An e-cigarette in Paris on March 05, 2013
Kenzo Tribouillard—AFP/Getty Images
By Mandy Oaklander
September 3, 2014
TIME Health
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For a product so young, e-cigarettes are already generating volumes of research. And the latest, appearing in the New England Journal of Medicine, suggests that e-cigarettes serve as a “gateway drug” — meaning they could make users more likely to use, and become addicted to, other drugs like cocaine.

The wife-husband research team Denise Kandel and Eric Kandel has been studying nicotine for years, and in their earlier work they found that nicotine dramatically enhanced the effects of cocaine by activating a reward-related gene and shutting off inhibition. When mice had nicotine before cocaine, they behaved differently too — they ran around more and spent more time in the space where they were fed, likely driven by a need to satisfy their craving for the drug.

Denise’s epidemiological data shows that similar effects might be occurring in people; most who start taking cocaine were smoking at the time, and her studies showed that nicotine can prime users to turn to harder drugs to keep the reward system satisfied. While e-cigarettes don’t contain the tar and other byproducts of regular tobacco-burning cigarettes, they still rely on nicotine, and the Kandels believe they would lead to similar use of other drugs. “E-cigarettes are basically nicotine-delivery devices,” she says, and Eric agrees. “This is a powerful facilitator for addiction to cocaine and perhaps other drugs as well,” he says. “If people knew that this is in fact the danger … they’d be much less enthusiastic about using nicotine.”

While some, including those in the health community, have supported e-cigs as a tool to help smokers quit, the backlash against them has been building. Last month, the American Heart Association released a policy statement calling for stricter laws, more industry oversight, and a ban on marketing and selling e-cigs to adolescents. Toronto just banned e-cigs from the workplace. And the World Health Organization recommended a host of new regulations around the growing e-cigarette market. At the same time, it’s not clear whether the devices actually help smokers to kick the habit; at least one study found that they don’t.

The Kandels argue that it’s time to consider nicotine’s effect not just on the lungs but on the brain as well. “The fact that this is a significant influence on encouraging or facilitating the use of other drugs is never discussed, and it’s just a major omission,” Eric says.

“We’ve worked very hard to reduce smoking in this country, and I think it’s been a fantastic success,” Denise says. With the introduction of e-cigs, “Now I think we’re on the verge of destroying all of the progress that we’ve [made].”

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