Electronic cigarettes are a billion-dollar industry, with an estimated 4 million users in America according to the Tobacco Vapor Electronic Cigarette Association. These battery-operated nicotine vaporizers are portrayed by celebrities like Jenny McCarthy as a chic alternative to tobacco cigarettes. Before e-cig users “light up,” recent research or lack thereof could cause some to reconsider.
What is an e-cig? A brief history lesson
Traditional electronic cigarettes were originally three-part devices consisting of an atomizer, a battery and a cartridge, which was filled with e-liquid. Many users faced complications with three parts, complaining of e-liquid leaking from the cartridge.
Today, most e-cigs have two parts: a rechargeable battery and a cartomizer, the piece that combines the atomizer and the cartridge into one unit. The atomizer heats the e-liquid until it produces vapor. E-cigs produce the same amount of vapor no matter how hard the user inhales.
Users can choose to “vape” non-nicotine e-liquid or nicotine e-liquid. Nicotine levels vary and are selected according to the user’s preference. E-liquid normally contains the chemical propylene glycol, nicotine, flavorings and other unidentified additives. The end of the e-cig lights up to simulate the glow of a real cigarette.
Users can pay anywhere from $30 to $100 for a starter kit. The Tobacco Vapor Electronic Cigarette Association estimates replacement cartridges cost about $600 annually, less than half the price of a yearly tobacco cigarette habit.
UMKC pharmacist publishes review paper about e-cigarettes
Dr. Lauren Odum, a board certified pharmacotherapy specialist and graduate of the UMKC School of Pharmacy, recently published her discoveries about e-cigs as a method to quit smoking. She was quoted in a Sept. 9 article in The Washington Post regarding her research and her work at a smoking cessation clinic in Columbia, Mo.
Odum told The Washington Post that the research is skewed because “…people who have a positive experience [with e-cigs] are more likely to report back.” Odum said they received a lot of helpful information from surveys conducted on former smokers who use e-cigarettes to quit smoking.
Odum said the best trial to date was conducted by The Lancet, the world’s leading medical journal. Researchers did a control panel in which participants were randomized by ethnicity, sex and nicotine dependence level. They tested the use of nicotine e-cigs, nicotine patches and placebo e-cigs to help quit smoking. The results concluded that all three were moderately effective at helping smokers to quit.
“The one flaw with this study is they needed a few more people to enroll,” Odum said. “E-cigarettes hold a lot of promise, but they need to be FDA regulated.”
Odum said a lot of patients have attributed e-cigs to helping them cut back or quit smoking.
“These are people who have tried to quit over and over using the FDA approved medications,” Odum said. “They still had trouble quitting.”
Lack of federal regulation creates concern
Although the Food and Drug Administration was given the authority to regulate e-cigarettes under existing tobacco product laws, it has no authority to regulate the ingredients, advertisements or sales to minors.
“Manufacturing processes aren’t the best,” Odum said. “The FDA has found things like a product with trace amount of toxins. Some cartridges leak which could be a hazard for pets and children. Practices need to be better so they can be safe and so what is actually in them [e-cigs] is what is being advertised.”
Electronic cigarettes were invented in the 1960’s but have only recently gained popularity, particularly among teens. USA Today reported that e-cig use among high school students has risen from 4.7 percent in 2011 to 10 percent in 2012. U.S. middle school students are also vaping at an increasing rate: 1.4 percent used e-cigs in 2011 and 2.7 percent in 2012. The Center for Disease Control estimates that 1.78 million middle and high school students have tried e-cigs.
This recent doubling in statistics is alarming to Odum, who fears children and teens will eventually switch to real cigarettes.
“E-cigarettes may become a gateway to tobacco cigarettes,” Odum said. “We live in a culture where cigarettes are becoming less and less popular, but the concern is if everybody starts using e-cigs will they start to smoke real cigarettes?”
Odum said because e-cigarettes come in a variety of flavors and appearances they may be appealing to people who may have never smoked any form of cigarette in the first place.
“E-cig companies are selling them just fine without running clinical trials, and they are not necessarily motivated to run a trial,” Odum said.
Since e-cigs are not regulated by the FDA, companies can skirt around mandatory trials and they are not allowed to claim it as a method to quit smoking.
“If they want to make that claim, they have to go through the FDA,” Odum said.
One UMKC senior who wished to remain anonymous uses a VP vaporizer, a three piece device that she refills with e-liquid.
“I normally only use it when I’m drinking,” she said. “It’s pretty harsh in the beginning, but it smoothes out after a couple puffs.”
The student uses e-liquid that contains 18 to 20 milligrams of nicotine. She also smokes tobacco cigarettes regularly. She bought her vaporizer online for $25.
“The problem is there is no end point,” she said. “I can sit and puff on my vaporizer all night. You can just constantly smoke it.”
She had previously tried e-cigarettes and she did not like the experience. Her brother used a vaporizer to help him quit smoking last year and he referred them to her.
A UMKC junior who also wished to remain anonymous used e-cigarettes hoping they would help him quit smoking and save him money.
“I bought the cheap $10 gas station kind,” he said. “It was a snap decision I made at 7-11. I wanted to see if it was a good avenue to help me stop smoking. It [the product] claimed it would last for two packs but it didn’t. They were just alright. It’s definitely not the same.”
The student said he probably would have spent more money on e-cigs had he continued to use them. He still smokes tobacco cigarettes.
Senior Grace Freeman bought a non-nicotine e-cig two years ago. She smoked in high school and she often vapes around her friends who still smoke tobacco cigarettes.
“I normally use it when I’m drinking with my high school friends,” Freeman said. “I like them. I don’t feel the need to smoke when I vape.”
Freeman’s only complaint is her e-cigarette dies quickly and often needs to be charged.
Sub: Push for regulation, additional research
E-cigarettes containing nicotine still create dependency on the additive. Odum has seen the negative long-term effects of tobacco smoke, but she said there are too many uncertainties to claim that e-cigarettes are a healthy and safe alternative.
“We still don’t know the long-term consequences of e-cigs,” Odum said. “Can the vapor irritate people’s lungs? We probably won’t know for years. The concern is similar to cigarettes. We didn’t know tobacco smoke was bad for us for so many years.”
Forty attorneys general sent a letter to the FDA last month pushing for the regulation of electronic cigarettes. The FDA set an Oct. 31 deadline to propose a plan to regulate them, but there is doubt as to whether the deadline will be met.
“It [e-cigarettes] defeats the purpose of public health,” Odum said. “It’s a different issue for people who are trying to quit smoking. E-cigs don’t have tar, which causes cancer. If e-cigs have a role in society at all, it is to help people quit smoking.”