Acute effects of waterpipe tobacco smoking: a double-blind, placebo-control study

Drug Alcohol Depend. 2011 Jul 1;116(1-3):102-9. doi: 10.1016/j.drugalcdep.2010.11.026. Epub 2011 Feb 1.


Background: Waterpipe tobacco smoking usually involves heating flavored tobacco with charcoal and inhaling the resulting smoke after it has passed through water. Waterpipe tobacco smoking increases heart rate and produces subjective effects similar to those reported by cigarette smokers. These responses are thought to be nicotine-mediated, though no placebo-control studies exist. Accordingly, this double-blind, placebo-control study compared the acute physiological and subjective effects of waterpipe tobacco smoking to those produced when participants used a waterpipe to smoke a flavor-matched, tobacco-free preparation.

Methods: Occasional waterpipe tobacco smokers (n = 37; 2-5 monthly smoking episodes for ≥ 6 months) completed two double-blind, counterbalanced sessions that differed by product: preferred brand/flavor of waterpipe tobacco or flavor-matched, tobacco-free preparation. For each 45-min, ad lib smoking episode blood and expired air CO were sampled, cardiovascular and respiratory response were measured, and subjective response was assessed.

Results: Waterpipe tobacco smoking significantly increased mean (± SEM) plasma nicotine concentration (3.6 ± 0.7 ng/ml) and heart rate (8.6 ± 1.4 bpm) while placebo did not (0.1 ± 0.0 ng/ml; 1.3 ± 0.9b pm). For carboxyhemoglobin (COHb) and expired air CO, significant increases were observed for tobacco (3.8 ± 0.4%; 27.9 ± 2.6 ppm) and for placebo (3.9 ± 0.4%; 27.7 ± 3.3 ppm) with no differences across condition. Independent of condition, symptoms of nicotine/tobacco abstinence (e.g., "urges to smoke", "anxious") were reduced and direct effects (e.g., "dizzy", "satisfy") increased.

Discussion: These results from the first placebo-control study of waterpipe tobacco smoking demonstrate that waterpipe-induced heart rate increases are almost certainly mediated by nicotine though the subjective effects observed in these occasional smokers were not.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Behavior, Addictive / metabolism
  • Carbon Monoxide / adverse effects
  • Carbon Monoxide / analysis
  • Carbon Monoxide / blood
  • Carboxyhemoglobin / analysis
  • Double-Blind Method
  • Female
  • Heart Rate / drug effects
  • Humans
  • Inhalation Exposure
  • Male
  • Middle Aged
  • Nicotine / administration & dosage
  • Nicotine / blood
  • Nicotine / pharmacology*
  • Nicotinic Agonists / adverse effects
  • Nicotinic Agonists / blood
  • Nicotinic Agonists / pharmacology*
  • Nitrous Oxide / analysis
  • Placebos
  • Respiratory Function Tests
  • Smoking / adverse effects*
  • Smoking / physiopathology
  • Treatment Outcome
  • Water
  • Young Adult


  • Nicotinic Agonists
  • Placebos
  • Water
  • Nicotine
  • Carbon Monoxide
  • Carboxyhemoglobin
  • Nitrous Oxide