E-Cigarettes: A Safer Alternative?
Stephanie McClain PharmD

The use of electronic cigarettes, or e-cigarettes, is rapidly growing in all age groups in the United States and worldwide, including both regular cigarette smokers and non-smokers. The growing popularity of vaping, or using an e-cigarette, is highly controversial among the healthcare, scientific, and political community.

An e-cigarette device is designed to deliver nicotine in an aerosol form that simulates smoking a real cigarette, but without the real smoke. The hand-held devices resemble a cigarette or small cigar, and contain replaceable cartridges that deliver the nicotine. The cartridges contain nicotine, propylene glycol, glycerin, tobacco flavoring, and other flavoring agents.

Chemical analysis done by the FDA revealed propylene glycol to be the primary ingredient. While the ingredients are delivered in small doses, and are generally considered non-toxic and non-carcinogenic, the FDA analysis did discover small amounts of diethylene glycol, a known carcinogen and an ingredient in anti-freeze, to be present in about 5% of the cartridges analyzed. In addition, trace metals known to be carcinogens found in the smoke of regular burning tobacco, have also been discovered in some brands of e-cigarettes, possible a result of the various types of filter mechanisms inside the e-cigarette device.

Researchers from the Centers for Disease Control and Prevention (CDC) report an increase in the number of calls to poison control centers involving e-cigarettes from about 1 per month, in September of 2010, to 215 per month, in February 2014. As many as 51% of the calls involved children. E-cigarette poisoning can occur by inhalation, eye exposure, skin exposure, or ingestion. Almost 70% of the calls received involved ingestion. The e-cigarette cartridges are not currently regulated by the FDA, therefore the amounts of nicotine per cartridge, vary widely from the labeled amounts, and the cartridges, available in candy, bubblegum, and fruit flavors, are not required to be child proof, posing the increased risk to small children and pets.

Additional information provided by the CDC in September of 2013 revealed an increase in e-cigarette use among children and adolescents in grades 6 through 12. The information provided showed the use of e-cigarettes, or vaping, in this age group to have doubled from 3.3% in 2011, to 6.8% in 2012.

In the spring of 2014, the FDA announced plans to implement rules expanding their authority to provide regulation of e-cigarettes. The proposed ruling would allow the FDA to provide regulatory supervision of e-cigarettes, and all tobacco products not currently under their control, as an extension of the 2009 Family Smoking Prevention and Tobacco Control Act. This ruling would cover e-cigarettes, as well as large and small cigars, hookah and pipe tobacco, smokeless tobacco, and other tobacco products.

The sales from the e-cigarette market increased from $250 to $500 million between 2011 and 2012, and are expected to approach $2 billion by the end of 2014. Advocates of vaping, supported by some clinical data, argue that using e-cigarettes provides a reduced harm approach to smoking. Many have successfully quit smoking completely using vaping, while many continue to use e-cigarettes as a substitute for smoking. In addition, the risk of second hand exposure is greatly reduced with the use of these devices.

As more people are vaping in public areas, state and federal systems are taking action. Recently, four Democratic U.S. senators, slammed the Golden Globes ceremony sponsors for allowing actors in the audience to be shown using e-cigarettes on camera during the televised presentation. The senators argued that showing celebrities vaping during the awards show, glamorizes smoking and the use of e-cigarettes. The state of Utah has banned the use of e-cigarettes from public places, and the city of Philadelphia recently made the same ruling. Other cities and states are considering similar actions.

The national president, CEO, and spokesman, of the American Lung Association, Harold Wimmer, welcomed the FDA proposal to provide long-awaited oversight of all tobacco products. The medical community continues to advise on the side of caution regarding the practice of vaping. The medical community concerns include the unproven safety of the use of e-cigarettes, and concern that their continued unregulated use could lead to increases in worldwide nicotine dependence.

Authored by Stephanie McClain PharmD June 6 2014
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