Two years ago we wrote about Ryan, a 35 year-old nursing student who was trying to kick a cigarette habit by smoking e-cigarettes. Ryan was ordering his vaping supplies online, as sales were prohibited in Canada and retail outlets were uncommon. While Health Canada hasn’t officially altered their stance in the interim, vape shops have proliferated and Canadians are using electronic nicotine delivery systems more than ever.

At the time, there were still many unknowns. The jury was still out regarding whether e-cigarettes helped people quit smoking traditional cigarettes, and there were questions about the safety and standardization of the product. But in the last two years, several research studies have helped clear the smoke of uncertainty, and experts now believe e-cigarettes to be 95 per cent safer than their combustible cousins. Despite the growing clarity, Health Canada’s 2009 edict that people should avoid e-cigarettes still officially stands. E-cigarettes containing nicotine are not approved for sale in Canada. Nevertheless the governments of Great Britain and the United States, among others, have taken a progressive stance and adopted reasonable safety standards. Hopefully Canada will soon follow, and a standing committee has presented a report to the House of Commons containing 14 recommendations regarding the regulation of these products.

While our government considers its course of action, vape shops are springing up on every corner and our patients are asking us all kinds of questions about e-cigarettes. We turned to the latest evidence to find the right (albeit non-government authorized) answers to their questions. Helpfully, this evidence was recently summarized in a publication by Public Health England, which weighed in on a number of key issues of concern to our patients.

Smokers who currently shiver at building entrances and on their own back steps want to know if e-cigarettes produce volatile chemicals similar to those in second-hand smoke. The evidence from the last two years indicates that it’s not a worry. E-cigarettes do emit small amounts of vaporized nicotine, but the amount is negligible from a health perspective. This air-borne nicotine does eventually get deposited on surfaces, but in minute quantities. One 2014 study concluded that an infant would need to lick over 30 square meters of exposed surface to obtain one milligram of nicotine. And although this is a bizarre visual, one milligram of nicotine is unlikely to be toxic to a small child. The same goes for other chemicals contained in the e-cigarette vapour — there is currently no evidence that they pose a health risk anywhere near on par with tobacco smoke.

A greater concern is the ingestion of the e-cigarette liquid itself by unwitting children, who might be attracted to some of their candy-like flavouring agents. Recent data from the U.S. and U.K. indicates that calls to poison centres regarding e-cigarettes have increased substantially in the last five years, meaning that little ones are getting their hands on the e-liquids. However, manufacturers have been responsive to calls for childproof packaging. If you have children or pets and decide to use e-cigarettes, buy the small 10 millilitre bottles rather than the large super-concentrated bottles available in the U.S., and store them as you would any medication or household chemical.