A lot of patients ask me, "Are electronic cigarettes safe?" E-cigarettes are battery operated devices that consist of a plastic or metal tube connected to a mouthpiece. The cartridge contains a heating element and a reservoir of liquid, usually nicotine, dissolved in propylene glycol (the same substance contained in antifreeze). When the user inhales, which is also called vaping, the liquid nicotine is vaporized into a visible mist.
Use of e-cigarettes has been advocated as an aide for smoking cessation, as well as an acceptable way to smoke in public spaces, since the smoke traditionally associated with a regular cigarette is not generated. It’s also been suggested that vaping is a safer way to smoke, since most of the identified carcinogens are avoided.
Safety of E-Cigarettes
All of these assumptions have recently been brought into question. The first issue is whether e-cigarettes reduce the risk of exposure to secondhand smoke. Certainly, the "side stream smoke" that emanates from a regular cigarette even when it’s not actively being smoked is absent. An e-cigarette’s vapor only emanates when it’s triggered.
The second issue of concern involves the carcinogens. Traditional tobacco smoke contains cancer-producing polycyclic hydrocarbons. These are reduced to zero presence in secondhand smoke from e-cigarettes, because electronic cigarettes don’t burn organic material, while traditional cigarettes do. However, metal particles coming from the cartridge devices in e-cigarettes can include metal toxins, like zinc and lead, which is of significant concern. Additionally, the liquid in the e-cigarettes contains substances that can become nitrosamines, which are classified as carcinogenic.
Here’s the challenge: The amounts of these dangerous substances are questionable, since the FDA defines "trace amount" as detectable but too small to accurately measure. Studies of their presence in the immediate environment suggest less than eight parts per trillion, which is not considered significant.
There has been no evidence to date that engaging with e-cigarettes results in significant success in smoking cessation. It is fair to suggest that other pharmacological measures also only result in limited success, based on current study models.
A much more important question is whether this electronic smoking technique will influence tech-savvy young individuals to engage with a new habit and, thus, result in a new population of nicotine-addicted smokers. E-cigarettes are readily available on the Internet and typical ad campaigns, using celebrities and alluring flavors, make these products more appealing to children and adolescents. The possibility of accidental overexposure (overuse) is also greater, because this is a relatively painless and, frankly, hip method to consume nicotine. Indeed, a recent CDC study showed that the number of calls to poison control centers involving e-cigarettes’ liquid-containing nicotine rose from one per month in 2010 to 250 per month in 2014. More than half the calls involved children under age 5. Poisoning from e-cigarettes can occur in three ways: ingestion, inhalation, or absorption directly through the skin or eyes.
The current recommendations from health professionals can be summed up by a position statement from the American Heart Association that strongly recommends that these products should be subject to all laws that apply to these (nicotine-containing) products. The policy recommendations also call for strong new regulations to prevent access, sales, and marketing to youth. The statement includes a pledge to prevent the tobacco industry from addicting another generation of smokers. The American Thoracic Society has offered their position that the safety of electronic cigarettes has not been adequately monitored, so the byproducts that are unique to this technology varies with the manufacturer. More importantly, the addictive power of nicotine in e-cigarettes should not be underestimated.
What cannot be argued is that nicotine is a highly addictive and dangerous chemical in all forms. Substituting its mode of consumption will only create a different culture and activity that seeks its associated rewarding elements, and is vulnerable to its addictive qualities. E-cigarette technology, and future high-tech options, will create a different set of challenges, as it promises to make a more readily available and more efficient mode of nicotine delivery.
Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.