

"Our data suggest that effective interventions would not only prevent smoking and its negative health consequences but also decrease the risk of progressing to illicit drug use and addiction," they add.

Medical News Today recently reported on new recommendations from the American Heart Association stating that e-cigarettes should be subject to strict federal regulation.

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