E-cigarettes are marketed to be used for smoking cessation. In addition, they are also being used for recreation in persons who have never used tobacco cigarettes, particularly in youth.
E-cigarettes are also used in alternate ways (with and without nicotine); such as for smoke tricks (including competitions), inhalation of flavors, inhalation of other substances (e.g., marijuana), etc. There is an abundance of information on ways to use and manipulate these devices online and within social media.
“Dripping” is one alternate use that may be increasing the danger of e-cigarettes. The e-liquid is dripped directly onto the heating coil of the device and the resulting vapor is inhaled quickly. Exposing the liquid to this higher temperature may increase the release of toxins (e.g., formaldehyde, acetaldehyde, acetone, etc) in the vapors. “Dripping” is reported to give users thicker clouds of vapor, improved flavors, and a stronger “throat hit” (which appears related to a certain [higher] level of nicotine). Higher temperatures may also increase the nicotine in the vapor, leading to higher nicotine serum levels.