TobaccoHarmReduction.org

Electronic Cigarettes

Here is a May 2009 television interview with Dr. Phillips on electronic cigarettes with Jay Ingram on the Daily Planet (Discovery Planet) and be sure to check our Interviews with the Experts page (the interviews are mostly about electronic cigarettes). Also see our (reading list) if you are interested in the technical reports. But if you want a fun way to hit many of the major issues surrounding e-cigarettes, take the quiz below, furnished thanks to the folks at ecigarettedirect.co.uk.

Are you a vaping master or a vaping newbie?

Take our electronic cigarette quiz to find out - or embed the quiz on your own site to entertain your web visitors!





[4.0] What are electronic cigarettes?

Some electronic cigarettes (or e-cigarettes) look exactly like regular cigarettes or cigars; others look more like pens. They are battery powered, and create their effect by vaporizing nicotine which is dissolved in a solution of water and propylene glycol (which, minus the nicotine, is basically the fog that is used in fog machines). The result is something that feels somewhat like smoke in the mouth and lungs but without involving any real smoke, tobacco or combustion. This e-cigarette fog (or vapour) dissipates rapidly, and leaves little scent in the air or on clothing.

E-smoking is almost identical to cigarette smoking. The major difference is that the e-cigarette is always "lit". Most of them even have an LED on the end that lights up like a cigarette ember when you draw on it. You can put it down or pick it up at any time without worrying about burning anything. It is only on when you actually draw on it. How much you smoke is related more to how many puffs you desire rather than on the length of the cigarette.

When switching over to e-cigarettes, a person needs to buy a kit which includes the battery containing smoking tube, cartridges which may or may not be flavored, and which may have high, low or no levels of nicotine, a recharger for the battery, an atomizer (this vaporizes the nicotine), and a set of instructions. As this is an electronic device, there may be a need in the future to purchase new batteries and atomizers as basic upkeep to keep your unit functioning properly. Even with refills and replacement pieces, there is still a phenomenal savings in comparison to tobacco.

There is also the option of buying individual disposable "cigars" which might be a good way to start without a big investment as long as there is not a big shipping charge. Of course, if you are fortunate enough to have a retailer stocking these items, you can bypass that cost.

For a good overview of the basics of the e-cigarette product and its use see How to Vape.

[4.1] Are they really safer than regular cigarettes? -Yes.

Though we are uncertain as to how safe they are, we are fairly sure that they are safer than smoking cigarettes. Part of our certainty derives from knowing how harmful regular smoking is. Almost anything is certain to be safer.

Almost anything else that is not acutely toxic (and we know the e-cigs are not) will be safer. Even if e-cigs are about ten times as harmful as smokeless tobacco, that still makes them about 1/10th as harmful as smoking. Smoking is just that bad.

First of all, there is no burning of any plant matter so all those combustion related carcinogens are no longer present. Of course, in most cases, nicotine is still present but, as we've written elsewhere, nicotine is one of the more benign elements in tobacco (see our Nicotine FAQ for more on this). All that remains is some uncertainty about the effects of propylene glycol with long term regular use.

However, though there is little danger in smoking e-cigarettes, there are some safety issues involved if people are using refillable versions and handling liquid nicotine. In the liquid form, nicotine is quite dangerous and any spills onto skin should be immediately washed off and certainly it should never be ingested. For more details, see Laugesen's cautions here.

[4.2] Are they as safe as using smokeless tobacco? -Maybe.

We cannot be as certain of their safety range as we are with smokeless tobacco (ST) simply because they are so new.

With smokeless tobacco, we have evidence from decades and decades of use by many different populations. Evidence that comes only from examining substance effects on cells in laboratories, measuring constituents in blood or urine, or its effects on nonhumans does not provide enough information to know what the effects will be on humans over time.

There are some but not that many studies of the potential harms that might come from using electronic cigarettes. To date, there is no indication of anything substantial. So, all we can say at this point is that they could be as safe, or even safer, than using ST or pharmaceutical nicotine products but we cannot be certain of that.

There are studies that confirm the chemicals that the body receives from some e-cigarettes, but not all of them. There is some concern about quality control -- making sure they are only what they say they are -- given that many factories in China are producing various versions with little regulation or oversight. We recommend using major brands that have been well tested. The most comprehensive study so far is on Ruyan (the largest producer) and indicates a clean product. (You can find that report online here.) Or you can find the link and also a few other reports in our Research Bibliography section under Electronic Cigarettes, as well as a risk report on propylene glycol.

Unfortunately, the studies that we have are all about chemistry, and a chemistry study does not tell us everything about human health effects. Since nicotine seems to be the source of most, if not all, of the risk from using smokeless tobacco, e-cigarettes, like traditional pharmaceutical nicotine products, will likely have those same risks (which we discuss HERE). To date, there is no reason to believe there is any substantial additional risk from the e-cigarettes, but we cannot be certain of that.

[4.3] How can I be sure I will like them?

You can't. But here is a link to a couple of resources out there. The first is a forum of former smokers discussing their experiences, and how they feel about the different available products, and the second is a reviewer who is trying to gather and review all the available products;(E-cigarette forum.com, and E-smoker forever). And here at E-cig review is a summary page for one person's experience with many brands. (Or watch this video of one long time smoker's experience with various methods including e-cigarettes).

[4.4] Is vaping as expensive as smoking?

The following is a British resource which will give you some idea of how much healthier your pocketbook will be (as well as your lungs).

[4.5] Where can I buy them?

Note: As of March 2009, Health Canada has decided to officially advise Canadians not to use electronic cigarettes (see the Advisory here) and has also curtailed the marketing (see here). In the United States, many of health organizations such as the American Lung Association, and the American Cancer Society are also actively campaigning to remove e-cigarettes from the market. We hope this is temporary and that the situation changes. We are also not entirely certain what this means in terms of finding and using e-cigs. Unfortunately, this means that Health Canada and those American groups are actually advocating smoking regular and proven to be harmful cigarettes over their almost certainly safer electronic alternatives.

We will keep you informed of any major developments.

Presently, electronic cigarettes are much more commonly available on the internet than in stores; some personal orders appear to be successful. You might check with your local tobacco shop as to whether they carry or plan to carry these products. At this time, Canadian distributors have been shut down indefinitely (Health Canada has essentially made it impossible to gain approval) while American distributors are suffering from haphazard confiscations by the FDA.

A few governments are discouraging these products and threatening eventual confiscation. Of course, this makes it much less likely for this product to be on the shelves. We are hoping that the situation improves so that electronic cigarettes become at least as easy to purchase as regular cigarettes. In the meanwhile, E-cigarette Ban is currently the best site for keeping track of the status of e-cigarettes around the world.

[4.6] If these are so good, why aren't governments and anti-smoking groups supporting them?

We do not know for sure. There does not seem to be a concerted effort to block these products in most countries, though that remains a possibility. Regulatory agencies have a legitimate responsibility to help make sure the products are pure and contain what they say. This creates a challenge in the current environment. Groups that are truly anti-smoking should embrace any alternative, but those that are more interested in making life difficult for smokers or nicotine users do not like these products because they could make nicotine users more comfortable.

Whenever government regulatory agencies are confronted with a new product, they need to find the proper category to put it into, and then make sure it complies with the standards associated with that category. In this case, even though nicotine is widely available in many forms, it is still important to make sure the products do not contain any hidden toxins, that they function properly (e.g., cannot accidentally deliver an overdose), and so forth. In this case, the waters have been muddied by the claims that it helps people quit smoking. Whether or not it does is not the concern of the agency, but when such a claim is made, the claim needs to be proven (and that means more than anecdotes).

In some sense, the situation is absurd because someone could much more easily introduce another harmful product that was part of an already established category than introduce a new and obviously safer alternative. Governments typically worry more about hypothetical new risks than clear old risks.

Some commentators have suggested that governments are so used to tax revenues that if electronic cigarettes became more popular they could threaten this income. This is not an absurd concern, given the current economic conditions and given that governments have been raising tobacco taxes to make up shortfalls in other areas. We can only hope that if that is the plan, that they keep the taxes lower than on tobacco products because the last thing you want to do is make people choose traditional cigarettes because they are cheaper.

However you do hear official spokespersons from both government, NGOs and anti-tobacco agencies making statements that either betray ignorance of where the harm in smoking comes from, or statements that are ideological rather than concerned with health.

You might hear that e-cigarettes are dangerous because they deliver nicotine which they say is a poison. See our nicotine FAQ for why this has little basis. You also hear people say that these just keep people smoking. That may sound like a health statement but it is simply expressing an opinion that no one should smoke, not even if it is entirely safe. This statement ignores the public health harm reduction principle that we should do all we can to protect the health of those who choose to smoke, and part of that protection involves educating people about the comparative risks of these products and in promoting the safer options. Or you might hear that this will lead people to smoking. This makes little sense since it is much easier to obtain traditional cigarettes, and what you hear most from people who enjoy these, is that apart from being able to smoke inside again, they feel they are making a healthier choice.

We like to think that those against will realize that e-cigarettes (and smokeless tobacco) remove all that second hand smoke they are so worried about, and also remove the health risks associated with nicotine use. How can you argue with that?

At the very least, we hope that anyone who has doubts about these products will realize that the elimination of second hand smoke and a likely reduction in health risk will mean that governments will eventually come to approve them. Anti-nicotine extremists, on the other hand, might stay with their goal of trying to punish smokers rather than offer them good alternatives.

[4.7] Can I use these in nonsmoking areas?

Technically you should be able to use these anywhere. No smoking sections refer to the smoking of tobacco so legally there is no prohibition against these. However, you might have to let people know that you are not smoking tobacco. Even though you are not generating anything remotely like second hand smoke, some might prohibit your e-smoking simply because they disapprove of even the appearance of smoking. Over time, this should become less necessary to explain to people.

Some of these products come with information cards to give to people who might think you are doing something illegal.

[4.8] Could these help me quit all nicotine use? -Maybe.

They might. Switching away from smoking is the most important thing to do so even if you end up not quitting. At least it won't harm you the way smoking will. Some people have found that electronic cigarettes reduce their need to smoke somewhat. E-cigarette Direct has posted a collection of e-cig user comments about their experiences with many reporting that they have reduced or quit traditional smoking. The products are available with varying levels of nicotine, from a lot to none, so they can be used as a weaning product.

It does not strictly qualify as scientific evidence but indications are that e-cigarettes are being used successfully by many to quit smoking, with many of the quitters having a history of trying other methods and failing. And though anti-tobacco activists see them as an attraction for adolescents and those who never would have smoked, we have seen no reports of previously never smokers starting up with this product. Every anecdote so far appears to tell the same story; a cigarette smoker is switching over, sometimes just part time but more often full time, to this safer alternative.

Other quit smoking methods have little success with many smokers, so it is not surprizing that people who are trying to quit will try this too. And given the reports, it seems to be working for many. In time we should see some formal studies but in the meanwhile, on a person to person basis, some smokers are rapidly reducing their health risks.

[4.9] Other unanswered questions or concerns?

See our Reading List, our Interviews with the Experts page, or this FAQ over at electroniccigarettereview.com for more information.