Are E-Cigarettes Safe?

Written by Dan Radmacher
This article was published in the Summer 2014 print issue of Carilion Clinic Living.

In 2013, sales doubled to $1.7 billion. Across the country, teen use recently doubled as well, with 10 percent of teenagers saying they’ve used e-cigarettes, according to the U.S. Centers for Disease Control and Prevention.

The slim electronic devices, which mimic the look and feel of real cigarettes, use a rechargeable battery to heat a cartridge filled with a liquid containing nicotine. The heat turns the liquid into a vapor that users inhale.

But a debate has erupted among public health officials over the safety of e-cigarettes, and whether they will help people limit or quit smoking.

Teenagers are also flocking to a sub-genre of e-cigarettes that come in an assortment of flavors like Belgian waffle and peppermint blast. Many of them don’t even realize they are using e-cigarettes. Instead, they call the products “vape pipes” or “hookah pens.”

Experts worry that teenagers will unwittingly become addicted.

A Heated Debate

How safe are e-cigarettes? Proponents argue that they are far safer than real cigarettes because they don’t contain toxic tar, the component that most damages health. Opponents point to the dangers of liquid nicotine used to refill some e-cigarettes, calling it a strong neurotoxin that has caused accidental deaths in children. They also fear that e-cigarettes may have unknown health effects and give smokers an ongoing crutch without weaning them off nicotine.

Unfortunately, few scientific studies have been done, and the results have been inconclusive. “We don’t have enough data right now to reach a straightforward conclusion,” says Maciej L. Goniewicz, Ph.D., Pharm.D., a pharmacologist, toxicologist, and assistant professor of oncology at the Department of Health Behavior, Roswell Park Cancer Institute in Buffalo, N.Y.

"We know little about the actual effects of the product. We don’t know what will happen after 10, 20, or 30 years of daily use,” he says.

Evidence so far indicates that e-cigarettes are about as effective as other nicotine-replacement therapies. There is enough evidence to conclude that they are safer than tobacco cigarettes, says Goniewicz, but not enough data to show they are entirely safe.

“If you are not a smoker, there is no reason to experiment with this product,” Goniewicz says.

Doctors also emphasize the need for caution. Jose M. Goyos, D.O., a Carilion Clinic specialist in pulmonary, sleep, and critical care medicine, advises those who’ve never smoked to avoid e-cigarettes. “Data show that young people who experiment with electronic cigarettes are more likely to pick up the real thing,” he says.

Donna Bond, R.N., D.N.P., a Carilion pulmonary clinical nurse specialist, agrees, noting that the flavors and some of the advertising for e-cigarettes appear to be aimed at the youth market. “Nicotine is a much more powerful addiction if you start when you’re young,” says Bond.

E-cigarettes may be marginally better than smoking, says Bond, but she recommends smokers quit by using gum, lozenges, or a nicotine inhaler available by prescription, especially until more studies are done.

Dr. Goyos and Bond both stress that, unlike the inhaler available by prescription, e-cigarette vapor delivers carcinogens, including diethylene glycol and nitrosamines.

"The biggest problem is you don’t know what you’re getting,” Bond says. Nicotine levels and other additives in the “juice” that is vaporized vary by brand, and even brands that advertise they contain no nicotine have been found to have small amounts, she says.

Dr. Goyos says he has seen a few longterm smokers successfully use e-cigarettes to quit altogether. This may be because, unlike nicotine patches, gum, or the prescription inhaler, e-cigarettes fulfill some of the psychological aspects of smoking.

That’s important to Jeff Allen, a Roanoke Valley resident who is using e-cigarettes in his latest effort to stop smoking. “You want to have something in your hands while you’re talking to someone,” Allen says. “E-cigarettes check off all the boxes that cigarettes do.”

Still, Allen knows there hasn’t been much research into the health impacts of e-cigarettes. “It does concern me very much. I don’t consider it a healthy substitute. It’s the much lesser of two evils.”

Regulations Pending

The U.S. Food and Drug Administration in April proposed new regulations for e-cigarettes, which include treating them as “tobacco products” and banning sales to anyone under 18. But industry observers are divided over whether the rules will curb the growth in sales. Some say much will depend on exactly how the FDA implements them.

Another concern is that although it is illegal in most states for those under 18 to buy regular cigarettes, many teenagers do manage to obtain and smoke them. Would the same thing occur with e-cigarettes?

For his part, Dr. Goyos would like to see the enticing flavors that appeal to youth banned, along with an effective ban on sales to minors. “The most important thing for people to know is this: e-cigarettes are not benign,” he says. “They do, in fact, contain chemical substances that are toxic to the lung.”