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E-cigarettes And Vaping: Safe or Not?

Medically reviewed by Carmen Fookes, BPharm. Last updated on Aug 16, 2021.

The History Of The Electronic Cigarette

In 1963, Herbert A. Gilbert invented the first electronic cigarette (EC) and took it to market. His business wasn't successful - he was in an era when smoking was well accepted and not considered dangerous in any way. It took forty years before time caught up with Gilbert's idea, when Chinese pharmacist Han Lik developed another device that transformed liquid nicotine into a vapor, enabling smokers to satisfy their addiction without smoke or tobacco; eliminating the hundreds of other chemicals that make up cigarettes.

ECs first hit the American market in 2007, although they could be purchased in Europe several years prior to their U.S. availability.

Authorities couldn't decide initially what these devices were. Were they technically a medical product, a form of tobacco, or a drug delivery device? No formal classification meant they sat outside FDA regulations for years, and it was left to individual states or businesses to propose their own restrictions.

E-Cigarettes And The Act Of Vaping

Some ECs look and feel like conventional cigarettes or pipes. Others resemble pens, USB sticks, or are made to be discreet. They are powered by a battery and take cartridges filled with a liquid mixture of propylene glycol, glycerin, water, nicotine, and sometimes flavorings. A small heated coil inside the EC heats up the liquid and delivers it to the user as an aerosol mist, which is then inhaled. Vaping is the term used to describe inhaling and exhaling the vapor produced by an EC.

ECs are not the only products that vape. Several other devices, commonly referred to as APVs (Advanced Personal Vaporizers), Vape Pens or Vape Mods are bigger, bulkier, and more complicated vaping devices. The FDA classifies vaporizers, vape pens, hookah pens, ECs, and e-pipes as Electronic Nicotine Delivery System (ENDS).

Lack Of Regulation Meant Lack Of Control

In 2016, nationwide tobacco regulations were extended to allow the FDA to regulate ALL nicotine and tobacco-related substances and devices. This was arguably considered a win for both pro-smoking lobbyists and anti-smoking groups.

Prior to 2016, the industry was one for cowboys. There was no need to standardize concentrations of nicotine in each product because nobody was policing this. As such, levels of nicotine could vary markedly between companies and even within the same company's product. Mislabeling was common - that is, if there was actually even a label on the canister - or provided only limited information, meaning that nobody really knew what was actually contained inside.

For those who choose to use e-cigarettes and other types of ENDS, the new FDA rule means a puff on an ENDS is no longer a roll of the dice. All new tobacco products are now reviewed prior to coming on the market for misleading claims. In addition, all product ingredients will need to be fully evaluated and warnings about the potential risks involved with vaping clearly visible.

Will Vaping Change With The New Rule?

In 2016, when nationwide tobacco regulations were extended, the FDA gave all manufacturers of vaping products and their components until August 8th, 2018 to comply with ALL the FDAs requirements. This date changed several times until companies had until Sept 9th, 2020 to submit a Premarket Tobacco Application (PMTA).

On May 20th, 2021, the FDA published a list of deemed new tobacco products for which a PMTA had been submitted. This list includes over six million individual product SKUs submitted by hundreds of companies. One company submitted more than four million products itself!

This indicates that the process of having to submit a PMTA does not appear to have deterred vaping companies. In fact, experts estimate worldwide vaping sales will reach $40 billion by 2023 (up from $15.7 billion in 2018).

Are E-cigarettes Less Harmful Than Cigarette Smoking?

Henry Lik's incentive for the development of the EC was his father's death from lung cancer. Because his father was an avid smoker, Lik wondered if things would've been different if a smoke-free device was available to satisfy his nicotine cravings.

But whether ECs are any better than smoking is still controversial. Surveys have shown that ECs do little to help smokers quit, and may potentially increase the likelihood that adolescents will start smoking. The FDA does not recognize ECs as a stop-smoking aid.

Nicotine reduces blood flow, and may be detrimental prior to surgery. Nicotine is also highly addictive.

Although, levels of toxins such as formaldehyde, acetaldehyde, and acrolein are 9 to 450 times lower in ECs than tobacco products, ECs may also contain different types of toxic substances, heavy metals, or chemicals linked to lung disease, because of certain flavorings used or other liquid components. Vitamin E acetate, an additive used in some THC-containing e-cigarette or vaping products was strongly linked to lung injury with over 2800 hospitalizations or deaths reported.

Do ECs Help You To Quit Smoking?

According to the American Lung Association, ECs are not safe and they have been urging the FDA to crack down on unproven claims by the e-cigarette industry that their products are a way to quit smoking. In December, 2019, a study reported that adults who currently or ever used e-cigarettes are 30% more likely to develop chronic lung disease, including asthma, bronchitis and emphysema.

Although ECs have been around for over 10 years, there are surprisingly few well-conducted studies investigating their effectiveness at helping people to quit smoking. A Cochrane review updated in 2016 found that ECs do help smokers to stop smoking in the long-term compared with placebo ECs; however, the quality of the evidence was deemed 'low'. Other surveys have failed to find a significant effect on smoking cessation rates.

Several well-respected professional bodies, such as the Royal College of Physicians, state that health hazards from ECs are unlikely to exceed 5% of the harm from smoking tobacco.

But this view is not universal. A report by The World Health Organization suggested countries signed up to the Framework Convention on Tobacco Control consider banning or severely restricting the sale, distribution, and marketing of e-cigarettes.

Are ECs A Gateway To Smoking In Teenagers?

Yes, they are. Research has shown that more than 30% of teens who start using e-cigarettes begin smoking traditional tobacco products within six months. Young people are four times more likely to try cigarettes and three times more likely to smoke regularly if they have already used vaping products.

They are also more likely to vape marijuana as well with a survey showing the use of pot in e-cigarettes by youth rose from 11% in 2017 to 15% in 2018. Another study from the University of Michigan found that 14% of 12th graders in 2019 reported marijuana vaping in the prior month, an increase from about 7% in 2018.

A survey conducted in 10 California high schools also reported teenagers used JUUL twice as often as those smoking conventional cigarettes, with many oblivious to the fact that they might be addicted to nicotine, and that this addiction is potentially life-long.

In February 2020, a ban by the FDA came into effect with regards to the distribution of sweeter e-cigarette flavors that appeal to kids, such as fruit and mint. Health and Human Services Secretary Alex Azar commented “The United States has never seen an epidemic of substance use arise as quickly as our current epidemic of youth use of e-cigarettes.”

All Products Containing Nicotine Are Poisonous To Children And Pets

ECs contain concentrated liquid nicotine which should be treated like any other poison in your home.

Calls to poison centers regarding ENDS rose nearly 1500% between 2013 and 2015. Most of these calls were regarding the nicotine-laced liquid inside EC cartridges. Almost 50% of the affected children were under the age of two. In 2019, there was a total of 5356 calls to poison centers regarding exposure to e-cigarette devices and liquid nicotine. This figure is on the decline, with 3832 calls reported in 2021, and 2972 up until July 2021.

Young children are particularly at risk of nicotine poisoning. Symptoms include abdominal cramps, agitation, difficulty breathing, drooling, rapid heartbeat, vomiting, and in some cases, death.

All vaping supplies should be kept out of reach of children, preferably in a locked cupboard. This applies to both full and empty refills, as well as the actual device. Kids (and even pets) can be attracted to the smell and color of ECs, so they should not be left lying around on a coffee table or in the car. Drinking, sniffing, or even accidentally touching the liquid in ECs can cause poisoning.

If you suspect your child has been exposed to liquid nicotine, call the Poison Help Line immediately, at 1-800-222-1222.

Explosions in Your Pocket: Hopefully Your Device Will No Longer Go Up In Smoke!

Explosions involving ECs have become far and fewer in between. At one time, lithium batteries contained in ECs were nicknamed the "mini-bomb in your pocket" because more than 200 separate incidents of exploding ECs were reported soon after the devices first came onto the market. 62% of these occurred when the EC was either in somebody's pocket or in use.

Most vapes and ECs are powered by 18650-style batteries, which are slightly larger than common AA batteries. Only batteries recommended by the manufacturer should be used, and where products are supplied with the battery already installed, the manufacturer of these devices has generally added a battery management system to ensure safe charging and discharging.

Finished: E-cigarettes And Vaping: Safe or Not?

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.