Welcome to this week’s Knowledge is Power blog series. Over the past several weeks, we have looked at several aspects of the health questions surrounding vaping. Today we’re going to be discussing e-cigarette legislation. Regardless of how we feel about it, legislation is coming, but that doesn’t necessarily have to be a bad thing. Let’s look at a few of the regulation areas that have been mentioned in the media.
First, let’s look at age restrictions. Johns Hopkins1 conducted a study Effects of Tobacco on the Adolescent Brain which found “Compared to adults, teen nicotine users experience more episodes of depression and cardiac irregularities, and are more apt to become quickly and persistently nicotine-dependent. In teenagers, the damage is worse in the minds memory bank.” Meaning, that nicotine has a more intense and negative impact on the still developing adolescent brain. We all know kids are going to be kids and experiment with things they are told they shouldn’t have. However, that does not eliminate the need for safety protocols. So, we say yes to age restriction regulation.
Second, should e-juice flavors be allowed? Ecigarette Research Advocates Group2 conducted a study regarding Flavored Electronic Cigarette Liquids in which they stated “I [Konstantinos Farsalinos, MD] had the privilege of performing the only study evaluating the impact of flavor variability in electronic cigarette experience among dedicated electronic cigarette users. The study analyzed the responses of 4618 users, half of whom were from the US. The results of the study confirm that flavors are marketed to satisfy demand by dedicated vapers (all of whom were adult smokers or former smokers) and not attract youngsters. The most popular flavor types were fruit (69.4%), followed by sweet (61.4%), and tobacco (43.9%) flavors.” Based on the results of this study, adults like flavors, and they are a benefit in the end goal of using e-cigarettes as an alternative to smoking traditional cigarettes. Therefore, we say no to flavor restrictions.
Third, big tobacco in conjunction with the pharmaceutical industry has proposed a ban on all open tank systems of e-cigarettes. Their justification, e-juice poisonings. The Pharmaceutical Journal3 published the article Poisoning Incidents Increase, which said “In 2013, the National Poisons Information Service (NPIS) received more calls related to exposure to e-cigarette fluid than in the six years previously. Nicotine poisoning has the potential to cause vomiting, hyperventilation, and changes in heart rate. In half the cases, there were no obvious clinical features of toxicity, but mild effects were reported in 94 instances, moderate effects in 2 cases, and one person was treated in intensive care. Parents should be careful about keeping them out of the reach of children, just as they would cleaning products.” It’s important to note that in 2013, on based on the NPIS report, only one person in the US was hospitalized due to nicotine poisoning. So, we say no to banning the availability of open tank systems. However, more poisonings are obviously a bad thing, so we say yes to regulation requiring child proofing all e-juice.
Fourth, regulating the production standards of e-cigarette hardware. CSPnet.com’s4 article Was the Exploding E-cig A Mod shared with us “It appears this incident [e-cig explosion] does not involve an off-the-shelf e-cigarette product, but rather what’s known as a mod. These are, in essence, homemade devices that are constructed from parts available on the internet and put together by the consumer. Modified e-cig devices have a history of explosions and fires due to cheap, unprotected lithium ion batteries and the possibility of overcharging the devices. We shouldn’t condemn an entire emerging industry even if it is determined the consumer played no role in the incident.” Meaning, some of these explosions you hear about in the news are not necessarily a standard e-cigarette. Many of the other explosions and fires heard about in the news are due to using an incorrect adaptor or overcharging. However, ensuring the quality of the hardware being provided to consumers is always important. Therefore, we say yes to regulating safety standards for hardware.
Fifth, requiring warning labels on e-cigarettes. Interestingly, the American Lung Association (ALA)5 posted a Statement to FDA related to Nicotine Replacement Therapies in which they proposed to the FDA a reduction in warning labels on over-the-counter nicotine replacement therapies by stating “The current restricted framework governing the packaging and sale of nicotine replacement therapy does not adequately balance the benefits and risks in context of the comparatively unrestricted sale and packaging of other hazardous sources of nicotine, such as cigarettes. Warning labels should state the risks in relation to the risks of continuing to smoke, not in relation to total abstinence of any product. Current warning labels can intimidate smokers and imply that it is not worth trying to quit.” This means excessive warnings actually work against the goal of the product, reduction in smoking traditional cigarettes. Therefore, we would like to follow the ALA’s advice. E-juice has nicotine, so it should have a warning. As such, we say yes to reasonable warnings that are not overly restrictive as suggested by the ALA for nicotine replacement therapy.
Our sixth and last subject is banning e-cigarette usage in certain areas. The Oxford Journal6 conducted a study on Secondhand Exposure to Vapors from E-Cigarettes which summarized “We measured selected airborne markers of secondhand exposure: nicotine, aerosol particles, carbon monoxide, and volatile organic compounds in an exposure chamber. We also compared secondhand exposure with e-cigarette vapor and tobacco smoke generated by five dual users. The study showed that e-cigarettes are a source of secondhand exposure to nicotine but not to combustion toxicants. The air concentrations of nicotine emitted by e-cigarettes were ten times lower than that from a tobacco cigarette. Using an e-cigarette in indoor environments may involuntarily expose nonusers to nicotine but not too toxic tobacco-specific combustion products.” Meaning, none of the 2nd hand smoke toxicants are found in 2nd hand vapor, but there are minor traces of nicotine. This is possibly the most difficult regulation to determine, as we do not want the general public exposed to nicotine if they don’t want it, but we do not want vapors exposed to 2nd hand smoke. Vaping sections would be a more appropriate alternative than sending the vapers to the smoking section. As such, we say yes to limited regulation regarding vaping areas, but no to requiring vapers to using the smoking sections.
At the risk of stating the obvious, vaping is not smoking and should not be treated as such. However, there are regulations that will offer safety and security to vapers, not just limitations. Therefore, we encourage regulation and legislation involvement as we discussed above. The key is finding the sweet spot where vapers are protected and can ensure they are receiving safe equipment, without over-restriction limiting access. The only way we can actually make this happen is if we stand together as a community, and in a positive and educational way, let our voice be heard by the lawmakers.
As always, I encourage everyone to educate themselves. Read the studies and information listed in the references below, and learn more about the different regulation options. Come back next week when we look a summary of all we have learned throughout this series, and look at the reasons behind the controversy. Until then, we look forward to your questions and comments. Vape on!
Written by: Michelle Harnden
- Johns Hopkins ‘Affects of Tobacco on the Adolescent Brain’
- Ecigarette Research Advocates Group ‘flavored electronic cigarette liquids’
- The Pharmaceutical Journal ‘Poisoning Incidents Increase’
- CSPnet.com ‘Was Exploding E-cig a Mod’
- American Lung Association ‘Statement to FDA related to Nicotine Replacement Therapies’
- Oxford Journal ‘Secondhand Exposure to Vapors from E-Cigarettes’