Attempting to commit suicide with E-Liquids: Witless!

Even if some won’t feel too comfortable about it, today’s blogpost concentrates on a taboo of our society: The desire to wilfully end one’s own life without assistance.

People committed suicide throughout history. About one of the most famous we can already read from Plutarch: Cleopatra, who arranged to be bitten by a poisonous snake.

There are many other prominent examples of suicide:

The European Parliament and in particular the European Commission and the European Council seem to fear the possibility of an accidental or intentional fatal nicotine intoxication due to a high nicotine concentration in E-liquid. For this reason, the negotiating parties of the trilogue agreed to a number of rules for the proposed tobacco directive in order to make this impossible:

  • Nicotine concentration limit defined at 20mg/ml
  • E-liquid refill containers restricted to 10ml
  • Disposable electronic cigarettes and single use cartridges limited to 2ml
  • Refillable devices need to have some mechanism that avoid spilling – technical specs to be defined by Commission

It should be noted that the European Commission and the European Council are ignoring not only the small number of (harmless in most cases) accidental nicotine poisoning due to E-liquid over the last years, but also the current data situation concerning the slight poisonous effect of nicotine.

The facts

An article concerning three suicide attempts was published in the scientific journal „Clinical Toxicology“ by Lars B. Christensen et al. in May 2013.

Case 1. Woman, age 36, admitted to a psychiatric ward, who had ingested 20 mL of nicotine liquid labelled as containing 18 mg to commit suicide. The Poisons Information Center was contacted 10 minutes after intake.
What is surprising is even though the patient ingested 360 mg nicotine, she presented no symptoms.
Medical treatment: The patient was admitted to the emergency ward for treatment with activated charcoal.

Case 2. The same woman as in case 1 was admitted to the emergency ward after ingestion of 50 mL of nicotine liquid labelled as containing 30 mg of nicotine/mL, to commit suicide.
What is very surprising is even though the patient ingested 1500mg nicotine, two hours after ingestion the symptoms present were abdominal pain, nausea, and voluminous vomiting.
Medicinal treatment: Activated charcoal and observation for 6 hours.

Case 3. Male, age 13, ingested 3 mL of nicotine liquid, no information about concentration, to commit suicide. Fifteen minutes after ingestion symptoms were nausea and shivering.
Medical treatment: Activated charcoal and 1 hour after ingestion symptoms were decreasing.

Three cases… In one case the patient ingested 1500mg nicotine and thus more than 25 times the presumedly lethal dose of 30 to 60 mg. The only symptoms were nausea, abdominal pain, shivering and voluminous vomiting.

Toxicity of nicotine

Although the unsubstantiated claim is often repeated by scientists, physicians and tobacco control advocates that 30–60 mg of nicotine are fatal, there is little concern that e-cigarettes can harm their users by delivering toxic nicotine levels.
There have been numerous recorded incidents of accidental or intentional nicotine poisoning in the last decades – they show that the LD50 of 30-60 mg nicotine has to be wrong.

A recent study of Prof. Dr. Mayer (Department of Pharmacology and Toxicology, Karl-Franzens University Graz) managed to trace the statement concerning the lethal toxicity of nicotine back to self-experiments in the 19th century. He published his results in the scientific journal „Archives of Toxicology“ in August 2013.

Fulltext: How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century

Due to a mistake in the 19th century, generations of researchers repeated these findings uncritically ever since. The conclusion of Prof. Dr. Mayer is clear:

Nicotine is a toxic compound that should be handled with care, but the frequent warnings of potential fatalities caused by ingestion of small amounts of tobacco products or diluted nicotine-containing solutions are unjustified and need to be revised in light of overwhelming data indicating that more than 0.5 g (500mg) of oral nicotine is required to kill an adult.

(emphasis by me)

More toxicity of nicotine

Prof. Dr. Goniewicz et al. published a research report in the scientific journal „Addiction“ in December 2013, which is focused exactly on this subject:

Nicotine content of electronic cigarettes, its release in vapour and its consistency across batches: regulatory implications

The study determined the nicotine content of the cartridges of the most popular EC brands in the United Kingdom (18 to 24 mg nicotine) and the nicotine levels they deliver in the vapour, and estimated the safety and consistency of nicotine delivery across batches of the same product as a proxy for quality control for individual brands and within the industry:

There is very little risk of nicotine toxicity from major electronic cigarette (EC) brands in the United Kingdom. Variation in nicotine concentration in the vapour from a given brand is low. Nicotine concentration in e-liquid is not well related to nicotine in vapour. Other EC brands may be of lower quality and consumer protection regulation needs to be implemented, but in terms of accuracy of labelling of nicotine content and risks of nicotine overdose, regulation over and above such safeguards seems unnecessary.

(emphasis by me)

In the full text of the study, Prof. Dr. Goniewicz made no bones about the toxicity of nicotine:

Although an unsubstantiated claim is often repeated that 30–60 mg of nicotine is fatal, several suicide attempts have been recorded where people drank up to 1500 mg of nicotine in e-liquid (i.e. 50× the presumed lethal dose) without any consequence other than abdominal pain and ‘voluminous vomiting’ [13]. A recent study managed to trace the statement concerning the lethal toxicity of nicotine to dubious self-experiments in the 19th century. It has been repeated uncritically ever since. Given the low toxicity of nicotine at the doses observed and the fact that, long before any dangerous levels of nicotine concentration could be reached, an over-enthusiastic user would be warned by nausea, there is little concern that e-cigarettes can harm their users by delivering toxic nicotine levels.

(emphasis by me)

and the corresponding appropriate regulations:

Our finding that the nicotine content of e-liquid has little, if any, relationship to nicotine content in vapour (let alone nicotine intake by users) suggests that a pharmaceutical level of accuracy of labelling of the nicotine content in EC cartridges is also unlikely to be informative for the user. It would appear that a general indication of strength such as that used, for example, on the packaging of coffee, would provide sufficient guidance to buyers.

(emphasis by me)

As Prof. Dr. Goniewicz states, the currently available E-liquid poses no serious threat to the health of human beings. An excessive regulation is therefore completely daft and unnecessary.

My conclusion:

Regulation of ECigarettes should be done with a sensible and light touch. The proposed regulation of the EU goes to far. The EU might as well regulate selling household cleaners in bottles of max. 20 ml…. Or painkillers like „Paracetamol“ in packages which contain a maximum up to two pills.

Lessons learned:

If someone wanted to commit suicide, he or she should not use an E-liquid. Execpt from nausea, abdominal pain, shivering and voluminous vomiting it will not have any effect.

An attempt to commit suicide by means of E-liquid is witless in various aspects.

 

Jens Mellin

German version of this text: Suizidversuche mit Liquid – Sinnlos

 

References:

1 F. Lee Cantrell – „Adverse Effects of e-Cigarette Exposures

2 Clinical Toxicology -Lars B. Christensen „85.Three cases of attempted suicide by ingestion of nicotine liquid used in e-cigarettes

3 Archives of Toxicology – Bernd Mayer „How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century

4 Addiction – Maciej L. Goniewicz „Nicotine content of electronic cigarettes, its release in vapour and its consistency across batches: regulatory implications

Comments

  1. Thank you for a good and informative read.

  2. nice article and all but if something was to happen, im sure we would see a few cases after the first ecig hit the market in 2006. so far no known cases of death (or anything serious for that matter)

    • For your information:
      In the USA a total of 35 cases of nicotine intoxication due to ELiquids were identified since 2010.

      4 in 2010, 12 in 2011, 19 in 2012.

      Source: Adverse Effects of e-Cigarette Exposures

      35 out of 317 millions human beings in the US!

      BTW: Reported symptoms were mild and transient!!

  3. The spirit of the eu regulations are a knee jerk reaction to a product which is proving so succesful across the world. What is most disturbing is that the advice the eu has been receiving from its own ‚experts‘ is flawed and demonstrates a complete misunderstanding of certain critically important factors. The most important of these factors is the subject of nicotine concentrations.

    When a bottle of Eliquid or a cartridge is labelled as 20mg strength it does not mean that there is 20mg present in the bottle or cartridge. Also the comparison between the quantity of nicotine present in an ordinary cigarette and Eliquid concentration is entirely erroneous and there is no way of making a scientific comparison between these 2 methods of taking nicotine.

    Nicotine concentrations expressed in Eliquids and cartridges of say 20mg actually mean that 20mg (weight) of virtually pure nicotine has been included in every 100ml. Simple arithmetic shows that this means the actual amount in a 20ml bottle is 4mg or 2% when expressed by volume.

    In the case sited above. Where the patient has ingested 20ml of Eliquid labelled as 18mg (1.8%) she has actually taken 3.6mg of pure nicotine, not 360mg. In order for her to ingest the generally accepted minimum lethal dose of 30mg she would have to take 167ml of this Eliquid. This would require a much more concentrated effort.

    The author of this article is entirely correct that, as consumers, we are surrounded with toxic substances which can be used to commit suicide. Paracetemol can be easily acquired in sufficient quantities to cause death as can many other substances.

    What is much more concerning to any right minded person is that the eu do not have an understanding of nicotine concentrations and the point at which they should rightly be considered dangerous. My understanding is that concentrations above 75mg per 100ml (7.5%) on the open market are currently illegal in the UK and this is surely very sensible. If an ecigarette were put on the market at this level of strength it would be ridiculously strong. As a retailer, we sell 24mg as our strongest Eliquid and this is not in any sense dangerous to the user. Some retailers sell 36mg Eliquids and again these are not dangerous to the user. The user would have to actually drink 100ml of this Eliquid or somehow smoke all of this at once to take approach a fatal dose. In any case, if someone is hell bent on killing themselves they will surely find a way to do it. Safety of children and animals is paramount, of course, and the bottles and caps are of great importance.

    At manufacturer level nicotine concentrations of 90% (90%) plus are routinely held in stock. The reader may be interested to know that nicotine at this level of purity is so toxic that even fumes from the liquid can be fatal.

    However, to restrict concentrations on the open market to 20mg per 1ml (2%) is complete and total nonsense. The comparison between this level of ’strength‘ and the amount of nicotine supposedly contained in an ordinary cigarette is entirely erroneous and wrong and shows the eu advisors to be pitifully ignorant of the facts. The advisors have obviously not taken the time to become acquainted with a subject before advising a ruling that incorrectly restricts citizens enjoyment of nicotine and may even go on to threaten a marvellous product which is proving to save the lives of so many smokers.

    This is surely regulation for regulation’s sake. The eu should think again after taking full and informed advice.

  4. Nick, your post is confusing. Every other resource I’ve read states eliquid concentrations are labeled mg/ml, not mg/100ml. Based on that, your post is misleading and I wouldn’t want anyone to think their liquid contains 1% of the nicotine it actually does… or, am I missing something?

  5. Yes, the 100ml is a typo, should be 1ml/mg. Apologies for confusion, delete the post if you think it too confusing.

  6. Excellent review.

  7. Kevin@Vaporliquids
    28. Februar 2015 - 8:32

    E-Juice also known as smoke juice, E-liquid, etc. is a nicotine-based liquid used in electronic cigarettes and personalvaporizers.

    • That’s not true. E-Juice is not „nicotine-based“! It’s a „Propyleneglycol-based liquid“ with a tiny amount of nicotine.

  8. Thank god I read this artical lol.

  9. Nick Guyler says above: „In the case sited above. Where the patient has ingested 20ml of Eliquid labelled as 18mg (1.8%) she has actually taken 3.6mg of pure nicotine, not 360mg. In order for her to ingest the generally accepted minimum lethal dose of 30mg she would have to take 167ml of this Eliquid. This would require a much more concentrated effort.“

    No, the article had it right. She took 20ml of 18mg/ml e-liquid which adds up to 360mg of pure nicotine. Nick is right about the 1,8% being pure nicotine by weight. This would mean that a 20ml (approx. 20000mg) bottle of 1,8% strentgh would have approx. 20000mg * 0,018 = 360mg pure nicotine in it.

  10. Hasse Karlgreen
    28. März 2016 - 14:35

    Cigarette smoking is seen everywhere now a days. Every third person do cigarettes smoking. Cigarette smoking causes lung cancer. So please stop smoking for your better future.

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