Can e-cigarettes help me quit smoking and are they safe?

I have been doing a lot of research into electronic cigarettes since that is what my next book will be about. There have been many confusing headlines, some saying that they are just as harmful as tobacco cigarettes, while other headlines will tell you they will help you quit. The truth is somewhere in the middle.

The controversies that make headlines are often not the real issues, such as-cig containing formaldehyde--that chemical was only created at very high temperatures--a temperature that no vape users would realistically use.  While w-cigs do have some carcinogens, they are amounts that are 9 to 450 times less than traditional cigarettes.

1. The biggest problem is dual use long term, using electronic cigarettes while you are continue to  smoke and continuing this practice long-term instead of quitting smoking. Using an e-cig for short term while trying to quit, probably isn't a problem, but with dual use, even reducing the number of cigarettes doesn't help with the damage smoking does to your cardiovascular system. Unlike cancer where exposure to a carcinogen is linear (the more exposure, the greater the risk of developing cancer), heart disease is not linear: 50 to 80% of the damage to the cardiovascular system from smoking occurs within the first 3 to 5 cigarettes. For those who do use e-cigs to quit smoking but continue to use them long term, there are no long term studies as to the health effects. Very likely it will not be the same as smoking but e-cigs will have their own unique disease profile and associated risk.

2. The cig-a-likes don't deliver enough nicotine to really help with cessation. The mods or tanks do a better job of that. A lot has to do with the particle size in the vapor. If the particle is either too small or too large, the vapor isn't absorbed. For example, the MarkTen offers some of the highest nicotine content (44mg) but very little of that is absorbed by the smoker, so you can't count on the nicotine content. It is not what is in the liquid but what is absorbed that is important. Almost all users start with a cig-a-like and either find them unsatisfying and go back to smoking, or they switch to a tank/mod which delivers enough nicotine to satisfy.

3. While there are some health risks with nicotine, the real problem is with the flavorings. Vapor shop owners will say that the flavorings are "FDA" approved--which most are--as a food, but not as an inhalant. (Actually flavorings are not FDA approved but approved by FEMA--Flavoring and Extract Manufacturing Assoc and given a "no objection" letter by the FDA). Digestion and inhalation are two very different delivery systems. When eaten, a flavor goes through the stomach and digestive tract where it is subject to gastric juices and then is filtered by the liver where toxins are removed. When inhaled, substances go straight to your blood system with no filtration. Some flavorings are toxic when inhaled--like cinnamon, buttery flavor and cherry. There are probably more but little or no testing has been done on the over 7000 e-cig flavors available. 

4.Users like the hand to mouth use of e-cigs and when compared to the nicotine inhaler which also mimics this motion, users say that e-cigarettes give a better throat hit than the nicotine inhaler, (which is an FDA approved cessation device for cessation). A common issue with people using NRT is that they don't get enough nicotine from one delivery system, so we now suggest combination therapy, such as the patch or bupropion with either the inhaler, gum, lozenge, or nasal spray. This pairs one long acting agent with a short acting one. I have heard of many people using both chantix and bupropion together with great success but I haven't seen any research studies on it, only anecdotal.

5. Up to 90% of these devices are made in China (regardless of what the label says--no one is looking to see if the labels are true), where there are no manufacturing standards, the batteries can be defective and blow up, poorly made atomizers can leach metals into the vapor, contents of the e-liquid can be very different than the label--for example instead of using pharmaceutical grade nicotine, a less pure grade could be used or instead of propylene glycol, they could use diethylene glycol--which is cheaper but toxic. Plus there are many counterfeits on the market, so even if the manufacturer is one who is trying to create a good product, you may not know if the one you buy is real or counterfeit. This is a common problem with products made in China: Lumber liquidators, toothpaste, dog and cat treats.

Having said all that, I do believe that once some of these issues are addressed through FDA regulation, there is a place for e-cigarettes as a harm reduction device which will help a smoker quit tobacco cigarettes and hopefully will only be used for a short time instead of continuing a nicotine addiction. 

Hidden danger of e-cigarettes

At a recent social event a man seated next to me pulled an e-cig out of his pocket he said, "I hope you don't mind, but this isn't a real cigarette, it's only vapor."
"I guess you don't know what I do for a living?" was my response.
Steve had quit smoking 15 years ago. He had smoked two packs a day and quit cold turkey. Now he was using 8 to 10 cartridges a day in his e-cig.
When I asked why he started using the e-cigarette after having quit smoking so long ago, his answer was-- curiosity. But now Steve is hooked on nicotine again and spending up to $150 a week.
Some people in tobacco control have been endorsing e-cigarettes as "harm reduction" which is when a smoker, who either can't or won't quit smoking, switches to an e-cigarette because it is "less harmful" than smoking regular cigarettes. But for Steve this isn't about reducing his need to smoke but re-starting his addiction to nicotine and someone is making a lot of money off of Steve's addiction.
E-cigarettes are big business, expected to generate $1 to 2 Billion in sales in 2013. The tobacco companies are adding e-cigs to their list of products. But could it be that since over half of all smokers have quit, that a new marketplace is opening up? Former smokers who can be lured back into nicotine addiction with e-cigarettes and teens who would never think of lighting up a cigarette but don't see an e-cigarette as anything but a fad to try.
So while the rate of smoking has been declining over the years and we have made great strides in preventing teens from starting, I think the real hidden danger of e-cigarettes is that we will be seeing a rise in the number of nicotine addicts. Since few double blind studies have been done and currently there are no one regulating the manufacture and marketing of e-cigarettes, is this the next tobacco epidemic or will nicotine be just another "harmless" addiction like caffeine?

"Quit or Die" or use harm reduction?

Jim quit smoking when he was in his 30's after receiving a diagnosis of Chronic Obstructive Pulmunary Disease (COPD). He took his doctor's advice and switched from smoking cigarettes to using smokeless tobacco or "chew". Thirty years later Jim is in my Stop Smoking, Stay Quit class to stop his nicotine addiction to smokeless tobacco.

This is an example of "harm reduction". The premise is that some individuals are so addicted to nicotine that they just can't quit, so harm reductionists advocate switching to the use of a less harmful tobacco product. Harm reductionists say a "Quit or Die" approach doesn't work and by using a less harmful form of nicotine is a better way to go. While I do believe that the physical addiction to nicotine can be so strong that it seems impossible to quit, that does mean we should just give up on these individuals? The same concept is used with heroin addicts by replacing heroin with methadone but not every heroin addict uses methodone to quit. There are no easy answers.

But there is a new player in mix and that is e-cigarettes. The US District Court in Washington DC just ruled that the FDA does not have the authority to regulate e-cigarettes as a drug device combination. Instead, e-cigs are a recreational product that promotes the use of nicotine in a less harmful way than by smoking cigarettes. There are many antedotal stories of smokers quitting by using an e-cig but they cannot be advertising as such because then the product would fall under the jusdiction of the Food, Drug, and Cosemtic Act (FDCA). While it would appear that e-cigarettes maybe less harmful because there are less components to the vapor of an e-cigarette than the thousands of chemicals found in tobacco smoke, we don't know for sure since there are no long term studies on e-cigs. Since currently there is no regulation on the manufacture of e-cigs, the public must rely on the integrity of the manufacturer. Are they after your money or to better your health?

Switching from smoking cigarettes to chew tobacco most certainly saved Jim's life, yet now he is dealing with the health effects of 30 years of chewing. Jim has gum disease, tooth loss, and has had both a kidney and a liver transplant. His doctor now wants him to totally quit the use of nicotine since nicotine is excreted through the kidneys into the bladder. Jim wishes that when he stoped smoking that he would had tried to stop using all nicotine products, instead of switching to chew.

I think the debate should end and nicotine be declared a drug/medication. You can't have it both ways--it can't be both a recreational product AND one that is so addictive that some individuals are unable to stop using. As a drug/medication, there may be benefits to the continued use of nicotine, just as there are benefits (as well as risks) to every drug/medication that is used.

Is Harm Reduction the New Way to Quit Smoking?

Some health care professionals are encouraging smokers to switch to smokeless tobacco or snus as a way to quit smoking because smokeless is less harmful than the combustion and inhalation of smoke. I consider harm reduction the same as wearing a seatbelt--how often do you need to wear one?? Most would say everyday but really you only need a seatbelt when you get into an accident. If you don't get into an accident, then you don't need a seatbelt. The problem is that we don't know when that accident is ging to happen so we prepare for the worse by wearing seatbelts everytime we drive. Same with the use of any tobacco products--Wouldn't it be nice if we knew what our genetic weak link is, so that we could avoid those substances and environmental hazards that will increase our personal risk. What it boils down to is what is the risk an individual is willing to take. By switching to smokeless, there may be a reduction in some types of cancers but there is an increased risk for oral cancers. Regardless of the form, tobacco is a dangerous product. As a 20 year cancer thrivor (I did much more than just survive), I choose to eliminate as many known risks as I am able. The use of addictive substances usually is to satisfy an emotional or spiritual need. I advocate addressing the emotional or spiritual need rather than the use of addictive substances. The tobacco companies used this same philosophy when they came out with low tar and nicotine cigarettes but we found out that they didn't reduce the health risks at all but millions of smokers switched instead of quitting altogether and they health suffered for it. So instead of switching to smokeless, the best thing for you health is to embrace a tobacco free life and enjoy your better health.