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 anti-tobacco campaigner Janice Burgess:

• 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, 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 e-liquid 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 glamorise their use and e-cigarette companies make an estimated A$1.28 billion a year.

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 because tobacco smoke is the mode of nicotine delivery that leads to smoking-related health problems.

The opponents

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

Adds Professor Ian Olver of the Cancer Council Australia, “It is also a serious concern that non-nicotine electronic cigarettes are available in Australia, can be lawfully sold to children and are subject to no controls. This is despite the risks they pose in re-normalising cigarette use in young people—to whom they are clearly targeted, with fruit and energy drink flavours, as well as tobacco flavours.”

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 normalising and even glamorising smoking can make it look cool again, which could encourage both youths and adults to start (or restart) smoking.

What’s the regulatory status in Australia?

Currently, it’s illegal to sell e-cigarettes containing nicotine in Australia and, from January 2015, Queensland took the step of subjecting all e-cigarettes to the same laws as tobacco cigarettes: no sales to children, no use in indoor or outdoor public places and no promotion or advertising in retail outlets.

This state legislation followed a report released by the World Health Organization in August 2014 calling for a number of restrictions, including banning flavoured e-cigarettes, ending their use in indoor workplaces and public places and restricting their promotion.

Under Australian Customs law, e-cigarettes (and/or their components) are not prohibited imports, but they may be subject to control under the Therapeutic Goods Act 1989 if the packaging makes any claims of therapeutic benefit.

Regulatory grey zone

Unfortunately, because of the internet, it’s quite possible to purchase e-cigarettes and their component parts, such as nicotine cartridges, by ordering from an international supplier. 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 some states of Australia.

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 for their benefit?

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. 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.

Smoking cessation aids?

A 2014 US study on smoking cessation found that people who used e-cigarettes daily for at least one month were six times as likely to quit smoking cigarettes as non-users or occasional users of e-cigarettes.

However, Burgess points out that there have been well over 1000 clinical studies done on other smoking cessation aids, and well-studied, safe and effective aids should still be recommended over electronic smoking.

“We need to do more clinical studies on e-cigarettes before we can safely recommend them to tobacco users,” says Burgess.

A typical electronic cigarette consists of three elements:

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