E-CIGARETTES -- WHAT ABOUT 'EM

Recently a man came in for treatment for anxiety, an emotional reaction to narrowly escaping a serious burn.  Upon plugging his e-cigarette charger into his car’s charge outlet there was a sudden explosion and a resultant fire that consumed the car, totaling it, with he and his daughter barely escaping without injury.  Afterwards, he resumed smoking conventional cigarettes (to relax) because now he had no transportation to and from work, along with insurance issues, and needed some down payment money, which he didn’t have, for another used car since this one was 9 years old.  He had begun vaping e-cigarettes as a way to quit the habit.

The same intent likewise was that of the man my wife and I saw recently in the Grand Theater in D’Iberville.  We were sitting near the top waiting for the movie to roll when a red light suddenly caught our eye several rows below and to the left.  A moment later the man exhaled a large cloud of smoke.  He was vaping too, perhaps trying to quit.  I didn’t realize it was permissible to smoke e-cigarettes in theaters.

But both of these guys, if they were in fact trying to quit, were doing so because of slick marketing and advertisement, not because of evidence-based science, since there is yet available any scientific literature affirming or refuting the claim by proponents and manufacturers that e-cigarettes are better than nicotine patches or gum for quitting the habit.  The scientific jury is still out on whether e-cigarettes are harmful or helpful.  For sure they have the potential to be one or the other.

Since the mid-2000s their popularity has grown exponentially, probably because they provide a nicotine buzz without the many carcinogenic substances found in conventional cigarettes.  About 32% of all smokers have tried them, and 8% of kids in grades 6-12 have used them.

Currently they are unregulated but the FDA has proposed a rule to allow them to regulate e-cigarettes.  The FDA is/will be seeking a ban on free samples and sale to minors, a warning label, a required submission of ingredient listings; and a prohibition against "modified risk descriptors" such as "light," "low," and "mild."

As a result of the currently unregulated industry, the entire market is in a state of flux, something akin to the Wild West, with no federal regulation, no critical mass of peer-reviewed literature, and a multitude of lawsuits over various e-cigarette designs.  Marketing and competition is fierce.

There are three questions attempting to be answered in the research studies: 1. What is the efficacy of e-cigarettes as a smoking cessation device? 2. Will they encourage more conventional tobacco smoking or less? 3. And what is the safety of the vapor itself for users and people around them?

Some risks have already been identified.  A study published two months ago in Nicotine and Tobacco Research found that e-cigarettes that use tank systems allow for larger quantities of “juice” to be vaporized, and with batteries that heat with higher temperatures, can produce formaldehyde, a known cancer-causing agent, at the same levels as the combustible cigarette.  Also, if you happen to practice “dripping,” in which liquid nicotine is dripped on the heating coil, this can increase the amount of formaldehyde.  Since there is no standard (not yet FDA regulated) for the amount of nicotine in the “juice” it can potentially cause vomiting and seizures, especially for light-weights, and even death for a small child.  Some manufacturers are now packaging their juice in child-proof containers, but there‘s still no standard.

The number of calls to poison center linked to e-liquids increased threefold last year.  And in April of this year the CDC reported that calls to poison centers involving e-cigarette liquids with nicotine rose from one per month in September 2010 to 215 per month in February 2014.

A study that appeared in the May journal Addiction interviewed 6,000 smokers who tried to quit on their own.  In that group, of those who used e-cigarettes, one in five (20%) said they quit for good.  Of those who used conventional nicotine patches and/or gum, only one in ten (10%) said they had quit the habit.  Advocates of e-cigarettes claim that unlike the patch or nicotine gum, e-cigarettes mirror the entire smoking experience, which makes it a far more enjoyable and potentially effective cessation device.

But the research so far is contradictory.  A study in the Lancet found that e-cigarettes helped smokers quit at “similar” levels as did the patch and gum.  Another study in JAMA Internal Medicine said e-cigarettes were not associated with greater rates of smoking cessation or reduced cigarette consumption.  Currently, no e-cigarettes are approved for smoking cessation.

Until the FDA makes its final rules, you can expect to see slick marketing loaded with language similar to ads back in the day of tobacco cigarettes.  For example, one includes a one-minute video ad with television personality Jenny McCarthy that simultaneously plays on people's health concerns and their desire to protect their personal autonomy. "Now that I've switched to blu, I feel better about myself," says McCarthy, hunched over an e-cigarette in a nightclub, adding: "Finally, with blu, I took back my freedom."

So in summary, if you are currently vaping, or thinking about it, know that…
1. The science on its safety or potential for smoking cessation is in flux.
2. Vaping from a large tank e-cigarette and/or “dripping” exposes you to the carcinogen formaldehyde.
3. Try to taper off their use if you can.
4. Go to the Emergency Room if you develop sudden nausea or vomiting, headache, dizziness, gait disturbance, fast heartbeat, or sudden muscular weakness (nicotine toxicity).
5. Avoid switching brands/types if yours is ‘comfortable’, to avoid higher concentrations of a brand with higher nicotine levels in the juice. 

And for what it’s worth, you may want to think twice about charging your e-cigarette in your car’s charge outlet.