Search This Blog

Thursday, April 23, 2015

A Vexing Conflation of Vaping with Sex

So let's get this straight...

E-cigarettes and vaping are bad.

There's no substitute for abstinence where sex smoking is involved.

After all, all forms of sex smoking are bad and can lead to trouble for young people.

Well, kids are kids, and kids are going to have sex, no smoke, no "vape" regardless.

Er, maybe we ought to push e-cigarettes birth control so kids can "do it" safely.

You know, they are young, they are going to vape have sex, so why not just offer them "protection."

Well, birth control vaping, even without nicotine the pill, is not 100% safe effective...

Good thing I can buy less than 100% safe cigarettes birth control at the drug store.

But for God's sake sex, no smoking, no vaping might be dangerous...

(There's currently between a 40% to 70% out-of-wedlock birth rate in the US.

Somebody, some day, might die from vaping.)

How's that abstinence working out?

Sunday, April 19, 2015

CDC: Throwing Smoking Veterans "Under the Bus"

Among all the hype of the recent headlines shouting "Teen E-Cig Use Triples" there is a lot of interesting back story.

Among the tidbits of e-cig data put out by the CDC we find the chart to the left.

The full study result is here - the study was done in Montana in 2013.

Among adults the primary reason for "ever use" of an e-cig was curiosity.

Now as anyone with a teenager knows, kids, particularly teenagers, are curious.  So the fact that more than 60% of adults reported curiosity as the reason to "ever use" an e-cig leads one to believe that kids will be even more curious.  Particularly given all the horrible things they hear about traditional cigarettes and smoking.

Note the next two reasons to use an e-cig: "To quit/reduce cigarette use" and "E-cigarettes are less harmful".   You can consider the next three reasons (instead) if you believe that "Not disturb others with smoke" is health related, e.g., a parent with children.

In researching this I came upon another interesting chart from here.  Under the section "Military Service Members and Veterans" we find this statement: "In the United States, cigarette smoking prevalence is higher among people currently serving in the military than among the civilian population. Cigarette smoking prevalence is even higher among military personnel who have been deployed."  The chart to below left is next to it.

So what does this say?

Well you might think that if you are poor and enter the service to advance yourself that, because you are poor, you are more likely to smoke.

But I don't think that's true because according to the above statement if you get "deployed" you are even more likely to smoke.

Note that other sources such as this and this confirm smoking as a problem for service men and women as well as veterans.

So maybe it has something to do with STRESS?

"Deployment" for those who don't know - means going off to somewhere in the world where, more than likely, something unsafe to your mind or person (gun fire, disease, long tour away from family, etc.) might be going on.  Whether to war or just building Ebola treatment centers no doubt deployment is some cause for stress.

When I was started high school in 1971 there were two things you did when you graduated: go to 'Nam (Vietnam for those too young to remember) or get a deferment and go to college.

In those days there wasn't anything like a medical diagnoses of "Post Traumatic Stress Disorder" (PTSH) - you just dealt with the results.  Hence people smoked (see this).

So let's just imagine you are a smoking veteran from Montana.

You have heard decades of CDC/FDA/Surgeon General rhetoric about how bad smoking is.  If you have kids, you probably suffer additional guilt (and stress) from the fact that you think you are poisoning them with your smoking: of course adding to your PTSD.

You probably feel guilt in general about smoking because, after all, that's what the CDC/FDA/Surgeon General want's you to feel so you'll quit smoking.

But given what's medically known about the dangers of e-cigs and vaping (as in very little danger particularly relative to cigarettes) wouldn't you be curious about whether they would help you (just like the Montana study indicates)?

The same stress relief from nicotine without the tar that causes cancers or the smoke that screws up your cardiovascular system.

Wouldn't you try one?

If you had kids you'd really be interested in not smoking so the next few survey responses also make sense.

Now as many vapers know e-cigs are often a gateway to stopping smoking (see this Newsweek article from 2014).

It's well known today the e-cigs are a better thing to do than smoke.

Yet no one at the CDC apparently cares about this relative to the nations service men and women and veterans.

I would think that getting service folks off of cigarettes would cause people to jump for joy.

After all its a well-known smoking population.

Instead we hear about how it might be a problem for others, like kids.

But wait, weren't those kids SMOKING before e-cigarettes?

And if they weren't isn't it likely, like adults, they are just curious?

So come on Dr. Frieden, what about helping our veterans out here?

They are putting their lives on the line for our freedom, as in going to war.  Are you really planning on taking something like an e-cig/vaping away from them for their health?

Saturday, April 18, 2015

Vaping: Not Enough Science? or Smoking: Too Much "Old Technology"

I've attached a graphic taken from the Washington Post on e-cigarettes.

It shows some remarkable things.

For one, there is a significant drop in high school students smoking; particularly from 2013 to 2014 (you can find the details in this CDC report).

If you couple this with my post about the drop in cigarette tax revenue revenue it would seem that use of cigarettes by young people is definitely dropping by a substantial amount.

However, the uninformed look at only the increases in e-cigarette use.  The result is a weird but not unexpected panic (some example comments from this NYT article - underline's mine):

"Do people who use Ecigs really and truly want to quit smoking? I mean, if nicorette gum, the patch or cold turkey didn't do the trick, Ecigs won't either."

"What does the New York Times and this reporter plan to do to ensure that interview subjects for articles are not hoaxing them?"

"The tobacco industry is criminal. It should be outlawed and all the profits accumulated should be confiscated to pay for healthcare since it has caused so much illness."

And from the NYT article: "[ the CDC ] warned that e-cigarettes were undoing years of progress among the country’s most vulnerable citizens by making the act of puffing on a tobacco product normal again, and by introducing nicotine, an addictive substance, to a broad population of teenagers." and "CDC Director Tom Frieden, M.D., M.P.H. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.”"

The same data from the above right chart is matched here in the NYT article at the left - except there is a little more detail.

Interestingly only Hookahs and E-cigarettes increased while cigarettes, smokeless tobacco, tobacco pipes and cigars not only decreased but have been decreasing for the last few years.

If you read the CDC article it looks like, on the Middle Schoolers chart (above right), that each 1% is about 140,000 students.   So does that mean all these hundreds of thousands of middle school kids are are now hooked on nicotine?

Well according to Bill Godshall of Smoke Free Pennsylvania the CDC falsely classifies all e-cigs and hookah as “tobacco products” (as many e-cig and shisha products contain no nicotine) to exaggerate use of nicotine containing e-cigs and hookah, to falsely claim tobacco use increased

So it seems extremely likely that fewer people are actually consuming nicotine.  In fact, its possible that the total number of nicotine users is declining as well.

So let's think about Tom Frieden's comments...

Today virtually all consumption of nicotine by adolescence is done via tobacco.  Now, as many vapers know, nicotine in vaping and nicotine when mixed with whole tobacco alkaloids behave somewhat differently.  Similarly there are many studies that point to the fact that nicotine alone, i.e., without the tobacco alkaloids, is not addictive (see this older post).

So his comments are truly disingenuous because clearly he is comparing apples (nicotine) and oranges (tobacco).

And, by the way, since all the ANTZ including Mr. Frieden know that its too early (there's not enough science, etc. etc.) to tell if vaping is a healthier alternative to smoking then, by this same reasoning, it must also be too early to assume that pure nicotine without tobacco is as bad as tobacco burning (obviously there's not enough science...!!!!)

Not enough science for vaping to be healthier than smoking?

Then how can there be enough science to know that nicotine without tobacco is as bad as tobacco?

So now let's turn to how someone under 18 gets access to vaping...

According to the NYT article:  "... a junior at a private school in Pennsylvania, said he used to ask seniors who were 18 to buy him e-cigarettes at convenience stores, but now he has equipment and buys his liquids on the Internet.

“You can just go online and click yes,” he said. He has used e-cigarettes to quit smoking..."

So apparently this kid has a credit card of some sort.

I wonder where he got it from...?

Its awfully difficult to get if you're not 18.

So perhaps, just perhaps, someone else is complicit in this "junior" accessing ecigs online while underage.

Another under age kids said: "Some teenagers described vaping as an entirely different culture from cigarette smoking, and scoffed at the idea that it could be a way into cigarettes."

What all this sounds like is that Mr. Frieden wants to stay in the past with his "burning tobacco" while todays youth wants to move on.

After all today's kids are much more technologically adept than "old people" and so why should they continue to use great great grandpa's nicotine delivery system when modern technology has provided a much more efficient and safer one?

Sunday, April 12, 2015

ANTZ: Evil is the disease, not smoking or vaping!

Many people talk about an addiction to nicotine as a disease.  In fact there is a larger, more insidious "disease" involved with respect to the efforts to stop vaping: evil.

Now I understand that's a pretty strong statement.

But let's break down what's happening bit by bit...

First off, ANTZ (and by ANTZ I include government officials, the various heart and lung associations, etc.) view the world from a perspective of "justice" and "happiness."

Everyone, i.e., not them, would be "happy" if they didn't smoke.  There would be social justice ensuring that everyone was not subjected to the unpleasant will or actions of others.

But is that really possible?

There is plenty of evidence that, in fact, everyone tests positive for cotinine (a metabolite of nicotine described elsewhere on this blog).  Cotinine, along with nicotinic acid (vitamin B3), is involved in how the brain processes serotonin.

It doesn't take a rocket scientist to imagine that not everyone has the right balance of serotonin in their bodies.  After all there is plenty of medical evidence that people of different cultures and genetics process nutrients in their food differently.  So why not vitamin B3?

And what does cigarette smoke do in the human body?

Why it converts, among other things, to vitamin B3 and cotinine, which control serotonin.

However the ANTZ idea of "social justice" requires that everyone process nutrients in their bodies the same way hence no one should need to smoke or chew.

Now not only is this silly and ridiculous, but its also very wrong...

While you might not like me smoking to get these nutrients you have no business telling me I don't need them.

So there's a problem - we have people in authority dictating to you, now a former smoker (vaper), what you should be doing with your body.

I am sure many readers have seen "insanity is doing the same thing over and over and expecting a different result."

This applies here.  I can tell you over and over not to smoke - but if you need to smoke you are going to anyway.

So these people are, by any reasonable definition, simply insane.  You'd think after 50 years of telling people not to do it they'd have figured out there must be more to it.

Personally I think that ANTZ and their friends have turned into what's called a "ponerogenic association."

A ponerogenic association stated goals are often at variance with its true nature. Colorful literature and humanitarian values often mask its true motivations, i.e., we all want to live in a "happy" world so you will do what you are told.

The people at the top of these groups are nuts - literally banging away with the same shit over and over and over and expecting a different result.  And this trickles down to the members of the these groups.

Imagine - you are Glantz or the head of the California Public Health (CPH) - do you really think its possible that no one vapes or smokes around them?

Do they have no families, no friends, no children, no associates at work?

About 18% of the population smokes (or vapes)... that's about 1 in 5 people.

So its highly unlikely that they don't know anyone trying to quit smoking or who vapes.

Instead they must be living in some sort of egotistical "bubble" thinking that their decisions and thought processes are somehow above everyone else.

And what about the people that work for these people?

Surely they must know someone who vapes.  Like the all employees of CPH are non-smokers?  Again, even more unlikely...

So what you have are a group of people basically run by egomaniacs that insist that the entire state or planet or whatever follow along with their model of the universe.

And one supposes their lackies employees just have to go along with them, despite the fact that their mom or sister or brother or kid vapes, just to keep their job...

So we arrive at First Criterion of Ponerogenesis (from the link): “One phenomenon all ponerogenic groups and associations have in common is the fact that their members lose (or have already lost) the capacity to perceive pathological individuals as such, interpreting their behavior in fascinated, heroic, or melodramatic ways” (Lobaczewski, 158). When a group has succumbed to pathological influence its members soon lose the ability to distinguish normal human behavior from pathological. 

So these support people, staff, etc. are working for kooks and they are stuck.

Secondary Ponerogenic Unions: ... The secondary ponerogenic associations are groups founded with an independent and attractive social ideal [ such as stopping smoking ], but which later succumb to moral degeneration. This degeneration leaves an opening for "infection and activation of the pathological factors within, and later to a ponerization of the group as a whole, or often its fraction” (Lobaczewski, 160).

So the bottom line here is simple.

While the ideal of stopping everyone from smoking is a good basis for a group or association.  What's happened over time is that all connection to rational thinking has been lost, i.e., it becomes incomprehensible that some people might actually need what smoking provides them.  Instead "these people" (smokers or vapers) are just out trying to poison children with their nicotine juice or aren't grown up enough to stop or trying to cause society to glamorize smoking again (as if they, the ANTZ, are the sole social arbiter of such things).

To paraphrase from the above link: When the ANTZ leadership are treated as normal, more perceptive individuals will leave the group. When the group has become sufficiently pathological, members will either perceive its new direction in moral terms (e.g., “We must make them continue to smoke cigarettes on the principle that vaping doesn't really solve the "smoking" problem”), or as a form of psychological terror.

Ultimately you end up (and you can read more on the above link) with a "pathocracy."

You end up with what we are seeing today in relationship to vaping: social hysteria.

"Oh my God! They are making smoking glamorous again!"

Implied is this: Vaping is just an extension of smoking.  So we shouldn't sell vapes to children under 18.

However, the converse of this is exactly what?

We all no no child ever gets hold of a pack of cigarettes before they are 18... (right).

But if the child is smoking cigarettes the child apparently should continue to do so until 18 and not vape because vaping is bad too.

So, instead of letting them "eat cake" we let them smoke because its good for them not to vape...?

Really? Why is this?  So they might continue to use tobacco when the turn 18 so governments and big Tobacco can continue to profit?

This is truly insane.

And in fact EVIL.

If anyone cared for the "lives of the children" one imagines they would actually want them to STOP SMOKING...

Monday, April 6, 2015

The Big Tobacco Tax Revenue Drop

This report from (The Federation of Tax Administrators) shows how precipitously tobacco tax revenue in the US is falling.

This group is a effectively a trade association of individuals who work at the job of collecting taxes, i.e., tax collectors, both state and federal.

They've been reporting on this for decades, perhaps even a century.

This is the key takeaway from the report appears on the first real page:

Focus your attention on the upper right.  State cigarette taxes have dropped about 4.5% in the last year or two; approximately $780 million US dollars.

Federal cigarette taxes dropped about 13.5% in the last year alone, a decline of about $2 billion US dollars.

What's I think more important is that it took about 65 years for cigarette taxes to reach this level.

At this rate of decline one imagines we'll be back to roughly mid 1990's levels of tax collection in less than five years.

Like you, I have "heard" that tobacco revenue for "government" is dropping.

This demonstrates the point quite clearly and unambiguously.

There are other pages of note discussing average prices of smokes, etc. but you really have to download and examine each year's worth of reports (I found 2011 and 2012, but not 2013).

From examining the site I would imagine 2015's report to come out later this year.

The only thing I can think of that corresponds to this drop is the rise of vaping.

Sunday, April 5, 2015

Comparison of NRT Inhalation Products with Vaping

It seems pretty clear after thinking about this and studying the various FDA links that the argument about "GRAS is not for inhalation" is bogus.

Clearly things like sucralose, edetate disodium, and polysorbate 80 were likely never intended to be inhaled.

Yet here they are...

I was unable to find any "studies" or commentary on the inhalation of these products.

edetate disodium is known to kill people in certain situations.  You can find this right on the FDA's website.

I have thought about doing this for the NRT gum's and patches but what would be the point?

Organic e-liquids using only VG (glycerol) and natural flavors (with or without nicotine) would appear to have nothing to be concerned about (nicotine is after all a natural plant product).

Even with the involvement of flavors and PG its hard to imagine anything to be worried about.

Worst as I see it the various other trace components of the NRT products probably reflect about as much objective danger as diacytel or acetyl propionyl.  After all no one knows what happens if you inhale too much edetate disodium.

Saturday, April 4, 2015

Nicotrol Inhalers, Nasal Sprays and 10mg/ml

After learning about the "Nicrorette QuickMist" product I wondered if there were other similar products on the market or at least available elsewhere in the western world.

One I discovered was the nicotrol inhailer (technical and prescriber link) which is made by pfizer.

This product is markedly different from the Nicorette QuickMist in that it involves no carrier.  Nicotine and menthol are embedded in a porous filter.  As you inhale the nicotine and menthol are drawn out of the pours of the filter and inhaled.

This product actually uses fewer ingredients than a vape: just nicotine and menthol.

Obviously then at least these two vaping ingredients are safe for inhalation.

Now this is not the same as vaping but it has the effect (according to the prescriber link above) of vaping.  According to the link "Most of the nicotine released from the NICOTROL Inhaler is deposited in the mouth. Only a fraction of the dose released, less than 5%, reaches the lower respiratory tract. An intensive inhalation regimen (80 deep inhalations over 20 minutes) releases on the average 4 mg of the nicotine content of each cartridge of which about 2 mg is systemically absorbed. Peak plasma concentrations are typically reached within 15 minutes of the end of inhalation."

More interesting is the CLINICAL TRIALS section.  Here we find a description of a "two single-center, placebo-controlled, double-blind trials with a total of 4 445 healthy patients."

Next the describe roughy the trials: "In both studies, the recommended duration of treatment was 3 months; however, the patients were permitted to continue to use the product for up to 6 months, if they wished. The quit rates are the percentage of all persons initially enrolled who continuously abstained after week 2. NICOTROL Inhaler was more effective than placebo at 6 weeks, 3 months and 6 months."

The following table is provided:

You can see from the table that the inhaler works better than the placebo: significantly so in the first three months.

If vaping creates similar absorption rates relative to nicotine one imagines that vaping would be as effective as this product in helping people to quit smoking.

Since vaping is probably more effective at delivering nicotine absorption you probably don't need "80 deep inhalations over 20 minutes."

So again, claims that vaping is "unknown" and "dangerous" are silly when compared with currently available products that produce the same results and operate in substantially similar ways.\\

Under the "WARNINGS" section we read that the cartridge used in the device (which contains the nicotine and menthol) is deadly to children and pet.

That's right - DEADLY.

So if Rover or little Suzy gets hold of the cartridge (either before use or after) and eats it or chews on it they die.

So from the vaping perspective its probably a bit more efficient as a killer than chugging a bottle of e-liquid.

Interestingly the Australian document on "Nicorette QuickMist" discusses "dual use" in detail.

The pfizer version here in the US does not.

It's only admonition (at page 15) is "Commit yourself - NO SMOKING! For the NICOTROL Inhaler to help, you must be firmly committed to quitting! Stop smoking as soon as you start using the Inhaler. Do not smoke or use any other tobacco products at any time while using the NICOTROL Inhaler."

Apparently, given the same scientific process of putting nicotine in your bloodstream, here in the US you simply must "STOP SMOKING" as opposed to going "dual use" for a while.

This seems rather ANTZ-like (anti-smoking zealot).

Either commit to quit or don't bother effectively.

I wonder if the lack of success with Big Pharma solutions like NICOTROL compared to vaping is tied up with this last point?

I started looking around in other countries but apparently pfizer does not sell NICOTROL anywhere but the USA (as least as far as I can tell).

But in looking around I found NICOTROL NS - a nasal spray version.  This is the "prescribing document."

My, my but isn't it interesting: "Each 10 mL spray bottle contains 100 mg nicotine (10 mg/mL) in an inactive vehicle containing disodium phosphate, sodium dihydrogen phosphate, citric acid, methylparaben, propylparaben, edetate disodium, sodium chloride, polysorbate 80, aroma and water."


I'll leave it to others to troll through what these chemicals are.

EDIT: A 10ml at 10mg of nicotine.  Not the 100mg I original posted.

Interestingly it contains "aroma."  Nothing more specific.  You can read the document for yourself to ascertain what you think...

Down a ways we find the clinical trial result.  In part we see a table similar to the one above:

The NS version looks to be highly effective relative to the basic inhaler: maybe because you're doing 100mg/ml of nicotine?

I know people that have done high nicotine accidentally and its not good.

And I thought the FDA was worried about vapers using too much nicotine.

Interestingly vaping provides both the absorption in the mouth and on the exhale through the nose.

Perhaps its why vaping works better than these types of products?

NICOTROL NS does, in passing, admit to the "dual use" scenario (page 15): "Since patients using NICOTROL NS may also smoke intermittently, it is sometimes difficult to determine if patients are experiencing nicotine withdrawal or nicotine excess."

Also they say "Controlled clinical trials of nicotine products suggest that palpitations, nausea and sweating are more often symptoms of nicotine excess, whereas anxiety, nervousness and irritability are more often symptoms of nicotine withdrawal" which likely means that they've at least studied the "dual use" scenario relative to smoking.

BTW, this is a "do not inhale" medication - which seems unlikely given how most people would likely use this.

I guess all that's missing here is the fluffy "white powder" form of nicotine.

All joking aside what's the bottom line here?

While if I were a scientist it wouldn't be too hard to do a "study of studies" and hypothesize that getting nicotine into the bloodstream of smokers and vapers kills the urge to smoke (I'll leave that to an enterprising PhD student to attempt - so long as they don't get fired for doing it).

EDITED: There's certainly plenty to think about here - while 10mg/ml nicotine is not bad new people shooting it up directly their noses in order to quit smoking...  you've gotta wonder about that; especially as compared to vaping.

Vaping's chief difference from these kinds of products is the "heating" and "flavor" aspects.  Using heat to atomize a nicotine liquid is, based on my research and well as many other scientific papers, probably not doing anything bad so long as nothing burns.

From the flavoring perspective menthol is clearly a "go" being in both QuickMist and the non-nasal products.

Its really getting hard to tell what, at least from a science perspective, is the difference between these products and a vape.

Friday, April 3, 2015

Comparing "Nicorette QuickMist" to Vaping

I found a post on Facebook (thanks to Paula P.) which had an image that seemed interesting (see photo right).  Paula was clever enough to compare the ingredients of Nicorette QuickMist to those of a standard vape.  (This is available in the US, Canada, Australia, and others.  Its unclear whether the FDA has cleared this for US customers but you can buy it none-the-less.)

These ingredients are confirmed from this Australian document (from the Australian Register of Therapeutic Goods - this is what you find on their site.)

With apologies to Paula I believe that "Cooling flavour" and "Sucralose" are also vape "Flavoring."

So at least in the rest of the western world Nicorette Mist products would appear to have been cleared by their respective government health organizations for regular use, i.e., no prescription required.

Under the heading in the Australian document we see Pharmacodynamics.  There we see "Clinical studies have shown that nicotine replacement from nicotine containing products can help people give up smoking by relief of abstinence symptoms associated with smoking cessation."

Okay good - this does help with smoking cessation.

So what does this say for "nicotine mist?"

"Compared to nicotine gum or nicotine lozenge, the absorption of nicotine from the mouth spray is more rapid and based on prior experience with nicotine replacement therapy, this will result in a faster onset of relief of cravings and other symptoms. A single dose study in 200 healthy smokers demonstrated that two sprays of 1mg reduced urges to smoke one minute after administration and to a significantly greater extent than nicotine lozenge 4mg during the first 1, 3, 5, and 10 minutes."

Seems pretty clear that nicotine mist works better than lozenges.

Nicorette makes both of these types of products so it seems clear that they think the spray is better than the lozenge.

Next we see "The pharmacokinetics of the mouth spray has been studied in 4 studies. The studies enrolled a total of 141 subjects. "

Wow.  A total of 141 people tested.

There are probably five to six million vapers world-wide.  Most vaping every day.

Gee, so far its safe...

You can read the rest of this section yourself.  If you know anything about what's know of the science of vaping you'll see that the spray users end up with reasonable blood nicotine levels that work to stop their urges to smoke - just like vaping.

Next you can read about the clinical trials - not much interesting there other than to say it must work well enough against a placebo to allow the various government agencies to approve it for sale in their respective countries.

Now let's look at the PRECAUTIONS section...

"In stable cardiovascular disease NICORETTE® QuickMist presents a lesser hazard than continuing to smoke."

That's reasonable...

But this one is interesting: "Transferred dependence  Transferred dependence can occur but is both less harmful and easier to break than smoking dependence."

So if you transfer your dependence over to this mist it is "less harmful and easier to break than smoking dependence."

Well that's kind of interesting.

Not exactly what you hear from the CA department of public health on vaping.

Now we get into "Continued smoking while using NRT" - this is the FDA and CDC feared "dual use" scenario.

Here's what this Australian document says.  First: "NICORETTE QuickMist can be safely used while smoking."

Hmmm... Contradicts what you hear about vaping and smoking...

Then: "The adverse event profile (incidence and severity of events) of intermittent NRT products in studies to reduce smoking did not differ markedly from that in smoking cessation studies."

This means that bad things that happen when you quite smoking are not made worse by this spray.

So is "dual use safe:" "Intermittent use of intermittent dosing NRT products and cigarettes does not appear to produce more side effects than use of NRT alone."

I added the underline - so mixing mist and cigarettes is not a problem.

And finally: "Most regular smokers are adept at self-titration of their nicotine in order to maintain their plasma nicotine levels within a narrow range."

So with dual use most regular smokers (and of course vapers) are able to control their consumption of nicotine and reasonably regulate it on their own.

The rest of the document provides a lot of general information on how to use and misuse the product.

Apparently no one thinks this mist is dangerous (save for the section on nicotine poisoning when addresses overdoses in both adults and children).  One imagines that if a child drank this it would be like drinking eliquids.

Apparently not enough people use this (or it tastes bad) hence there are no poisoning statistics that I have seen.

What's the difference between this and vaping?

Probably a several things:

1) Its an aerosol spray (pumper with air and a bottle of liquid) as opposed to an atomizer.  Obviously atomizers heat the liquid to create the mist as compared to blowing air across the surface of the liquid.  It seems like that at low temperatures vaping would be quite similar.

2) There is less nicotine in the mist.  Perhaps this explains why its not a popular product?

3) Its expensive.  A small kit with two sprayers costs around $30 USD on Amazon (link above).

It would seem, at least in my opinion, that there's no real difference here.

So, Mr. CDC and FDA, why the fuss?