Are e-cigarettes blowing smoke?
A recent trend in that arena, however, has some medical and cessation experts somewhat concerned. The trend has been in the use of e-cigarettes and other electronic devices that emit vapors to simulate the inhalation of tobacco smoke.
"I've had mixed reviews on them, because they are not (U.S. Food and Drug Administration) approved and they are not regulated in any way," said Kate McNally, program coordinator for the Cheshire Coalition for Tobacco Free Communities. "The results people are going to get will be very random. And so they are not an evidence-based strategy for quitting tobacco, although I know some people have had success, and I've had other people say they just tossed it on the shelf and it didn't help them at all."
Sold over the counter at most convenience stores, e-cigarettes are nicotine delivery devices that plug into either a wall socket or a computer to charge, rather than being lit with fire. Most of these gadgets look like cigarettes, but instead of producing smoke, they emit what manufacturers call a harmless vapor.
But according to a researcher at Norris Cotton Cancer Center and Dartmouth-Hitchcock pediatrician who studies and teaches ways to prevent kids from using tobacco, there are several problems with using these e-devices.
Echoing the Cheshire Coalition's McNelly, the researcher, Susanne Tanski, noted that such devices are not regulated by the FDA. And, Tanksi said, the FDA has warned that manufacturers are not to market these devices as smoking cessation devices or as safer than conventional cigarettes since there is no proof of their effectiveness or safety.
"This is like buying vitamins from a street vendor," Tanski said recently in a Norris Cotton publication. "You really have no way of knowing what you are getting or where it comes from, yet people willingly inhale these unregulated chemicals into their lungs."
Teresa Brown, cessation specialist for QuitWorks NH, said the studies that have been done indicate that levels of nicotine from e-devices are all over the board, with some cartridges containing a little and others contain a lot. She said that some studies have shown that certain brands of e-cigarettes even have as much as double the nicotine found in other smoking cessation aids.
Some of the devices also have turned up positive for carcinogens.
"There definitely are detectable levels of carcinogens," Brown said. "There is inconsistency not only with the nicotine but with the carcinogens."
When smoking an e-cigarette, air is inhaled through the plastic device, in the same manner a traditional cigarette is smoked. As described by Norris Cotton officials, the inhalation creates a vacuum that engages a battery, which in turn initiates a heating element to warm chemicals housed in a replaceable cartridge. If there are carcinogens present in the cartridge, this heating process causes them to multiply, Brown said.
The stabilizer used in many e-cigarette cartridges - propylene glycol - also is also cause for concern, according to Tanski. Propylene glycol is found in products such as deodorant and hand sanitizer, according to the Norris Cotton Center, but "no testing has been done on the short- or long-term effects to humans of inhaling it repeatedly and deeply once it's been vaporized."
At the recent C. Everett Koop Tobacco Treatment Conference. which was sponsored by Dartmouth-Hitchcock Medical Center in Lebanon, an official from the Maine Health Center for Tobacco Independence also pointed out that contaminants such as diet medications and erectile dysfunction drugs had been found in some of the e-cigarette cartridges.
Further, the Norris Cotton Center's Tanski said, the storage of the e-cigarette's nicotine replacement cartridges and refill bottles are colored and flavored, potentially making them attractive to small children and pets. A single refill bottle of nicotine can contain as much as 100 mg of nicotine. If ingested, 10 mg of nicotine is a toxic dose for a small child, according to Norris Cotton officials.
"These cartridges and refill bottles must be kept safely away from children or pets. A single cartridge can have 10 times the nicotine in a cigarette and could be lethal if ingested," said Tanski. "I don't recommend this product as a nicotine replacement therapy or smoking cessation aid . They are not safe or reliable."
Instead, most experts recommend trying methods that are more proven before resorting to e-cigarettes.
"The front lines for people who want some assistance," said McNally, "would be the nicotine patch, nicotine gum, nicotine lozenge, nicotine inhaler, nicotine nasal spray . Those are the top lines of defense. Those are FDA-approved, they have specific amounts of nicotine, and research shows they work."
In addition, she said, some people also have success with medications like Chantix and Wellbutrin.
Quitworks NH's Brown points out that combining medications can increase a person's chances for success.
"So, if you just use the patch, your chance of success is doubled if you use the patch and the gum," she said. "It's tripled if you use the patch and the gum and talk to a counselor on the phone."
"It's 2013," she added. "There's all kinds of things out there to help."