E-Cigarettes: Friend or Foe?

If you’re tired of smoke getting in your eyes (not to mention your lungs), you might be considering electronic cigarettes, popularly known as e-cigarettes. But before you inhale, be forewarned: read the fine print …

What are e-cigarettes?

An e-cigarette looks like a cigarette, is used like a cigarette, and sometimes even tastes like a cigarette. It’s made of stainless steel or plastic, and does not contain tobacco.

Why are they used?

As a device to quit smoking, an e-cigarette is designed to deliver nicotine to users (who are called “vapers”) without subjecting them to the toxic chemicals in tobacco and tobacco smoke.

How do they differ?

“There are essentially two different kinds of e-cigarettes,” says Janice Burgess, who works with PACT (Partnership to Assist with Cessation of Tobacco) in Regina, Saskatchewan:

• those with nicotine and other ingredients
• those with flavouring agents and other ingredients

“There is some question about the ‘other’ ingredients,” says Burgess. “Many e-cigarettes contain propylene glycol, which is an irritant to people with chronic obstructive pulmonary disease (COPD), asthma, or other lung issues.”

How do they work?

Vapers “smoke” an e-cigarette by drawing on the end, just like an actual cigarette. This inhalation heats the liquid nicotine and turns it into an aerosol that is inhaled, leaving a visible mist resembling smoke that is exhaled.

What’s the controversy?

“Hugely controversial” is how e-cigarettes have been described. Media reports abound worldwide about the dangers of e-cigarettes while celebrities glamorize their use and advertising executives reap huge benefits from their sale.

The proponents

Advocates believe e-cigarettes are a clean, safe way to satisfy a smoker’s addiction to both nicotine and the behaviours accompanying smoking, such as the physical sensations of handling the cigarette or inhaling.

Thus, they say, e-cigarettes reduce the risk of smoking-related disease and death. Proponents also believe e-cigarettes simply can’t be as harmful as cigarettes—even though e-cigarettes have not undergone rigorous scientific testing—because tobacco smoke is the mode of nicotine delivery that leads to smoking-related health problems.

The opponents

Opponents to e-cigarettes believe they should be treated like other products containing nicotine, and only sold after undergoing clinical trials to prove their safety and efficacy. They also fear that the promotion and use of e-cigarettes will result in people using both types of cigarettes, and undermine efforts to de-normalize smoking.

E-cigarettes may affect tobacco control policies in workplaces and public places, and provide visual cues to smoke. This could undermine other smokers’ attempts to quit and promote relapse.

Further, e-cigarettes may also be seen as novelty gadgets that have no health risks, and become attractive to youth. This could contribute to the use of real cigarettes and lead to nicotine addiction.

“Nicotine in any form is addictive,” says Burgess. “There is no question that e-cigarettes that contain nicotine could be used as a ‘start-up’ product. Internet sales comprise the majority of e-cigarette sales, and I am not aware of any regulations that are followed to ensure they are not sold [online] to someone under the age of 18 or 19.”

Photos of celebrities such as Lindsay Lohan, Paris Hilton, Leonardo DiCaprio, and Johnny Depp using e-cigarettes affect how smoking is perceived. Opponents of e-cigarettes believe that normalizing and even glamourizing smoking can make it look cool again, and encourage both youth and adults to start (or restart) smoking.

What’s the regulatory status in Canada?

Currently, it’s illegal to import, advertise, and sell e-cigarettes containing nicotine in Canada. In March 2009, Health Canada advised Canadians not to use e-cigarettes, and notified stakeholders that all electronic products intended to administer inhaled doses of nicotine are considered new drugs. As such, they fall under the Food and Drugs Act. This means that before e-cigarettes can be sold in Canada, Health Canada must grant authorization after reviewing scientific evidence demonstrating e-cigarette safety, quality, and efficacy.

However, Health Canada’s position only applies to e-cigarettes intended to deliver nicotine. This has created a regulatory grey zone; e-cigarettes that don’t make health claims and don’t contain nicotine may legally be sold in Canada. Thus, you can buy e-cigarettes with nicotine-free cartridges or with cartridges claiming to be nicotine-free. However, it’s possible to purchase cartridges and e-liquid containing nicotine under the table.

What’s the evidence?

As a whole, the medical community agrees that research on the possible health risks and efficacy of e-cigarettes is still in the early stages. There is no research evidence that supports e-cigarettes as a treatment to help people quit smoking. To date, knowledge about the short- and long-term effects of e-cigarette use and the quality control processes used in manufacturing e-cigarettes is very limited.

“We need to do more clinical studies on e-cigarettes before we can safely recommend them to tobacco users,” says Burgess. She adds that there have been well over 1,000 clinical studies done on other smoking cessation aids. Those products which have been demonstrated effective, safe, and proven to enhance a smoker’s chances of successfully quitting should be recommended over electronic smoking.

“Unfortunately, although promoted as cessation aids, [e-cigarettes] are not proving to be overly effective,” says Burgess. If it looks like a cigarette and acts like a cigarette, then how could it help people stop thinking about smoking?” a

A typical electronic cigarette consists of three elements:

• a cartridge containing nicotine, water, and flavouring in propylene glycol (PG), vegetable glycerine (VG), or polyethylene glycol 400 (some cartridges, which are often re-fillable with e-liquid or e-juice solutions, do not contain nicotine)
• an atomizer with a heating element that turns the liquid nicotine into vapour
• a rechargeable battery to run the atomizer and the indicator light that glows red on the end, like a lit cigarette.