E-Cigarettes: Clearing the Air

APRIL 08, 2016
Anyssa Garza, PharmD
Electronic cigarettes, otherwise known as e-cigarettes, have been sweeping the nation since their introduction in 2007 and have grown into a $2-billion market.1 According to the Mayo Clinic, nearly 6% of all US adults and 21% of US adult smokers have tried e-cigarettes. Among US middle and high school students, 50.3% are aware of e-cigarettes and those who report use of e-cigarettes has increased from 4.7% in 2011 to 10.0% in 2012 (Online Figure2).

Safety claims of e-cigarettes have been circulating, with the majority of the published information, which can be misleading, coming from the manufacturers of e-cigarettes. This article discusses 5 myths about e-cigarettes and the facts behind each one.

Myth 1: e-Cigarettes Are Safer than Conventional Cigarettes
With the growing popularity of e-cigarettes comes the perception that they are safer than tobacco cigarettes—but this is not necessarily the case. Although there is insufficient evidence to provide a definitive answer, according to the National Institute on Drug Abuse, there are many reasons why e-cigarettes may not be a safer alternative. To begin, e-cigarettes and cigarettes contain nicotine, a highly addictive drug that can lead to dependence regardless of the way it is inhaled.3

Some e-cigarette manufacturers claim their products are free of nicotine. However, the FDA conducted a laboratory analysis and found low levels of nicotine in 17 (94%) of 18 of the cartridges tested.4 In addition, although e-cigarettes do not produce tobacco smoke, they do contain other potentially harmful chemicals, including formaldehyde and acetaldehyde.3 Furthermore, the long- term health consequences of e-cigarette use remain unknown.5

In 2009, the FDA also announced findings of a laboratory analysis of ecigarette samples. The results were positive for carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze.6 E-cigarette manufacturers have attempted to debunk these results.

Myth 2: e-Cigarettes Can Help Individuals Trying to Quit Smoking
The American Lung Association (ALA) is concerned about claims that e-cigarettes are helping smokers to quit. The FDA Center for Drug Evaluation and Research has not deemed e-cigarettes to be safe and effective for helping smokers to quit.5 The ALA reports that many consumers use e-cigarettes and conventional cigarettes simultaneously, instead of quitting, which is a concern. In 2013, 76.8% of people who used e-cigarettes were found to also smoke conventional cigarettes.7

Despite many smokers using ecigarettes to cut back on conventional smoking, they are still being exposed to tobacco and actually prolonging their exposure to it. Although reducing the number of cigarettes smoked per day is beneficial to health, even exposure to a low level of tobacco carries a significant risk. No level of tobacco exposure is safe. Smoking cessation should always be recommended.2

According to a review published in Mayo Clinic Proceedings, the American Heart Association (AHA) suggests clinicians not recommend e-cigarettes as primary cessation aids and that patients using e-cigarettes should be encouraged to designate a quit date for them. However, the AHA also suggests that if initial smoking cessation treatment fails or a patient has refused conventional treatments and wishes to use e-cigarettes to aid quitting, it “is reasonable to support the attempt.”2

Myth 3: e-Cigarettes Are Regulated
According to the National Institute on Drug Abuse, e-cigarettes are not regulated by the FDA. This is mainly because they are not marketed as tobacco products or as devices having a therapeutic purpose. Currently, there are no accepted measures to confirm the purity or safety of e-cigarettes. In addition, the liquids used in e-cigarettes are not regulated.3