Nicotine Delivery and User Ratings of IQOS Heated Tobacco System Compared With Cigarettes, Juul, and Refillable E-Cigarettes

INTRODUCTION: Reduced-risk nicotine products are more likely to replace smoking if they match cigarettes in nicotine delivery and user satisfaction. AIMS AND METHODS: We examined the nicotine delivery profile and user ratings of IQOS heated tobacco system and compared it with own brand cigarettes (OBC), Juul, and refillable e-cigarettes (EC).Participants (N = 22) who were daily vapers smoking <1 cigarette per day on average, attended after overnight abstinence from smoking and vaping, to test at separate sessions OBC, IQOS, and Juul. Eight participants also tested two refillable EC using e-liquid with 20 mg/mL nicotine. At each session, a baseline blood sample was taken before participants used the product ad libitum for 5 minutes. Further samples were taken at 2, 4, 6, 8, 10, and 30 minutes. Maximum nicotine concentration (C(max)), time to C(max) (T(max)), and nicotine delivered over 30 minutes (AUC(0–>30)) were calculated. Participants rated their urge to smoke and product characteristics. RESULTS: IQOS delivered less nicotine than OBC (AUC(0–>30): z = −2.73, p = .006), and than Juul (AUC(0–>30): z = −3.08, p = .002; C(max): z = −2.65, p = .008), and received less favorable ratings than Juul (effect on urges to smoke: z = −3.23, p = .001; speed of urge relief: z = −2.75, p = .006; recommendation to friends: z = −2.45, p = .014). Compared with refillable EC, IQOS delivered nicotine faster (T(max): z = −2.37, p = .018), but received less favorable overall ratings (recommended to friends: z = −2.32, p = .021). CONCLUSIONS: IQOS’ pharmacokinetic profile suggests that it may be less effective than Juul for smoking cessation, but at least as effective as refillable EC; although participants, who were experienced vapers rather than IQOS users, preferred refillable EC. IMPLICATIONS: Because IQOS provided less efficient nicotine delivery than cigarettes and Juul in this sample, and also had a weaker effect on urges to smoke than Juul, it could be less helpful than Juul in assisting such dual users, and possibly smokers generally, to switch to an alternative product. IQOS, however, provided nicotine faster than refillable EC products, although participants preferred EC.