Are electronic cigarettes safe?

E-cigarettes may help smokers to quit, but are they safe? Our writer investigates whether e-cigarettes are really saving lives. 

By Nancy Ripton

Are electronic cigarettes safe?
Photography by Geneviève Caron
"Am I going to get arrested by the P.C. police?" asks actor Katherine Heigl as she puffs on an e-cigarette during a recent interview with David Letterman. Meanwhile, Jenny McCarthy takes a drag on one in a TV advertisement, while celebrities such as Johnny Depp, Leonardo DiCaprio and Kate Moss are spotted with them in their off hours.

Is smoking cool again? Not exactly, but "vaping" seems to be.If you haven't seen an e-cigarette yet, you will soon. Despite warnings from Health Canada not to purchase or use e-cigarettes, they were openly peddled at last year's Academy Awards, various fashion weeks and the Toronto International Film Festival.

What is an e-cigarette?
An electronic cigarette is a cylindrical device made of stainless steel or plastic that mimics an ordinary cigarette in appearance and use, but does not contain tobacco. Instead, it contains water, flavouring, propylene glycol and sometimes nicotine. There are prefilled disposable varieties and rechargeable varieties, the latter providing the closest approximation of the experience of smoking.

Though e-cigarettes vary in size and flavour, a typical e-cigarette consists of a battery and an atomizer (or "clearomizer") for converting "e-juice" to vapour. If nicotine is added, vapers—the common name for e-cigarette users—tend to start with 28-milligram varieties and transition to lower amounts over time, with 14 and seven milligrams being the most popular. Batteries are usually rechargeable, and there's an indicator light that glows like a lit cigarette when the vaper inhales. Small e-cigarette batteries last just 60 to 90 minutes, but larger ones can last for up to six hours.

Vaping requires a longer, gentler pull than ordinary cigarette smoking and produces only a slight odour, similar to that of theatrical fog. Although the start-up cost of e-cigarettes is a bit steep (about $75), it costs just $1.75 per day thereafter for a pack-a-daysmoker—much less than the minimum $10-per-day cost of smoking tobacco.

Can you buy e-cigarettes in Canada?

American Herbert Gilbert invented the mechanical smokeless cigarette in 1963, but vapour-producing electronic cigarettes weren't developed until 2003 in Beijing. Disposables came to Canada in 2007 and went largely unnoticed until Health Canada issued an advisory on March 27, 2009, warning Canadians not to purchase or use electronic smoking products. The reason for the warning? E-cigarettes hadn't been fully evaluated for safety, quality or efficacy by Health Canada. That was the organization's first and last official statement on the matter.

Since then, the popularity of e-cigarettes has skyrocketed. Between 2010 and 2011, five online Canadian e-cigarette companies were launched. During that same period, Health Canada issued compliance letters to 18 online Canadian companies selling e-cigarettes, at least one of which closed down out of fear of repercussions by government regulators.

Electronic cigarettes that contain nicotine or come with health claims fall within the scope of the Food and Drugs Act and require market authorization by Health Canada prior to being imported, advertised or sold. No electronic cigarettes with nicotine have been authorized by Health Canada. Which isn't to say they aren't being sold. The Internet is the largest source of e-cigarette sales in the country, but many convenience stores, gas stations, tobacconists and mall kiosks openly sell them, too, often with nicotine. Health Canada can refuse e-cigarette products with health claims or nicotine at the border, but enforcement is compliance-based.

Some vendors are now selling the e-cigarette hardware separately. "If you sell dry kits, they're considered a consumer product," says Rob Kane, owner of Evapers, an online Canadian supplier of e-cigarette gear. "It's similar to the way it is legal to sell bongs but not marijuana."  

Accordingly, there's a sort of "underground" approach to the sale of e-cigarettes, which can make quality assurance difficult. "What's happening is you're getting the sort of products that are willing to be sold in that way," says David Sweanor, an adjunct professor of law at the University of Ottawa. "Health Canada has chased the legitimate companies out of the country." While some larger companies are looking to enter the market—NJOY opened a Canadian office in September with one employee—the domestic e-cigarette industry remains mostly small businesses.

Who uses e-cigarettes?
Most e-cigarette users are smokers aiming to cut back on cigarettes or quit them altogether. There is evidence the devices are helping. "The use of small doses of nicotine is very helpful in getting individuals to stop smoking, which is reflected in the success of nicotine-replacement therapy," says Dr. Andrew Pipe, MD, chief of prevention and rehabilitation at the University of Ottawa Heart Institute. Also, many smokers feel the action of smoking is just as addictive as the nicotine. "Nicotine-free e-cigarettes have reduced the amount I smoke," says a 28-year-old, a North Vancouver–based smoker who asked not to be named. "If e-cigarettes with nicotine were readily available, I would likely stop smoking completely, and I think it would help others."

The average vaper is a 35- to 65-year-old former or current smoker. "There are a lot of new parents in their 20s who vape because they don't want to smoke around the baby," says Kate Ackerman, owner of  Electrovapors and one of the founding directors of Canada's Electronic Cigarette Trade Association (ECTA), which was started in 2011 by 10 e-cigarette companies. There is also an emerging market of young 20-somethings who vape in clubs simply to avoid going outside.

Yes, that's right, you can vape almost anywhere: in your office, in a restaurant and even on live television. Smoke-free bylaws don't apply to e-cigarettes, and laws regulating their use in public places are not under Health Canada's jurisdiction; any such laws would be the responsibility of provincial, territorial or municipal governments. "The fact that e-cigarettes can be smoked in defiance of smoking bans is a common theme in many advertising campaigns," says Suzanne Gaby, manager of Quit Now Services for the B.C. Lung Association. Gaby worries that increased social exposure to e-smoking may contribute to a new acceptance of cigarette use. "Several schools have reported that students are flaunting the use of e-cigarettes on school property," she says.

According to the American National Youth Tobacco Survey, electronic cigarette usage in high schools more than doubled between 2011 and 2012, and a Quebec study commissioned by the University of Montreal found that nearly a quarter of 18- to 24-year-olds have used electronic cigarettes. "When you take the risk away from nicotine, more people will use it," says Carl V. Phillips, PhD, scientific director of the Consumer Advocates for Smoke-free Alternatives Association.

Are electronic cigarettes harmful?
One thing is abundantly clear: "E-cigarettes are about 99 percent less harmful than ordinary cigarettes," says Phillips, who has extensively researched low-risk smoking substitutes.

Phillips and other experts believe nicotine is indeed addictive, but that its health risks are, like caffeine, so low they can't be measured. "Nicotine is not cancer causing," says Gaby. Smoking tobacco kills people; nicotine doesn't. With a few exceptions, such as pregnant women, nicotine has not been shown to cause harm to humans. And the propylene glycol found in e-juice has been used in asthma inhalers and nebulizers since the 1950s, and is often found in atomized medication. (Propylene glycol also produces the fog in theatrical stage productions.) It is included on the FDA's list of substances that are "generally recognized as safe."

Even Sweanor—who helped establish policies in the '80s and '90s that led to a 40 percent reduction in smoking and helped get cigarettes out of airplanes, restaurants and bars—is pro e-cigarettes. "What I am against is unnecessary disease and death, so I am in favour of things that keep people alive," he says.

Sweanor admits the inhalation of fine particulate matter could have long-term risks. "Nothing is completely safe," he says. "Driving is not safe. Driving drunk is really not safe.

It makes sense to ban drunk driving but still let people drive cars. Life will always have some risk—you need to learn to manage it."

The benefits of e-cigarette regulation
"By age 30, most smokers want to quit, but we're not giving them anything effective to help," says Sweanor. "We know cigarettes kill over half of long-term users." Worldwide, 1.5 billion people get their nicotine from tobacco products; e-cigarettes are the first viable alternative for many. So why won't the government authorize them?

"It's our culture of fear and our inability to manage and understand risk," says Sweanor. In Britain, where the percentage of smokers who've switched to e-cigarettes has grown from two percent in May 2011 to 16 percent in August 2013, a risk-reduction approach has been taken, leading e-cigarettes to be regulated like medicine.  

"Canada should regulate e-cigarettes immediately," says Dr. Pipe. Not only does lack of regulation make it difficult to get safer nicotine-based e-cigarettes, it means consumers have no way of knowing what they're getting. In some cases, e-juice is being mixed in distributors' basements.

Worst-case scenario: A consumer could buy e-juice with a higher nicotine content than advertised, possibly even toxic levels. (It should be noted, however, that nicotine toxicity can also be reached by smoking too many cigarettes or chewing too much nicotine gum.) "Health Canada should impose regulations including accuracy in labelling, the use of only pure ingredients, and controlled manufacturing," says Phillips. Until then, the ECTA is setting its own regulations in an attempt to be more accountable. Consumers worried about the quality of their e-cigarettes can look for the ECTA label on vendor displays.

Government regulations could make the sale of e-cigarettes to minors illegal, could limit where e-cigarettes can be vaped, could limit advertising and could make ownership by tobacco companies more difficult. In October, Lorillard, America's third-biggest tobacco company, acquired the U.K.-based e-cigarette maker SKYCIG for $49 million. If more tobacco companies gain control, why would they encourage people to move to a potentially safer, less profitable option? "I'm worried what will happen if the tobacco industry gains control of e-cigarettes," says Gaby.  

We have more information about smoking, including what happens to your body when you smoke.

This content is vetted by medical experts

                                               
This story was originally titled "Mind if I Vape?" in the January 2014 issue.
           
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