I was shocked and a bit saddened last week when a customer came into the store with her son who was smoking an e-cigarette. Perhaps they have not been educated about the hidden dangers since these products are not regulated by the FDA. It’s frustrating how these companies can get away with marketing these products as safe, but from what I have read, that is far from the truth. So, allow me to share with you some information that I’ve gathered from the CDC, ALA, National Institute on Drug Abuse, Harvard University and Pharmacy Times.
E-cigarettes are electronic devices that allow users to inhale a vapor containing nicotine or other substances. They are usually battery operated and use a heating element to heat e-liquid from a refillable cartridge, releasing a chemical-filled aerosol.
Because there is no government oversight of these products, nearly 500 brands and 7,700 flavors of e-cigarettes are on the market, all without an FDA evaluation determining what’s in them. So there is no way for anyone—healthcare professionals or consumers—to know what chemicals are contained in e-liquids, or how e-cigarette use might affect health, whether in the short term or in the long run.
Early studies show that e-cigarettes contain nicotine and also may have other harmful chemicals, including carcinogens. Lab tests conducted in 2009 by the FDA found detectable levels of toxic cancer-causing chemicals—including an ingredient used in antifreeze—in two leading brands of e-cigarettes and 18 various cartridges. A review of studies found that levels of toxins in e-cigarette aerosol varied considerably within and between brands. A 2014 study found that aerosol from e-cigarettes with a higher voltage level contains more formaldehyde, another carcinogen with the potential to cause cancer. According to Consumer Reports, one concern about e-cigs is the fact that larger doses of nicotine can be more harmful, especially to children. The findings are alarming, and the American Lung Association urgently calls for FDA oversight of these products.
Although they do not produce tobacco smoke, e-cigarettes still contain nicotine and other potentially harmful chemicals. Nicotine is a highly addictive drug, and recent research suggests nicotine exposure may also prime the brain to become addicted to other substances. Also, testing of some e-cigarette products found the vapor to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. The health consequences of repeated exposure to these chemicals are not yet clear.
Flavors in e-cigarettes also cause concern. Not only are flavors used to target kids, but they may be harmful on their own. E-cigarette and flavor manufacturers and marketers may suggest that the flavor ingredients used in e-cigarettes are safe because they have FEMA GRAS™ status for use in food, but such statements are false and misleading. The reality is that FEMA GRAS™ status does not apply to inhaled substances; it only applies to food, meaning that substances with FEMA GRAS™ status are safe to eat, but perhaps not to inhale. Diacetyl, a flavoring chemical linked to cases of severe respiratory disease, was found in more than 75% of flavored electronic cigarettes and refill liquids tested by researchers at Harvard T.H. Chan School of Public Health.
A survey conducted by the CDC in 2014 found that young adults are trying e-cigarettes more than any other age group. The 18-24 age group had the highest percentage of adults who had ever tried an e-cigarette in their lifetime at 21.6%, according to the CDC study. The percentage fell more and more for older age groups: 25-44 years (16.6%), 45-64 years (10.2%), and 65 and older (3.7%).
Another worry is the refillable cartridges used by some e-cigarettes. Users may expose themselves to potentially toxic levels of nicotine when refilling them. In the past year alone, the American Association of Poison Control Centers received more than 2,000 reports of incidents involving children and e-cigs, including many in which children drank the e-cig juice or spilled it on their skin. Cartridges could also be filled with substances other than nicotine, thus possibly serving as a new and potentially dangerous way to deliver other drugs.
In addition to the unknown health effects, early evidence suggests that e-cigarette use may serve as an introductory product for youth who then go on to use other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death. A recent study showed that students who have used e-cigarettes by the time they start 9th grade are more likely than others to start smoking traditional cigarettes and other smokable tobacco products within the next year (Rigotti, 2015).
A Centers for Disease Control and Prevention study found e-cigarettes have become the most-used “tobacco product” among high schoolers, and almost half of all middle and high school students who smoked one type of tobacco product used multiple types.
So parents, please educate yourselves and learn more about e-cigarettes so you can warn your children about the dangers associated with their use.
Sources: American Lung Association, Pharmacy Times, National Institute on Drug Abuse