Like conventional cigarettes, electronic cigarettes may function as a “gateway drug”—a drug that lowers the threshold for addiction to other substances, such as marijuana and cocaine—according to research published today in the online edition of the New England Journal of Medicine.

“While e-cigarettes do eliminate some of the health effects associated with combustible tobacco, they are pure nicotine-delivery devices,” said co-author Denise B. Kandel, PhD, professor of sociomedical sciences, Department of Psychiatry and Mailman School of Public Health, at Columbia University Medical Center (CUMC) and a research scientist at the New York State Psychiatric Institute.

E-cigarettes have been touted as a tool to curtail the use of conventional cigarettes and reduce the harmful health effects of combustible tobacco. But in light of the skyrocketing popularity of e-cigarettes, particularly among adolescents and young adults, the researchers say that more effective prevention programs need to be developed for all products that contain nicotine.

“E-cigarettes have the same physiological effects on the brain and may pose the same risk of addiction to other drugs as regular cigarettes, especially in adolescence during a critical period of brain development. We don’t yet know whether e-cigarettes will prove to be a gateway to the use of conventional cigarettes and illicit drugs, but that’s certainly a possibility. Nicotine clearly acts as a gateway drug on the brain, and this effect is likely to occur whether the exposure comes from smoking cigarettes, passive tobacco smoke, or e-cigarettes.”

Studies show that the typical e-cigarette user is a long-term smoker who has been unable to stop smoking. However, the researchers point out that e-cigarette use is increasing exponentially among adolescents and young adults. “The effects we saw in adult mice are probably even stronger in adolescent animals,” said Dr. Eric Kandel. “E-cigarettes may be a gateway to both combustible cigarettes and illicit drugs. Therefore, we should do all we can to protect young people from the harmful effects of nicotine and the risks of progressing to illicit drugs.”