Replacing Cigarettes with Smoke Sticks – Is it Safe?

September 29, 2010

By Terry Smiljanich:

Katherine Heigl, formerly of TV’s Grey’s Anatomy, recently “lit up” an electronic cigarette on the Letterman Show, thereby providing some free advertising to a relatively new smokeless tobacco product which is showing phenomenal sales in the United States. These “smoke sticks,” also known as “e-cigarettes,” deliver nicotine without the combustible smoke by-products found in regular cigarettes which contain most of the deadly carcinogens – but are they safe?

How They Work

Electronic cigarettes are tube shaped devices containing a cartridge of liquid nicotine solution heated by a battery. As a person inhales through the mouthpiece, the heated air vaporizes the nicotine liquid and delivers this to the “smoker,” but without the burning tobacco and its associated multiple carcinogens. There is even a small diode at the tip of the device that lights up red as the person inhales.

One cartridge of the nicotine solution is equivalent to a pack of 20 cigarettes, resulting in a “per pack” cost of about $2, much cheaper than the current cost of anywhere between $5 and $10 per pack of cigarettes.

The idea is that the device satisfies a smoker’s craving for nicotine, and further reinforces the hand-to-mouth repetitive motion of smoking that provides a psychological simulation of the smoking habit. As an added benefit, there is no risk of ‘second hand smoke” to others. No carcinogens means a safer product, right?

Enter the FDA

Manufacturers of e-cigarettes have been in a battle with the FDA during this past year. The FDA has tried to ban the importation of these devices, primarily made in Asia, categorizing them as unapproved drug-delivery devices. In January, however, a federal district judge ruled that, since their active ingredients are made from tobacco plants, they are tobacco products and, thus, not subject to drug restrictions under the federal Tobacco Act.

This ruling has been temporarily overturned by an appellate court, and on September 9, 2010, the FDA announced it was taking enforcement action against five companies for making unsubstantiated health claims and poor manufacturing practices. The FDA has written a letter to the “Electronic Cigarette Association,” (the industry-wide association of private e-cigarette manufacturers) demanding further research and efficacy studies regarding what the FDA considers to be both a drug and a drug delivery device.

The FDA notes that some companies promote their product as a way to quit smoking, something which the government claims has not been adequately tested. The FDA also notes that at least one of the cited companies, Johnson Creek Enterprises, has failed to establish adequate quality control and testing procedures, resulting in inconsistent doses of nicotine from cartridge to cartridge.

On the other hand, the American Association of Public Health Physicians has urged the FDA to approve e-cigarettes, claiming that such smokeless tobacco products have less than 1% of the mortality rate of regular cigarettes.

Health Concerns

Contrary to the claims of manufacturers, FDA tests have shown the presence of detectable levels of known carcinogens in some e-cigarettes tested, including nitrosamines and diethylene glycol, a chemical used in anti-freeze.

In addition, some recent studies indicate that oral “smokeless” delivery of nicotine increases the chance of contracting cancer. A study by the Medical Research Council of the University of London suggests that the levels of nicotine in nicotine gum and lozenges, sold as ways to help quit smoking, can contribute to mutations associated with mouth cancer. If so, smoke sticks may present the same dangers.

Dr Muy-Teck Teh, who led the British research team, said: “Smoking is of course far more dangerous, and people who are using nicotine replacement to give up should continue to use it and consult their GPs if they are concerned. The important message is not to overuse it, and to follow advice on the packet.”

User Complaints

We talked to a handful of e-cigarette users who said they were generally satisfied with the product, and said that while using “smoke sticks,” they did quit smoking regular cigarettes. Some liked the different flavors available, including menthol, mocha, and vanilla.

One major concern in using e-cigarettes is the fact that there is no built in time limitation while “smoking.” A real cigarette burns out in about ten minutes. Since one smoke stick cartridge contains the equivalent of a pack, however, it can lead to improper over-use.  One person told us he had been working at his computer while using an e-cigarette, and had not noticed that he had been inhaling for over an hour until he started to feel the effects of nicotine overdose.

A 1987 study of snuff and chewing tobacco found increased levels of nicotine absorption in users, with associated adverse cardiovascular effects. Will use of smoke sticks show the same effects? More studies are obviously needed.

Some users have experienced adverse reactions from members of the public while puffing on one. The product does create a vapor looking like smoke, but this water vapor does not violate any indoor air quality regulations. This means that one could “smoke” in a theater, a restaurant, or a mall.  Despite this, members of the public have come up to a user and complained: “You’re not allowed to smoke here!”

Joe Camel?

There is concern, also expressed by the FDA, the American Cancer Society, the American Heart Association, and others that promotion of such products will further encourage young  people to take up smoking.

Remember those white candy cigarettes with the red tips, that allowed kids to pretend they were smoking? Remember Joe Camel, the cool dromedary with sun glasses? Will e-cigarettes help hook a new generation to a consumer product that causes up to 400,000 deaths a year? Let’s sincerely hope not.