Though still awaiting FDA approval, the electronic cigarette, or e-cigarette, is growing in popularity among those attempting to quit smoking. The e-cigarette gives users the nicotine and physical sensations their brains crave, while allegedly reducing the amount of chemicals and smoke otherwise found in regular cigarettes. The side effects of e-cigarettes are not extreme, like those of prescription NRTs, nor are they as slow acting as other nicotine replacements.
That being said, e-cigarettes remain unregulated; the supposed benefits and risks of e-cigarettes will requires years of scientific scrutiny before they are anything more than claims. With that understood upfront, smokers who approach e-cigarettes as a solution to their smoking should recognize their highly experimental and uncertain status as an NRT. Below, we explore the status of the e-cigarette and pending government efforts to further regulate the product.
How Do They Work?
E-cigarettes offer the delivery of pure nicotine without deliberately added chemicals and carcinogens. Nicotine in liquid form is contained in a tiny cylinder that also holds a heating device. The cylinder is attached to a battery that, when triggered by the inhalation of air, activates the heating device. In a split second, a drop of liquid nicotine is vaporized by the heat and carried directly into the lungs. This heated gas carries not only the nicotine craved by the brain but also the "throat hit," the sensation felt in the back of the throat when smoking a cigarette. For some users, the throat hit is an essential part of smoking, and is something not delivered by other forms of nicotine intake.
Potential Risks and Negative Impact
While e-cigarettes have drawn the attention of the FDA, they have not yet been officially regulated, as we mentioned above. In 2014 the agency proposed, under the Family Smoking and Prevention and Tobacco Control Act, that e-cigarette manufacturers disclose all ingredients and market products only with FDA approval. However, this has not yet been added to existing legislation. Health concerns expressed by government entities include the fact that there have been no long-range studies of e-cigarettes’ impact on users, nor of synthetic nicotine vapor inhaled directly into lung tissue, nor even of propylene glycol’s effect when it is used in this product.
E-cigarette critics are also concerned with some secondary risks that offset the convenience of these devices. While e-cigarettes seem to be helping smokers kick the habit, usually by a gradual reduction of the amount of nicotine in each cartridge, it also appears to potentially attract new customers who have never smoked. Chocolate, strawberry, bubble gum and cherry are common vapor flavors for sale, and specialty stores are known to sell well over a hundred distinct flavors. This vast variety of available flavors is appealing to many users and not always as a replacement for a tobacco product. The risk of creating a new problem while solving an old one is a major reason the FDA questions whether to approve e-cigarette use.
Nicotine cartridges are potentially dangerous in themselves. Medical experts agree that nicotine, apart from its addictive qualities, is not an inherently evil substance. However, synthetic nicotine in its concentrated liquid form is exceedingly toxic and a different matter altogether. Minimal accidental exposure to liquid nicotine can be fatal, and drinking as little as a teaspoon can kill a child; less than a tablespoon can kill a grown man.
The risk doesn't end with ingesting the liquid, either; hospitalizations have been reported due to contact with bare skin. Lastly, the flavoring added to the liquid and the industry's lack of regulation on packaging combine to make tiny jars of nicotine "juice" appealing and accessible to children. In recent years, the CDC has reported a dramatic rise in calls to poison control centers about liquid nicotine.
Because users don’t inhale tar and the other additives found in cigarettes, some people may feel e-cigarettes are healthy. While it is true they do not carry the same cancer risks as tobacco cigarettes, it is not known whether e-cigarettes are safe over the long term. For instance, researchers have confirmed that synthetic nicotine still causes diminished lung function, elevated heart rate and constricted blood vessels.
Many smokers use e-cigarettes alongside tobacco, instead of as a replacement, and there is concern that these users may actually be exposed to more nicotine than before e-cigarettes. Though New York and Chicago have banned public use of e-cigarettes, most areas of the country allow vaping indoors. Rather than lead smokers away from cigarettes, practices like these might actually attract new users to e-cigarettes.
Future of Regulation
The FDA is currently reviewing existing data and conducting its own research, and industry manufacturers expect that e-cigarettes may soon be regulated by the government. This opens the door to taxation of the product, which has the dual effect of providing a new income stream to taxing bodies while driving up the price of the product. Aside from economic implications, however, regulating the manufacture and distribution of e-cigarettes could benefit the market. For example, FDA approval may carry with it:
- Restrictions on sales to buyers under age 18
- Quality control on dosage delivery of nicotine (testing has revealed that measurable nicotine in e-cigarettes can vary considerably from the amount stated on the packaging)
- Requirements to list known dangers and risk factors prominently on packaging
- Limited ability to advertise, similar to regulations imposed on the tobacco industry
- Restrictions on free samples or vending machine sales
- Limitations on the number of tasty flavorings on offer
- Restricted online sales
Meanwhile, in the grand tradition of capitalism, e-cigarette manufacturers are scrambling to rake in profits in an unregulated market. It is currently estimated that revenue from e-cigarettes in the U.S. will top $1.7 billion in 2014. Regulation would carry a mixed bag of rules for manufacturers and distributors to follow, but theoretically would result in a safer consumer experience.