E-Cigarettes: A Doctor’s Perspective
When it comes to e-cigarettes, no smoke doesn’t necessarily mean no fire.
Increasingly my colleagues and I have seen a growing number of children who have used or currently use e-cigarettes. E-cigarettes, short for electronic cigarettes, contain nicotine-laced liquids that are heated and inhaled as a smokeless vapor by users.
While cigarette use may be falling in general, the use of e-cigarettes is booming, especially in children. The CDC reported that the percentage of middle and high school students that have tried e-cigarettes has doubled between 2011 and 2012. In fact, 10 percent of high school students reported having tried e-cigarettes.
The first question that should arise is why are children being attracted to e-cigarettes? To this question I have a series of rhetorical but serious counter questions. Is it the enticing array of child-friendly flavors, like cherry, gummy bear, chocolate, cookies, and peach? Or it the celebrity endorsements and appearance in popular music videos, such as Snoop Dogg’s “Sitting by the Water” where e-cigarettes appear prominently? Or perhaps it’s the fact they cost just a fraction of the cost of traditional cigarettes? Or maybe even the relative lack of regulation and laws governing their sale?
The last point, however, may soon change because the FDA is considering moving to regulate e-cigarettes alongside conventional cigarettes, a move that would appease the 40 state attorney generals who have urged the FDA to bring e-cigarettes under the Tobacco Control Act. In the meantime an increasing number of towns in Massachusetts are taking a stand over the sale and use of e-cigarettes.
While we ponder why our children have started “vaping” on e-cigarettes, and the changes the FDA will make, we should also pause to consider whether e-cigarettes are dangerous in themselves, and secondly if they may led to children trying other drugs (the gateway effect).
Are e-cigarettes safe?
To be clear, there is almost no research regarding the long term effects of e-cigarettes in adults or children. There have, however, been robust tests on the contents of e-cigarettes performed by the FDA center for drug evaluation, with some worrisome findings. In their tests, they found that the majority of e-cigarettes contained harmful substances like anabasine, myosmine, and β-nicotyrine, which are tobacco impurities. Additionally, carcinogens, substances that are linked to cancer, were found in half of the samples tested. One sample even contained diethylene glycol, a toxic substance that is a component of antifreeze.
Let us also consider nicotine, the main highly addictive ingredient used in e-cigarettes. Nicotine in excessive amounts can be toxic, or even fatal. This is especially true in children and although such instances are uncommon, we have known for decades that products like nicotine gum and cigarettes can have toxic results in children.
Can e-cigarettes lead to the use of other drugs?
Debates continue as to whether smoking tobacco or cannabis may led to the use of more “hardcore” drugs such as heroin, a idea termed the “gateway” theory. My view is that we must exercise an extra degree of caution and vigilance where children are involved, and secondly, the dangers of dismissing the gateway theory if the debate eventually sides with its existence, could be harmful to many young and vulnerable individuals.
I am concerned with the potential for children developing nicotine addiction and subsequent tobacco use, a concern that is shared by the Massachusetts Medical Society, a society that is comprised of over 24,000 physicians and medical students. Adding fuel to the vapor fire, there are now emerging accounts of e-cigarette devices being used to inhale cannabis-based products, such as cannabis oil – a technique that unlike smoking cannabis, is odorless and less noticeable.
There are many unknowns regarding e-cigarettes, the few knowns, such as their exploding use in children, and the presence of toxic components, are not reassuring. The absence of evidence of harm is not equivalent to the presence of evidence of safety. I believe that regulation and restrictions of sales to minors are a natural first step to ensuring that we minimize the potential harm that e-cigarettes may cause to the youngest members of our society.