Con: Addictive properties could drive users to tobacco products

Jan. 19, 2014 at 10:02 p.m.
Updated Jan. 18, 2014 at 7:19 p.m.

Long-term studies on the safety of electronic cigarettes, which hit the American market in 2007, are unavailable.

"My main concern is that electronic cigarettes could become one more appealing gateway to the tobacco world for young people," said Dr. Alexander Prokhorov, professor of behavioral science for M.D. Anderson Cancer Center in Houston.

"Young people love technology, and some of the e-cigarettes look like futuristic devices with gauges," he said. "What are the chances that they will stick with the electronic version and not try traditional cigarettes?"

The problem is that the conventional cigarettes have not been removed from the shelves, said Prokhorov, a tobacco researcher who works with children to prevent them from starting to smoke cigarettes.

He also encourages those who have already started to quit as quickly as possible.

"I've tried for many years," Prokhorov said. "The addictive properties of nicotine exceed those of heroine and cocaine."

Federal funding to inform people about the dangers of using tobacco products has forced the cigarette companies to diversify, he said.

"Many of us thought e-cigarettes would be a fad when they showed up, but they have become prevalent," Prokhorov said.

Nicotine is among the least dangerous components of cigarette smoke, Prokhorov said.

Most of the harm in cigarettes, which are made of 7,000 chemicals and compounds, come from tar.

"Ingredients are radioactive and carcinogenic - things people are protected from with gloves and masks in hazardous industry conditions," Prokhorov said. "And smokers willingly inhale them."

According to the 2011 and 2012 National Youth Tobacco Survey, e-cigarette experimentation and recent use doubled among U.S. middle and high school students during 2011-12, which means an estimated 1.78 million students used e-cigarettes at least once.

Furthermore, in 2012, an estimated 160,000 students who reported using e-cigarettes at least once had never used conventional cigarettes, according to the Centers for Disease Control and Prevention.

In youths, concerns include initiation of the use of conventional cigarettes or other tobacco products, the potential negative impact of nicotine on adolescent brain development and risk for nicotine addiction, according to the CDC.

The majority of people addicted to nicotine were exposed at a young age, said Dr. Miguel Fernandez, medical director for the South Texas Poison Center and professor of emergency medicine at UT Health Science Center in San Antonio.

Nicotine and alcohol are the leading gateway drugs to tobacco, not marijuana, which is a common misconception, Fernandez said.

"If I told you that children could buy a vial of nicotine, the most addictive drug on Earth, without restrictions of any kind, you would say I'm crazy," Fernandez said. "But that is what's happening."

Electronic cigarettes are positioned as innocent and safe in the marketplace - that you can vape anywhere and not worry about damaging your health - without substantial evidence, Prokhorov said.

E-cigarettes need to go through a thorough toxicology process, he said. Consumers do not know the ingredients in the flavoring that makes vaping so appealing.

Without FDA regulation, a facility in Asia could report that a cartridge has 2 milligrams of nicotine when it has 1 or 10, he said.

"I doubt that vaping is completely harmless, but it could be a lesser evil," he said. "I wish there were more research and that I had more confidence."

Many smokers switch to electronic cigarettes because they think it is a healthier alternative, or they want to wean themselves off nicotine entirely.

The devices should be FDA approved and sold in pharmacies if that is their purpose, Prokhorov said.

E-cigarettes cannot be marketed as smoking-cessation aids until they are approved by the FDA, according to a U.S. District Court of Appeals judge.

There are many reasons to worry about e-cigarettes, wrote Harvard Medical School's Dr. Anthony Komaroff in an online post Jan. 8.

The dose of nicotine delivered with each puff may vary substantially, and nicotine is a stimulant that can irritate heart rhythm at very high levels, he wrote.

Also, e-cigarettes still contain an array of chemicals that include diethylene glycol, a highly toxic substance; formaldehyde, a powerful carcinogen; and at least four other chemicals suspected of being harmful to humans, Komaroff wrote.

"There is no proof that e-cigarettes increase the risk of cancer the way real cigarettes surely do, but again, that's because there are no good, long-term studies of safety," he wrote.

Pro: E-cigarettes help users quit smoking with alternative



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