Clinical Pharmacology of Electronic Cigarettes

Electronic cigarettes (EC) are nicotine delivery devices that generate a nicotine-containing
aerosol which is inhaled by the user. EC are perceived by users to be useful in helping
quitting smoking of conventional tobacco cigarettes (TC) as well as having a presumed lower
risk of adverse health effects compared to TC, the potential for use in public places,
reduced cost, and lack of the noxious clinging odors associated with TC use. Many believe
that electronic cigarette (EC) function as nicotine delivery devices in the same way as
tobacco cigarettes (TC), and that EC will prove to be just as addictive as TC, but this may
not be the case because of fundamental differences in the design and method of use of these
products. Investigators hypothesize that systemic nicotine exposure will be lower with EC
compared to TC; that despite lower nicotine intake EC users will experience similar reward
and no greater withdrawal symptoms or craving compared to TC; and that dual EC/ TC users will
not titrate their daily intake of nicotine in the same way that TC smokers of high- vs
low-yield nicotine TC do.

Investigators specifically focus on the areas that are thought to most closely relate to the
addictive potential of EC, namely: (1) EC as nicotine delivery devices, covering issues of
nicotine intake and pharmacokinetics, temporal patterns of use and titration of nicotine; and
(2) subjective effects of EC use, including relationship of use to reward, withdrawal and
craving. The investigators will also examine aspects of safety of EC use (by assessment of
cardiovascular and hormonal effects of use and of biomarkers of exposure to potentially toxic
constituents) and explore the identification and validation of biomarkers that may be useful
in distinguishing EC from TC use. Study subjects will be dual users of TC and EC so that the
investigators may compare both modalities of use in experienced users in a within-subject
design.

The study will consist of two 1-week blocks (EC-only or TC-only conditions) with 4 days of
outpatient ad libitum product use followed by 3 days in a clinical research ward to include a
single-use pharmacokinetic study, monitoring of product use, subjective assessments, blood
and urine collections to assess biomarkers, and a 24-hour period of cardiovascular
monitoring. Two additional days at the end of the 2nd block will assess similar measurements
during a period of nicotine-product abstention.

Inclusion Criteria:

- Healthy on the basis of medical history and limited physical examination as described
below:

- Heart rate < 105 BPM*

- Systolic Blood Pressure < 160 and > 90*

- Diastolic Blood Pressure < 100 and > 50*

- Body Mass Index ≤ 38.0 *Considered out of range if both machine and manual
readings are above/below these thresholds.

- Current regular "dual" user of both EC and conventional TC

- EC device is one of the most popular 1st, 2nd or 3rd generation brands (with the
exception of rebuildable atomizers) as determined at time of study commencement

- Carbon monoxide ≥ 5 ppm or per discretion of Principal Investigator

- Saliva cotinine ≥50 ng/ml or urine cotinine

- Age: ≥ 21 years

Exclusion Criteria:

- Current regular use of selected psychiatric medications

- Current regular use of cardiovascular medications for cardiovascular conditions
including hypertension (Example: beta and alpha-blockers)

- Current regular use of medications inducers of nicotine metabolizing enzymes CYP2A6
(Example: rifampicin, dexamethasone, phenobarbital, and other anticonvulsant drugs).

- Use of other tobacco products

- Pregnancy or breastfeeding (by history and pregnancy test)

- Concurrent use of nicotine-containing medications

- Drug/Alcohol Dependence

- Positive toxicology test at the screening visit (THC okay)

- Concurrent participation in another clinical trial

- Inability to communicate in English

- Planning to quit smoking within the next 60 days