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E-cigarettes & Vaping: Safe Or Not?

Medically reviewed by C. Fookes, BPharm Last updated on Oct 24, 2018.

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

ECs are designed to look and feel similar to conventional cigarettes. They are powered by a battery and take cartridges filled with a liquid mixture of propylene glycol, glycerin, water, nicotine, and 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 - many of which bear no resemblance to regular cigarettes - are readily available. The choice depends on preference for high or low nicotine levels, or the degree of vapor or flavor. As with ECs, most can be brought in a nicotine-free version.

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.

Could The New Rule Spell The End Of Vaping?

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.

However, that date has since been extended four years until August 8, 2022. But this only applies to products that were already on the market prior to August 8, 2016. Any new products introduced after this date require a Premarket Tobacco Application (PMTA) to be filed and approved before marketing.

A PMTA is associated with significant research and costs and theoretically could result in the market withdrawal of over 99% of vaping products that were on the market prior to the law change. Experts put these costs at around 3 million dollars per product - an amount not many small manufacturers would be able to shoulder, although one of the biggest e-liquid manufacturers, Cosmic Fog, has reportedly submitted a briefing document to the FDA.

Unfortunately, this could potentially fuel a black-market trade in e-cigarettes, an increase in the importation of products from overseas, or clandestine home manufacture. All these scenarios are of concern and undermine the FDA's mission to improve and protect the health of Americans, one of the reasons why the new rules were implemented in the first place.

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 actually start smoking. The FDA does not recognise ECs as a stop-smoking aid.

However, levels of toxins such as formaldehyde, acetaldehyde and acrolein are 9 to 450 times lower in ECs than tobacco products. Levels of other toxic and cancer-causing substances are also substantially reduced in people who only use ECs or nicotine patches compared to people who continue to use conventional cigarettes.

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. Users of ECs should also be mindful that nicotine reduces blood flow, and may be detrimental prior to surgery. Nicotine is also highly addictive.

Do ECs Help You To Quit Smoking?

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, encourage the promotion of ECs and other forms of nicotine replacement therapy as a substitute for smoking. They 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.

Juul: Hooking Teenagers Left, Right, and Center

Juul, which launched in 2015, is like no other product on the market.

For a start, it is much more discrete than other vaping devices, and looks like a USB drive, making it easy to smuggle into classrooms. Its popularity means that sales have soared, from 2.2 million in 2016 to 16.2 million in 2017. Juul now captures a whopping 73% of the e-cigarette (EC) market.

Instead of just using free-base nicotine which most other ECs use, Juul cartridges contain nicotine in a salt form as well as other organic acids. This means that more nicotine can be absorbed, making Juul more potent than other products on the market and it more closely resembles the experience of smoking a cigarette.

But experts are very concerned about the extensive use Juul among teenagers. In October 2018, the FDA conducted a surprise inspection of JUUL offices in San Francisco as part of their investigations into the company's marketing practices. High-levels of nicotine can harm a developing adolescent brain, and research has shown that many teenagers are not aware or do not understand fully the implications of using an addictive substance like nicotine. Illegal sales to minors by retail stores and the use of kid-friendly flavors are also being investigated.

Are ECs A Gateway To Smoking In Teenagers?

Yes they are. Research has shown that more than 30% of teenagers who use e-cigarettes go on to smoke conventional cigarettes within 6 months. Use of ECs in teens has risen nearly ten-fold since 2011, with boys twice as likely to vape as girls.

But even if teenagers don't switch to conventional cigarettes, they are likely to continue using e-cigarettes at a higher frequency. A survey conducted in 10 California high schools 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.

The FDA continues to tighten restrictions on the sale and advertising of ECs and is looking at regulating flavors in these products more closely.

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.

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: Could Your Device Go Up In Smoke?

ECs contain a lithium battery. These batteries have previously been nicknamed the "Mini-bomb in your pocket" because occasionally they can spontaneously ignite. 195 separate incidents of exploding ECs were reported between January 2009 and December 31, 2016. Fortunately, none of these resulted in death but 29% were classed as severe. 62% occurred when the EC was either in somebody's pocket or in use. It seems like the shape and construction of ECs makes them more likely than other devices containing lithium ion batteries to behave like a flaming rocket.

Always charge ECs in accordance with the manufacturer's instructions and with the recommended charger. Poor quality devices are also more likely to explode, so buy a reputable brand with more stringent manufacturing standards. Avoid leaving your EC charging for longer than is necessary or overnight.

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

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Further information

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