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Vice President of Community Health and Medical Director, LRHS Physicians Group
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Monday, January 28 2013

e-Cigarettes: A “Quitting Device” or Another Vice?

ecigarettes_smaller

For those struggling to quit smoking, have you seen recent advertisements about electronic cigarettes, or “e-cigarettes,” and wondered if this was something that could help you?

Instead of lighting up, a battery powers the production of water vapor (which looks like smoke), while the user inhales nicotine.  There is even a red light at the end to simulate burning.

They are basically a nicotine delivery device.  We are most familiar with other devices such as nicotine patches, gum, nasal spray and inhalers.

But, most of those are used as stepping stones to quit smoking.  This device, however, seems more like another addiction all together – with a recurring cost if an individual chooses to switch.

Some e-cigarette manufacturers do not advertise their products as a short term purchase to eventually give up.  It seems that with the availability of flavors such as vanilla, fruit, menthol and coffee, the manufacturers are leaving open the possibility of long term use.

Of course, any amount of nicotine makes it hard to stop, but there are choices in the level of nicotine – varying from high, medium, low and even none.  So, these products can be a tool to help someone quit smoking and hopefully save money in the long run.

Regarding the health effects, The Medical Letter recently reported the most common side effects were mouth and throat irritation, dry cough and even lipoid pneumonia – likely due to the glycerin in the vapor.

The FDA noted that contaminants such as cancer-causing hydrocarbons and nitrosamines were present in some of products tested along with diethylene glycol (which is also hazardous).

And just like smoking, the cost adds up because the “e-juice” in the cartridge needs to be replaced.  This is after an initial cost of about $50 for the battery, charger case, etc. One cartridge is similar in price to one to two packs of cigarettes.

In a recently published Nicotine & Tobacco Research Journal, Dr. Ii-Lun Chen shared an article that summarized FDA reports of adverse events in users of e-cigarettes.  The list contained serious incidents that were thought (not proven) to be associated with e-cigarettes.

In conclusion, it is safe to say that more information is needed regarding the safety and best use of this product.

What are your thoughts?  Are they a quitting device or another vice? Or, just another choice for consumers if they want it?

 

15 Comments

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Daniel Haight, MD
Mar 17, 4:20 PM

Debra — I have heard of many who found using e-cigarettes helpful in a well-rounded approach to quitting. In other words, connect the e-cigarette’s use with improved health, ultimate cost savings (if you can eventually get off of the e-cigarette), support from others, and someone to talk to about any anxiety. I wish you well in your efforts to come off of nicotine.

Debra McEowen
Mar 13, 1:24 PM

First time buyer. Made in China worries me. Bought a blu e-cig.. trying to quit. Have smoked for about 35 years. E cig is cheaper. Kind of made me feel a little sick. I need to quit because of health issues.

Elektrische sigaret
May 26, 7:02 AM

I quit smoking with e-cigarettes, feel so much more healthy!

Diane
Mar 22, 7:25 PM

You don’t have to inhale the juice to get the nicotine. You can blow it out your nose are do a French inhale. Out your mouth up your nose and back out your mouth. I use my e cig like this to avoid getting it in my lungs and after a week on e cig I am smoking 3 to 4 smokes a day. I enjoy using my e cig in the morning over a real smoke and I never thought I’d see that day come.

Melissa Vice
Mar 21, 10:35 PM

I do not believe that these devices help the general population of smokers quit. There seems to be a large educational gap with these devices. Patients believe that these are less harmful because they are not actually smoking, but just because there is no fire it does not necessarily mean that they cannot get burned. I have seen an increase in the number of times that smokers “smoke” the e-cigarettes because they are using them in places where traditional cigarettes are prohibited.

I have been faced with the problem of patients and visitors using e-cigarettes in the hospital. Often times they vapor smells like the real thing and can be confusing for not only how to handle their use by staff members, but other patients preception can be negative as well. So, is there an offical policy with regards to e-cigarette use in the hospital and if so where can I find it.

Another concern of mine is the effects of second hand “smoke” from these devices. I think that a lot more research needs to given to e-cigarettes before we can say that they are a stop smoking aid.

Diane K
Feb 27, 7:32 AM

I smoked almost 3 packs a day for over 30 years, I knew I had to quit and tried so many times, every means available to me but was never successful. I heard of the ecig and thought “why not?”. That was 4 years ago, I started with the highest nicotene available and within months went to med, then low and eventually none. I still smoke my ecig with just vapor but find myself not using near as much. I find I stll want a analog cigarette at times and that’s when I grab my ecig. It’s also very handy when I go out with friends who smoke, which in the past would be my weakness and I would “borrow” one cigarette and that would be all it would take. I make sure I buy my liquid from USA and know what’s in it. It still calms me so in my opinion they are so much healthier then cigarettes.

Mark Jenkins
Feb 20, 3:11 PM

This has been a really much long debate as to whether electronic cigarettes are considerably a smoking cessation aid. Many so called experts say that there’s no scientific evidence to support such claims yet still more and more people claimed to have given up smoking because of it. Well personally, I think that electronic cigarettes are probably are to be considered as one (even though others say that it’s still smoking but only in another form – electronic). A disappointment really is that many people can’t really understand the difference between vapor and smoke, and this is one of the reasons why officials are alarmed. Also in my opinion, ecigarettes resembles closely to the real thing, a reason why many have found success switching to it. By the way, what side-effects are you talking about?

Dr. Daniel Haight
Feb 11, 2:16 PM

Thank you all for this thoughtful dialogue. We appreciate the various points of view.

I just want to add that, thus far, there are no long term studies regarding safety for e-cigarettes and some side effects have been reported, but not necessarily linked to the product. They contain various levels of nicotine, which is addictive; and they are available in a variety of flavors that may attract youth to start (who otherwise might not). Just another thing to think about from my perspective.

Robert V.
Feb 9, 8:50 AM

I highly recomend e-cigs for smoking cessation. There are no short or long term studdies that I’m aware of that prove they are harmful. It also lets people keep thier routines the same without triggering the pathophysiology of COPD. ;)

Krystal White
Jan 29, 10:17 PM

My husband was a half pack a day smoker. He was able to quit smoking with the e-cig two months after buying it. He has not smoked cigarretes or used the e-cig in almost two years now. In comparison to the harmful effects of cigarettes I would highly recommend the e-cigs.

Daniel Haight
Jan 29, 6:01 PM

Nicholas, You made some very good valid points and I appreciate you sharing how they have helped you quit smoking.

I especially like your comment on how they may help with a person that misses the physical action of holding the cigarette.

Aaron P
Jan 29, 4:35 PM

The FDA would love for an e-cig manufacturer to make claims that an e-cig can help you stop smoking. Doing so would allow them to yank that brand right off the market. When the FDA was illegally seizing e cigs in 2009 U.S. District Judge Richard Leon ruled that the FDA had no authority to do so as long as companies were not making therapeutic claims. (Smoking Everywhere v. FDA)

Electronic cigarette manufacturers and vendors in the U.S. are not allowed to market their devices as smoking cessation devices because they have not undergone the extensive testing (like patches, gums, etc) that would be required in order to make these claims. This type of testing would take decades to complete. It would be very unwise for an e-cig company to market their product as a drug delivery device because doing so would bring major heat from the FDA.

Electronic cigarettes are not a smoking cessation device. They are merely a less offensive form of recreational tobacco use. They are also a much cheaper alternative to traditional tobacco cigarettes. The vapor produced by e cigs dissipates quickly and cleanly without leaving any lingering odors. In a world where no one can smoke nowadays e cigs are becoming more popular because of the convenience factor if anything else. As a former pack a day smoker I spend roughly $15 every two weeks on e-liquid as opposed to $6 a day on cigarettes. Even with the occasional $14 replacement battery my e-cig habit is far less expensive than traditional tobacco cigs.

The FDA’s so called study on e-cigs forgot to mention that the trace amount of chemicals found in electronic cigarettes were either equal to or less than that of the amount of chemicals found in already approved nicotine replacement therapy products ie. gums, patches etc..The DEG found in one of the samples was from a chinese e-liquid manufacturer. Big shocker there.

When e-cigs exploded on the scene the FDA wanted an all out ban on them! Wait a minute…ban e-cigs but regular tobacco cigs are permitted? Where is the logic in that?

Why should the FDA regulate an industry out of existence that grown adults choose to partake in recreationally? The answer: Big Pharma and their bottomless lobbying resources want us all on chantix. They have too much money invested in NRTs (which have a high failure rate) to allow such an ingenious and intuitive competitor on the market.

If you want to quit smoking buy a patch or chew the gum (good luck with that). If you want an alternative to your expensive and stinky smoking habit buy an e-cig and you can keep on puffing.

p.s. the flavors are the best part! Vanilla Bean all day!

Nicholas Pasquis
Jan 29, 4:10 PM

I think they can be used as a quitting device. As you pointed out they come with different levels so it’s up to the user to bring them self down the scale as far as strength. My biggest problem with the patch (that we give our patients) or gum are all of the side effects that they can cause. The list of them is enough to make most people not want to use them at all. The “e-cig” has it’s pro’s and con’s like it does make the user pull harder as they are breathing in the vapor, so this in turn helps people build back there lung capacity and strength. Also in the long run it is far cheaper, I my self when from a pack a day down to just my e-cig (and I know quite a few people that have as well) but by me buying a good more expensive model I don’t have batters to replace I just have e-liquid to but and the tips so in a month I spend about 15$.
The con of them like you had said they can be a long term thing, I am now down to zero nicotine but I keep using it. I have cut back on how much I use it, but it’s still nice to have it near me to be able to have it when I’m frustrated and would normally have a normal cigarette. I really like to have it on me when I’m near other smokers since the last few times I had quit it was hard to be around smokers, to at least have this as an opinion is great. But the regulation of it is important and where you buy it from it hard as well. I did a ton of looking and found a person in town that sells the unit and makes the e-liquid in front of me. I pay a little more for it, but that sitting there watching everything that’s going in to it makes me feel better about using it. He had detailed information about every thing that he had including safety as far as what to and not to do.

Overall I think they are great and wish more people would use them over normal cigarettes. Also encouraging more employes to use them to be able to quit since I know multiple people that tried the patch that employe health gave out and went right back to cigarettes.

Daniel Haight
Jan 29, 10:26 AM

Your comment is a great example of this new product helping someone who was suffering the effects of tar and tobacco smoke.

Your example also points out the idea of “buyer beware” and the need to take care with anything inserted or inhaled into your body. The need for FDA evaluation of safety is a hot topic

Lastly, the example given also brings up the issue of choice and the personal decision of the person: do they want to regularly pay for something they want and enjoy to do and how the addictive nature of nicotine impacts their view.

Kristen Miles
Jan 29, 9:19 AM

I was a pack a day smoker for over 20 years. I had tried everything to quit, from cold turkey, to the patch, lozenges, gum, acupuncture, and prescription medicines. Nothing worked. I would wake up in the mornings in a horrendous coughing fit. It hurt to breathe. I couldn’t take a flight of stairs without becoming winded. I heard about the electronic cigarette from a friend and decided to give it a try. Within two weeks I could breathe so much better. My sense of smell returned. Stairs were a piece of cake. I have done my research and continue to do so. I swear by the electronic cigarette as I am a firm believer that it has saved my life. I have referred many friends and strangers who were able to quit smoking using these devices. Some (like myself) continue to use the e-cig, others have been able to quit the nicotine all together. The problem you mentioned in your story was due to unregulated e-juice made in China. We need the FDA to help regulate these manufacturers to ensure the juice used for the electronic cigarette does not contain these harmful chemicals. I am very selective on what company I purchase my juice from. Please feel free to email me with any questions you may have, and do your own research extensively. I think you will be pleasantly surprised.

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