E-cigarettes: Cool, Cheap and Less Risky?

Electronic or E-cigarettes mimic normal cigarettes but they deliver nicotine through a vapour. The vapour is produced by battery-powered heating of a solution of chemicals containing nicotine and propylene-glycol. Inhaling the vapour from an e-cigarette is called vaping. There is no tobacco, no combustion and no smoke. For these reasons, vaping is often viewed as a ‘cool’, cheap and less risky alternative to conventional cigarettes.

E-cigarettes fall into three basic types: (1) “Cigalikes” that resemble tobacco cigarettes, disposable or with pre-filled cartridges; (2) Cylindical “tanks,” designed to be refilled with liquid; (3) Larger, rectangular tanks with a large capacity for fluid. Many of the most widely sold brands of cigalikes are now owned by the tobacco industry. Hardly a coincidence!

The full technical term for devices that deliver nicotine is electronic nicotine delivery systems (ENDS). Here I use the term ‘e-cigarette’ or ‘e-cig’.

Intense competition between hundreds of suppliers has created a diverse range of brands, strengths and flavours. Many of the flavours are designed to have special appeal to children and teenagers. They are also technologically quite ‘whizzy’. There are e-cigarettes with Bluetooth compatible with androids, iOS devices or tablets that allow the user to make calls or listen to music while vaping. E-cigarettes can even give vapers statistics about their consumption via a mobile app.

The accepted wisdom is that vaping should be less harmful than smoking. This is because it delivers nicotine without the thousands of toxicants in tobacco smoke. E-cigarettes do not contain carbon monoxide (CO) or many of the other harmful chemicals found in conventional cigarettes. However, because the e-cigarette mimics the tobacco cigarette in the mechanics of inhaled delivery of nicotine, it can substitute both for the pharmacologic (nicotine ‘rush’) and the behavioural (touch and feel) components of cigarette smoking.

E-cigarettes create the ‘illusion’ of smoking but without any actual smoke. Is this ingenious or dangerous? We can determine now on the basis of current knowledge that e-cigarettes are unsafe. There is already sufficient evidence that nicotine is a lethal poison and that e-cigarettes are unsafe. Only those with a commercial interest in increasing e-cigarette sales would wish to argue otherwise. As stated by The International Programme on Chemical Safety (IPCS): “Nicotine is one of the most toxic of all poisons and has a rapid onset of action.” There are many different avenues of harm that stem from the e-cigarette.

E-cigarettes: no tar, no carbon monoxide. But are they safe?

E-cigarettes have been on the market world-wide for more than a decade and are increasingly popular including among adolescents and pregnant smokers. Yet e-cigarettes are unregulated in most countries. Electronic cigarettes are currently the most popular stop smoking aids and evidence indicates they can help people to quit. On the other hand, they can can help people to continue smoking also. What is the truth about the e-cigarette?

Currently, there are around 2.5-3.0 million e-cigarette users in Great Britain. About 10 percent of U.S. adults vape, according to the online Reuters/Ipsos poll of 5,679 Americans conducted in 2016. However, this number includes many women who are using e-cigarettes during pregnancy and also adolescents. This places unborn children at significant risk and many teenagers may end up with damaged brains. Use of e-cigarettes among the young is increasing at exponential rates. This growth in usage is perceived as safe with unlimited advertising geared toward vulnerable populations, such as young women who are likely to smoke or vape during pregnancy.

There is real danger in maternal smoking during pregnancy and the consequences this can have on offspring lung function, including the increased risk of childhood wheezing and subsequent asthma, can be lifelong. Recent evidence strongly suggests that much of the effect of smoking during pregnancy on offspring lung function is mediated by nicotine, making it highly likely that e-cigarette use during pregnancy has the same harmful effects on offspring lung function and health as do conventional cigarettes. In fact, the evidence for nicotine being the mediator of harm of conventional cigarettes may be most compelling for its effects on lung development. This raises concerns about both the combined use of e-cigarettes and conventional cigarettes during pregnancy as well as the use of e-cigarettes by e-cig–only users who think them safe or by those sufficiently addicted to nicotine to not be able to quit e-cigarettes during pregnancy.

The unregulated distribution of e-liquid is a cause for concern. Liquids are available in 7.2%, and even up to 10% concentrated solutions. The higher concentrations are available in large quantities on the Internet—with sizes ranging from one litre to a gallon for consumer use and up to a 55-gallon drum for manufacturing purposes. A perfect new murder weapon is in the making. Crime writers take note!

The chemicals used to flavour liquids may themselves be quite toxic. There are already at least 8000 uniquely named flavoured e-liquids, with hundreds of new flavours each month. Makers of e-liquids don’t have to list the ingredients and nicotine amounts. The safety of flavourings in the e-liquids have not been evaluated for their risk levels to the lungs.

Explosions, Poisonings and a Suicide

E-cigarettes are sold with chargers. Every few hours the device requires recharging, like a mobile phone. A problem may arise when the user charges the device using the wrong charger. There is a risk that it may actually EXPLODE! One man lost part of hit tongue and had his teeth blackened. Not surprisingly he gave up vaping immediately. Many such cases have been reported in the media. One unfortunate victim lost an eye during a vaper explosion. This is leading to litigation.

Nicotine is one of the most toxic of all poisons. Accidental ingestion or absorption of nicotine liquid (“e-liquid”) from e-cigarettes is increasingly prevalent. The journal Pediatrics reported that in the period January 2012 to April 2015 the US National Poison Data System received 29,141 calls for nicotine and tobacco exposures in children younger than 6 years (Kamboj et al., 2016). This is an average of 729 child exposures per month. Cigarettes accounted for 60% of exposures, followed by other tobacco products (16%) and e-cigarettes (14%). The monthly number of exposures associated with e-cigarettes increased by 1492.9% during the study period. One death occurred in association with a nicotine liquid exposure.

The safety information on e-liquid containers is generally inadequate and poorly presented. In many cases, the information is printed in such small print that the warnings are invisible to the naked eye. If you can read the small print without a powerful magnifying glass, you’ve got better eyesight than I have.

This image of an e-liquid container is approximately twice the actual size

Candy-flavoured e-liquids are bound to have an instant appeal to children. Flavours such as: Bubble Gum, Blueberry Candy, Apple Candle, Licorice, Butter Toffee, Blueberyy Cotton (candy floss). Small wonder hundreds of children are smelling and swallowing these enticing fluids.

The Pediatrics journal authors’ report concluded that: “Swift government action is needed to regulate these products to help prevent child poisoning. Prevention strategies include public education; appropriate product storage and use away from children; warning labels; and modifications of e-cigarette devices, e-liquid, and e-liquid containers and packaging to make them less appealing and less accessible to children.”

There is also at least one e-liquid suicide. According to the Daily Mail (28 November 2015) a BBC TV contractor was found dead in his living room after drinking a mix of alcohol and the liquid used in e-cigarettes. Jonathan Keen, 46, described as a functioning alcoholic, was found by his girlfriend at his flat in Chesham, Buckinghamshire, next to remnants of fluid used in e-cigarettes and empty cans of cider. The Buckinghamshire Coroner Richard Hulett heard that Mr Keen would regularly mix his own concentrations of nicotine to use in the cigarette substitute. Recording a verdict of suicide, Mr Hulett said it was the first time he had heard of someone ‘dying directly from this’ in the county.

A hidden danger of e-cigarettes is mislabelling of the nicotine contents of the e-liquid. People may innocently vape on what appears to be a low dosage of nicotine when, in reality, the level can be much higher. The person would quickly becomes addicted and switch to conventional cigarette smoking. Writing in the Journal of Pediatric Nursing, Buettner-Schmidt et al. (2016) reported that only 35% of e-liquid containers were child-resistant. Moreover, more than half of the e-liquid containers were mislabeled by at least 10%. Again, these findings make a strong case for legislation on child-safe packaging and clear nicotine labeling.