Tuesday, October 8, 2013 | Categories: Dr. Brian's Blog
E-cigarettes allow people to 'pretend-smoke' by inhaling an electronically produced vapour. Proponents say it's a great way to quit tobacco. But an editorial just published in the Canadian Medical Association Journal says it may do the opposite.
If you're addicted to tobacco, it means you're addicted to nicotine. Smoking an e-cigarette that produces a vapour that contains nicotine allows the user to get their fix with an e-cigarette but without inhaling the tobacco smoke that leads to emphysema, lung cancer and heart disease. The concept is exactly the same as chewing nicotine gum or using a patch but with some important differences. Unlike patches and gums, e-cigarettes provide the user with the experience of holding and inhaling from what feels like a real cigarette. As well, inhaled nicotine undoubtedly gets absorbed faster and reaches the pleasure centres of the brain faster than other kinds of nicotine replacements, producing a rush that's a lot closer to cigarettes.
The other advantage to e-cigarettes is that they permit the user to adjust the dosage of nicotine: a higher dose in the early stages of quitting followed by a slow taper.
The editorial in CMAJ is calling for the government to regulate e-cigarettes that contain nicotine because they see nicotine as a drug, and e-cigarettes that contain nicotine as drug delivery devices. More than that, they believe there's a growing controversy over the use of nicotine e-cigarettes as devices that promote smoking cessation - which is ostensibly the reason why they exist. The editorial suggests that the opposite may happen: in other words, instead of helping smokers get off tobacco, they might turn non-smokers onto the effects of nicotine and encourage people in the process of quitting to relapse.
Let's look at the scientific evidence. In June of this year, the World Health Organization concluded that there's little compelling evidence that e-cigarettes have been proven effective at getting people to quit. CMAJ cited two recent clinical trials which failed to show that e-cigarettes are any better than nicotine patches at getting people to quit and to stay off tobacco for six months. Worse still, despite having a free supply of e-cigarettes, most of the study participants continued to smoke tobacco. That goes with some anecdotal evidence that instead of using e-cigarettes to quit, they use the devices to supplement their nicotine habit.
And, there are other safety concerns. In 2009, the US Food and Drug Administration (FDA) questioned the safety of these products. When the FDA analyzed samples of two popular brands, they found variable amounts of nicotine and traces of toxic chemicals, including known cancer-causing substances (carcinogens). This prompted the FDA to issue a warning about potential health risks associated with electronic cigarettes.
E-cigarettes are an issue now for two reasons. First, famous people, such as Angelina Jolie have been touting the benefits. Second, tobacco companies are emerging major players in a growing e-cigarette industry. Think about it. The tobacco industry makes cigarettes, not nicotine delivery systems, right? It's occurring at a time when Big Tobacco has not reduced production of its tobacco products. That suggests that the tobacco industry sees e-cigarettes not as a way of helping smokers quit tobacco but as a way to maintain or even boost their market share and their profits.
What should Canada do about it? Right now, Health Canada has designated e-cigarettes as drug-delivery devices. The implication is that Canada has among the most restrictive laws in the world regulating these devices. Canada prohibits the sale, import, or advertising of nicotine e-cigarettes.
If that's the case, why the heck are they even talking about it? For one thing, there's no doubt e-cigarettes are being brought into Canada from countries with less restrictive laws such as the US (where e-cigarettes are a $1-billion dollar industry), the UK and the EU. The latter two will soon step up regulation.
I wonder whether there's another reason behind the editorial. Is it possible that lobbyists are pressing the federal government to relax restrictions on e-cigarettes? Just asking.
The editorial in CMAJ calls for more studies on the efficacy, safety and consequences of long-term use. In this case, Canada got the regulations right. If you're in the US and are tempted to try one, caution is the word.
Click the listen button above to hear Brian talk about it on Calgary's Homestretch.