E-cigarettes & Vaping: Safe Or Not?
Medically reviewed on Jul 5, 2017 by C. Fookes, BPharm.
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?
The clock is now ticking towards August 8th, 2018, the date that vape shops that mix or prepare nicotine-containing products must comply with ALL of the FDA requirements.
This could spell an end to over 99% of the vaping products currently available, because of the prohibitive costs involved in conducting the research needed for these products to stay on the market. Experts put these costs at around 3 million dollars per product - an amount not many small manufacturers would be able to shoulder.
Unfortunately, a survey indicated that this might force some people to source their preferred e-cigarettes from non-licensed vendors, potentially fuelling a black market trade in e-cigarettes. Others said they would likely import e-cigarettes from overseas or make their own products at home. All of 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.
Although not smoking is still the healthiest option, ECs are undeniably safer than conventional cigarettes or tobacco products. Cigarette smoke is made up of thousands of different chemicals, many of which are known to cause cancer. Although ECs still contain low levels of some toxic substances (notably formaldehyde, acetaldehyde, and acrolein), the levels of these toxins were 9 to 450 times lower than those found in cigarette smoke. People who only use ECs or nicotine patches have substantially reduced levels of toxic and cancer-causing substances in their body than people who continued to use conventional cigarettes.
Some studies have reported toxic substances, heavy metals, and chemicals linked to lung disease in EC vapor, mainly linked to certain flavorings or other ingredients. Users of ECs should be mindful that nicotine reduces blood flow, and may be detrimental before certain types of 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'. Research in this field is ongoing, and the results of other trials are expected soon.
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.
Are ECs A Gateway To Smoking In Teenagers?
The National Institute on Drug Abuse reports that teens are more likely to use ECs than conventional cigarettes; with more than 30% of teen EC users going 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.
Manufacturers have also been accused of enticing youth to try ECs. With flavors such as bubble gum and cotton candy, many teenagers have been taking the bait and findings from the ongoing PATH study indicate 81% of current youth e-cigarette users cite the availability of appealing flavors as their primary reason for EC use.
While these statistics are of concern, a tightening of the restrictions on the sale and advertising of ECs may help curb future teen use. Since 2016, the sale of ECs and any other tobacco product to anyone younger than 18 has been banned, and retailers are unable to hand out free samples or stock ENDS in all-ages vending machines.
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. Over a period of approximately 15 months, the FDA identified 66 instances of e-cigarette explosions or fires. Many people required treatment for burns, and a small numbered reported facial injuries.
But it is debatable whether ECs pose any more of a risk than other lithium-containing devices such as cell phones or laptops. Most explosions occurred when the device was charging, and more often than not when an alternative charger was being used - one that was not sold with the device. Poor quality devices are also more likely to explode, so buy a reputable brand with more stringent manufacturing standards and always use the correct charger. Avoid leaving your EC charging for longer than is necessary or overnight.
Finished: E-cigarettes And Vaping: Safe Or Not?
- Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub3
- Gulland Anne. WHO urges restrictions on e-cigarettes BMJ 2016; 355 :i5991
- Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016.
- Conference of the Parties to the WHO Framework Convention on Tobacco Control. FCTC/COP/7/11. August 2016 http://www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf?ua=1
- Nicotine Addiction and Your Health HHS.gov. http://betobaccofree.hhs.gov/health-effects/nicotine-health/
- E-Cigarette Poisonings Skyrocket Among Young Kids: Study. May 2016. https://www.drugs.com/news/e-cigarette-poisonings-skyrocket-among-young-kids-study-61174.html
- Nicotine poisoning. Medline Plus. Updated May 2016. https://www.nlm.nih.gov/medlineplus/ency/article/002510.htm
- Shahab L, Goniewicz ML, Blount BC, Brown J, McNeill A, Alwis KU, et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Ann Intern Med. 2017;166:390-400. doi: 10.7326/M16-1107
- Lukasz GM, Jakub K, Michal G, et al. Levels of selected carcinogens and toxicants in vapor from electronic cigarettes. Tobacco control. 2014;23(2):133-139. doi:10.1136/tobaccocontrol-2012-050859.
- Teens and E-cigarettes. National Institute on Drug Abuse 2016. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes
- Malas M, Van der Tempel J, Schwartz R, et al. Electronic Cigarettes for Smoking Cessation: A Systematic Review. Nicotine Tob Res 2016 April 25. doi:10.1093/ntr/ntw119
- E-Cig Liquid Nicotine Containers Often Mislabeled. July 27, 2016. https://www.drugs.com/news/e-cig-liquid-nicotine-containers-often-mislabeled-62107.html
- E-Cigarettes Emit Toxic Vapors: Study. July 27, 2016. https://www.drugs.com/news/e-cigarettes-emit-toxic-vapors-study-62106.html