Bhekisia is a South African non-profit that styles itself as “The Centre for Health Journalism”. The online publication is primarily funded by the Bill & Melinda Gates Foundation, but also claims to have complete editorial independence while simultaneously pumping out pure WHO/tobacco control propaganda.

In a recent interview with Richard van Zyl‑Smit, a professor and consultant pulmonologist, the journalist Tanya Pampalone tries incredibly hard to state that vapes are more addictive than cigarettes.

I counted three separate times, including in the tweet to promote the article on X:

1)

2)

3)

The problem here is that despite Pampalone or the Bhekisia editorial team's deep desire for this to be true:

  1. It is not true
  2. Zyl-Smit does not say it is true either.

Let’s take a look.

Is vaping more addictive than cigarettes?

Researchers have asked this question in several ways over the years. Here are a few studies that counter the claims made in Bhekisisa.

Person vaping with a cigarette pack in the background

Penn State/PATH

Penn State College of Medicine analysis of the US PATH cohort found in 2017 that e‑cigarette users scored lower on multiple dependence indicators than regular cigarette smokers, such as:

  • Time to first use after waking
  • Craving
  • Self‑rated addiction
  • Difficulty refraining in restricted spaces

London South Bank University

A 2021 behavioural study by South Bank University looked at what product price sensitivity said about vapers and smokers behaviours. The researchers found that vapers were more sensitive to price increases, suggesting that “vaping is likely to be less addictive than smoking.’

International Tobacco Control (ITC)

ITC Four Country Smoking and Vaping Survey for England, published in 2023, looked at previous research that asked over 800 vapers if they felt they were “very addicted” to the product. A mere 17% said they were, while the majority disagreed that vapes were more addictive than cigarettes.

Drug and Alcohol Dependence

This study, published in Drug and Alcohol Dependence in 2018, asked people who had smoked but switched to vaping to rate their nicotine dependence both then and now. Dependence ratings were lower among those surveyed, with the researchers concluding that “Nicotine dependence appears to reduce markedly when smokers transition to vaping”.

We could go on. The studies above are just a taste of what is out there for researchers looking for an honest answer to the question.

Of course, it’s not the only way to look at the dependence differences between vapes and smoking. We can also look at pharmacology.

Why the pharmacology of vapes and cigarettes is different

The comparative pharmacology of vapes and cigarettes is an important question in determining which product is more addictive.

How fast and how sharply nicotine levels rise in the brain is the main neurobiological factor in determining tobacco dependence. When nicotine is smoked, it travels from the alveoli in the lungs to the heart and into the brain in around 7-10 seconds, per the Mayo Clinic. Like other stimulants, this produces a quick dopamine hit.

Additionally, pharmacokinetic profiles of cigarettes suggest plasma nicotine rises sharply, at around 5-8 mins, then drops sharply. This kind of sharp rise and fall is associated with many types of addictive or habit-forming substances.

Cigarettes

Cigarettes are purposely designed to rapidly deliver nicotine. Research shows that after taking a puff of a cigarette, brain nicotine levels can hit 90% in just two minutes, with a rapid ascent over the first minute. What’s more, cigarettes also include things like monoamine oxidase inhibitors that ramp up dopamine signalling.

To put it simply, Big Tobacco had huge R&D budgets and scientists who maximised the addictiveness of cigarettes in pursuit of profits over many decades. This has allowed them to make cigarettes uniquely addictive.

Vapes

The first kind of vape e-liquids were freebase nicotine. In one well-known study, researchers compared 5 minutes of cigarette and vape use, and found that:

  • After the cigarette, the peak nicotine level in the blood was about 13.4 ng/mL, which was reached in about 14 minutes.
  • After the vape, the peak nicotine level was only about 1.3 ng/mL, which took around 20 minutes to get there.

In other words, cigarettes deliver x10 nicotine, and more rapidly.

In another study, researchers measured one cigarette vs 5 minutes of vape use, and nicotine blood levels were higher after a cigarette.

Have nic salts changed the game?

Perhaps the most compelling argument for why cigarettes are more addictive than vapes is the invention of nic salts. This type of e-liquid emerged around 10 years ago precisely because some users felt there was too much of a difference between cigarettes and the experience offered by freebase nicotine.

Nic salts allow higher concentrations of nicotine without the attendant throat burn that would happen with freebase. They can get closer to cigarettes; however, they’re still not quite there in terms of combustibles’ speed and efficiency.

As mentioned above, nicotine from combustible cigarettes hits the brain in around 7-10 seconds, peak level in the blood (Tmax) is reached within roughly 3–5 minutes after you start smoking.

In one study on nic salts, those numbers were comparable with combustible cigarettes, with a 10-second hit and a peak at 4 minutes. However, the researchers used 25mg e-liquid to achieve that effect. Other reviews suggest you’d need a 40mg e-liquid to match a cigarette. In the UK and Europe, vapes are maxed at 20mg.

To surmise, nic salts have closed the gap, but they’re still not able to match cigarettes, especially in jurisdictions that have 20mg limits.

Why do people think vapes are more addictive?

I think the big reason why people think vapes are more addictive than cigarettes is that you can use them in places where you might not smoke. A sneaky puff in a bar, the minute you wake up, in the toilet at work, and so on. People have a few puffs here and there, instead of a dedicated cigarette once an hour, or whatever. But, as we’ve established above, that translates into more little nips of nicotine than what you would consume via a combustible cigarette, and also a less sharp and quick delivery of nicotine.

Finally, it’s worth saying that the word addiction is an uncomfortable fit with nicotine vaping. As we’ve said before, the degrees of harm between cigarettes and vapes are considerably different. For starters, one kills people.

Final thoughts

Despite outlets like Bhekisia putting their greasy thumbs on the scale to scaremonger about vapes being “more addictive” than cigarettes, the data do not bear this out. They’ve probably been hoodwinked by the narrative that more small puffs = more addictive. However, that’s a misunderstanding of pharmacology, human behaviour, and current research.