Nicotine, e-cigarettes, cannabis: All pose different risks and all can be hard to stop


Most of us have seen the TV commercials by anti-smoking organizations that remind us how much damage and harm smoking causes our bodies. However, some people who smoke excessively find it hard to quit despite knowing those health risks.

Nicotine is a powerfully addictive substance and can result in health issues such as heart disease, lung disease and cancer.

“Quitting the use of a nicotine substance is very challenging. Nicotine is more addictive physiologically in our brain than even cocaine or heroin is,” said Russell Buhr, MD, PhD, a pulmonologist at UCLA Health who also runs an outpatient practice in Westwood.

“A lot of people are so ashamed that they became addicted to nicotine that they don’t want to seek medical assistance,” Dr. Buhr continued. “They don’t want to face up to the fact they are addicted to nicotine.”

Dr. Buhr explained that nicotine (which is extracted from the tobacco plant) modifies the way our brains sense pleasure. Because of that, people get a rush from smoking.

Over time, the smoker’s brain develops less of a response to nicotine due to the high concentrations. One cigarette becomes not enough, so they develop an urge for more and ultimately it becomes hard to stop.

According to the CDC, almost two-thirds of smokers want to quit, but nicotine withdrawal can cause the body to go through uncomfortable stages.


“When you stop smoking, the nicotine exposure causes you to release other transmitters in the brain, like dopamine - the pleasure hormone,” Dr. Buhr said. “People experience less dopamine than before, then some people can start to feel a little withdrawn, depressed and even irritable.”

Dr. Buhr said that when a smoker quits, the brain has to rewire itself to start working without that constant supply of nicotine that it became used to receiving.

Vaping can also harm the lungs

When people try to quit nicotine, they may turn to e-cigarettes, or vaping, to ease the transition and because they feel it is less harmful to their health. There may be no smoke, but there are other dangers.

With vaping, nicotine is usually suspended in glycol, an organic compound similar to alcohol. The glycol is heated with a metal coil. Sometimes when the coil is heated, some of the metal will vaporize, putting users at risk of inhaling the vaporized metals into their lungs.

Metals such as zinc and cadmium are common in the heating coils and can cause inflammatory injuries to the lungs.

Depending on the response our bodies have to the metals, vaping can potentially be more hazardous than cigarettes, according to Dr. Buhr.

In addition, there are other assorted ingredients in e-cigarettes.

“These products are not FDA approved,” Dr. Buhr said. “So you don’t really know what’s in the vape solutions a lot of the time. Aside from nicotine and glycol, there are also different types of flavorings. These chemicals can cause lung injuries and irreversible lung damage.”

Cannabis confusion

Unlike nicotine and e-cigarettes, cannabis is not associated with lung damage. However, because of its medicinal attribute, its risks sometimes can be overlooked.

Dr. Timothy Fong, clinical professor of psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA and one of the lead faculty members of the UCLA Cannabis Research Initiative, understands both the beneficial and detrimental attributes of cannabis.

“With cannabis, you may experience euphoria, better sleep, pain relief, a sense of wellness, and optimism,” he said. “On the other hand, cannabis does have the potential to become addictive. There are men and women who develop an addiction to cannabis, also knowns as cannabis use disorder. Unfortunately, for people who develop this condition, they can experience significant harmful and emotional and physical consequences.”

Dr. Fong said it is important that people know the risks as well as the benefits when it comes to cannabis. Much confusion about marijuana, he said, stems from how it is administered.

“There is no other medicine that I know of where you smoke the medicine and ingest it into your lungs at a combustible temperature. In that capacity it’s not a safe way to deliver medicine,” said Dr. Fong. “There is no such thing as a medicinal cigarette or medicinal vape pen.”

Before being legalized in California in 2016, cannabis was only allowed to be consumed as a medicine with a doctor’s recommendation. Now, it’s legal for recreational use in 24 states and easily accessible. However, it is not monitored the way medicines approved by the U.S. Food and Drug Administration are, posing unique risks to users.

The cannabis effect

Cannabis, like nicotine, works in the part of the brain that is associated with pleasure. Dr. Fong explained that people who have a “positive” experience with marijuana after the first try are likely to go back and do it again, which is where the overuse begins.

“Cannabis is not as addictive as nicotine, but it’s not a zero percent chance,” Dr. Fong said. “With nicotine, there is about a 30% chance you get addicted. With cannabis, there is about a 9% chance.”

Our body already makes marijuana-like chemicals called endocannabinoids. Endocannabinoids act as the body’s own version of tetrahydrocannabinol (THC), the main ingredient found in the cannabis plant. The endocannabinoids in our bodies can help ease pain and inflammation. Marijuana, in some instances, can help the endocannabinoids in the body work better.

It becomes an issue when people overuse marijuana.

Overcoming the addiction to smoking

Marijuana, e-cigarettes and nicotine have qualities that can lead to overuse and potentially cause harm to our bodies. Dr. Buhr and Dr. Fong agree that overcoming overuse requires help from experts in the field.

People naturally experience cannabis withdrawal and nicotine withdrawal when making an effort to quit smoking. The bigger challenge of withdrawal, however, is overcoming it psychologically, says Dr. Fong.

Smoking withdrawal symptoms may include:

  • An urge to smoke
  • Feeling irritated
  • Restlessness
  • Being unable to focus
  • Trouble sleeping
  • Excessive hunger/weight gain
  • Depression

“For anyone who is interested in stopping tobacco or cannabis use, we do have an addiction psychiatry clinic here at UCLA and if anyone needs help they can contact the clinic or reach out to me,” Dr. Fong said.

“Nobody should feel embarrassed about being addicted to an addictive substance,” Dr. Buhr added. “It can happen to anyone, but the best way to mitigate that is to get help. You can reach out to your physician or seek help from your health care provider.”

Take the Next Step

If you have questions or are considering stopping smoking, visit the UCLA Respiratory Care Services smoking cessation page.