The Electronic Cigarette

Electronic cigarettes, or “e-cigarettes”, look and act like cigarettes, reproducing the same sensations and sometimes even the same taste. Manufacturers of electronic cigarettes often present them as a smoking cessation aid which is effective and danger-free. However, their efficacy and their effects on health have not yet been assessed. A degree of caution should therefore be exercised…

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Description

E-cigarettes are available in various shapes and sizes but they generally consist of a battery, a microprocessor, a spray and a cartridge which holds a liquid consisting of flavorings, nicotine and usually propylene glycol to produce a vapor.

e-cig-copie

When the liquid becomes mixed with air, it is diffused in the form of a vapor which acts in the same way as cigarette smoke and is inhaled by the user. When the cartridge is empty, the user either refills it or replaces it. Sometimes, electronic cigarettes have a red diode on the end which lights up to simulate the burning of a cigarette.

The chemical make-up of the inhaled substances and their toxicity is at the heart of the debate on the harmfulness of electronic cigarettes (and especially propylene glycol, whose long-term effects on human health are not known).

 

Find out more about the latest research on electronic cigarettes

Electronic cigarettes are becoming more fashionable, are odorless and give off vapor rather than smoke

Despite this, a study carried out by the University of Geneva has demonstrated the high levels of nicotine given off to the smoker of electronic cigarettes and those around them (Téléjournal: TSR 29 November 2011).   

 

Limited data available on the health effects

Over the past few years, electronic cigarettes have seen a considerable rise in popularity. A survey has suggested that nearly 9% of smokers in the UK have already tried them (Dockrell, 2010). Despite the enthusiasm provoked by the e-cigarette, we need to make sure that we understand its health effects. On this point, opinion is divided and not all specialists agree.

On the one hand, supporters argue that a smokeless cigarette is much less harmful than a normal cigarette since it is above all the substances contained within smoke that cause deadly diseases. They also insist that taking in nicotine in this way is much more pleasant than using substitutes such as patches, gums, and so on, and that it is without doubt at least as effective in aiding smoking cessation.

On the other hand, those opposed think that the harmlessness of smoking electronic cigarettes has not yet been demonstrated. Furthermore, they maintain that people are better off using authorized nicotine substitutes which have already been subject to rigorous production procedures and tests.

At the end of July 2009, the US Food and Drug Administration (FDA) published an article which raised awareness about the possible risks of electronic cigarettes (FDA and Public Health Experts Warn About Electronic Cigarettes). Laboratory tests appear to have revealed the presence of toxic or carcinogenic substances such as nitrosamines in the cartridges.

“The FDA’s Division of Pharmaceutical Analysis analyzed the ingredients in a small sample of cartridges from two leading brands of electronic cigarettes. In one sample, the FDA’s analyses detected diethylene glycol, a chemical used in antifreeze that is toxic to humans, and in several other samples, the FDA analyses detected carcinogens, including nitrosamines. These tests indicate that these products contained detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed.”

 

However, these substances were detected at much lower levels than when tobacco is burned in cigarettes.  Consequently, although the FDA warns against the possible toxicity of e-cigarettes, it does not claim that they are as dangerous as normal cigarettes.

In the end, the FDA’s resistance to the authorization of electronic cigarettes marketing is based on two arguments:

  1. E-cigarettes do not administer a measured quantity of nicotine, unlike authorized nicotine substitutes such as patches, gum, and so on.  For this reason, they do not constitute an effective aid to smoking cessation.
  2. The long-term effects of the product, especially those resulting from the repeated inhalation of the substances in the vapors, have not been studied and could potentially be dangerous for health.

The World Health Organization (WHO) adopts more or less the same line.

Although it is always necessary to be cautious, this report is less alarming if we consider the possible limitations of its results, pointed out by a second opinion (Technical Review and Analysis of FDA Report: "Evaluation of e-cigarettes").  The author of this alternative research holds that the FDA’s report is not sufficient to state that the electronic cigarettes which were tested pose real health risks.    

Bit by bit, more clinical studies are appearing which give opinions on the risk associated with long-term use of e-cigarettes (see “what we know”). Stop-tabac.ch, like many smoking cessation specialists, reminds you that it is better to stop smoking by using medication and other methods which have been tried and tested…

Quitting smoking is still the best solution

Whatever else may be true, the best way of avoiding the risks associated with tobacco consumption is obviously to avoid smoking. There is no better solution.    

Authorization

For now, the sale of these products is not completely authorized in Switzerland. Swiss Federal Law prohibits the addition of nicotine to objects which come into contact with the mucous membranes. The only way of these products becoming legal on the Swiss market is for them to be authorized by Swissmedic. To date, no authorization has been granted to the e-cigarette.

At present, the importation of electronic cigarettes (i.e. the device itself) for private use as well as refill cartridges which do not contain nicotine is authorized. Private usage is not subject to any restrictions and is undertaken at the user’s own risk. On the other hand, the importation for private consumption of refill cartridges is limited to 150 refill cartridges or 150 ml of refill liquid containing nicotine.

The marketing of nicotine-free electronic cigarettes is authorized if, and only if, the professional distributors can prove that the substances emitted do not pose a danger to health.

In France, the electronic cigarette is on free sale and its use is authorized in public places. The French Agency for the Safety of Health Products (AFSSAPS) calls nonetheless for the greatest caution. In fact, if manufacturers claim that electronic cigarettes are effective for smoking cessation, whether the cartridge contains nicotine or not, “the electronic cigarette comes under the definition of a medicine and must therefore obtain authorization in order to be put on the market”, as well as CE mark certification. This has not happened as yet. On the other hand, “if the product is not advertised as aiding smoking cessation and the cartridge does not contain” any medicated substance, or nicotine, “the electronic cigarette complies with regulations on general product safety”.

Since July 2008, the French health authorities have advised against the use of electronic cigarettes by pregnant or breastfeeding women.

AFSSAPS plans to conduct detailed analysis with toxicological experts in order to ensure that chemical substances contained within electronic cigarettes (propylene glycol, terpene derivatives such as menthol and linalool, and sometimes nicotine) do not produce toxic effects on the body. AFSSAPS asserts that “propylene glycol is a solvent which causes irritation and which can also cause neurological effects similar to those of inebriation, while terpene derivatives can have a negative impact on consumers who suffer from epilepsy”.

What the Federal Office of Public Health (FOPH) thinks

The FOPH recommends great caution in the use of electronic cigarettes since their impact on health has not been clearly established. Furthermore, it warns against the risk of poisoning in cases of improper use or accidental swallowing or inhalation by children.  You will find all the information and recommendations produced by the OFSP in their Information Letter no. 146:  electric cigarettes, electronic cigarettes, virtual cigarettes (in French).

Find out more

Latest research on electronic cigarettes

  • Press review: revue unige 25.05.10.pdf
  • Article from the Tribune de Genève, 22.11.10: la cigarette électronique débarque à Genève
  • Wikipedia: Electronic cigarette : components
  • Website of the Swiss Association for Smoking prevention
  • Article from the New York Times (07.11.11): A Tool to Quit Smoking Has Some Unlikely Critics

References

  • FDA and Public Health Experts Warn About Electronic Cigarettes
  • FDA: Evaluation of e-cigarettes, complete report
  • Janci Chunn Lindsay (2009). Technical Review and Analysis of FDA Report: "Evaluation of e-cigarettes" , critical analysis of the FDA’s report
  • OMS : Les cigarettes électroniques n'ont pas d'effets thérapeutiques démontrés
  • The position of the Swiss authorities: Federal Office of Public Health (FOPH), 12 May 2009 and Art. 37 de l’Ordonnance sur les denrées alimentaires et les objets usuels
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