E-cigarettes: On the Vapour Trail for Harm Reduction

Electronic cigarettes (e-cigs) have become a fad consumer product in several countries and are banned in others.  Here in Canada, nicotine-containing products are regulated (de facto banned) by Health Canada, and non-nicotine e-cigs are legal for sale.  However, nicotine products are openly sold in e-cig boutiques in Canada and are available online.

Everyone seems to ask one of two questions: “Are e-cigs harmful?” or “Are e-cigs less harmful than smoking?”
ImageIn a year or so, tobacco control researchers expect to have enough published studies for evidence-based recommendations on e-cigs.  Here is some of the data available now on the composition of inhaled and exhaled vapor.

Sellers and most users believe that what they are “vaping” (inhaling) is the base ingredient (propylene glycol and/or glycerine), flavouring ingredients, and nicotine (or none). However, research has detected other harmful substances in e-cig vapour, including formaldehyde, acetaldehyde, nickel, chromium, and lead.  Some vapour testing has identified lead and chromium concentrations equivalent to cigarettes, and nickel concentrations two to 100 times higher than in Marlboro cigarette smoke.  Yet the potential for harm reduction is evidenced by a study finding the average levels of 12 toxic substances in vapour to be nine to 450 times lower than in cigarette smoke

Now what about second-hand vapour?  Vapour has been demonstrated to produce second-hand nicotine exposure, even though nicotine levels in second-hand vapour were one tenth of those in smoke from tobacco cigarettes. For example, one study showed that of the 20 compounds present in second-hand smoke, e-cigs produced four of them, with three at significantly lower levels than cigarettes. However, one study found similar levels of nicotine biomarkers in research subjects exposed to second-hand vapour as to second-hand smoke.

Research to date informs us that vapour has fewer toxins than cigarette smoke, and has comparatively lower concentrations of other harmful compounds.  But e-cigs do produce problematic toxic exposures, and vapour does add some toxins to the air.  With studies documenting airborne nicotine and positive tests for second-hand nicotine exposure, the precautionary principle would subject vaping to current smoking bans to protect bystanders, as recommended by the German Cancer Research Centre.

Many more questions need to be addressed, including product safety and the potential increase in population rates of nicotine use, before the healthcare community will be able to assess if e-cigs can be endorsed for harm reduction.  In the meantime, e-cig users continue to vape, hoping that they are reducing their health risks, and bystanders breathe in vape, hoping that it is harmless.

From the available research, one fact is clear: while e-cig vapour exhibits potential for harm reduction, e-cig vapour is not harmless water vapour.

Author: Renee O’Leary, PhD student, Centre for Addictions Research of BC, University of Victoria

renee

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

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2 thoughts on “E-cigarettes: On the Vapour Trail for Harm Reduction

  1. “From the available research, one fact is clear: while e-cig vapour exhibits potential for harm reduction, e-cig vapour is not harmless water vapour.”

    Congratulations, I am not sure I have seen anyone use so many words to say so little. Obviously, no one is claiming that e-cigarettes are harmless. But all the evidence that you provided points directly to the fact that e-cigarettes are vastly less harmful than smoking. No scientific evidence or even theory has been advanced that would suggest otherwise. The growing mountain of evidence you failed to recognize is that e-cigarettes, where widely available, are rapidly reducing smoking rates, with nearly no non-smokers using them.

    You also fail to recognize that while tobacco cigarettes are a 100 year old technology with almost no ability to be changed, all parts of an e-cigarette are capable of being redesigned if necessary. If an ingredient is found to cause more risk than desired, it can be removed or substituted for another. If the metal in the heating elements is found to be problematic, a different material can be used. It’s a fundamental aspect of e-cigarette technology that it can be revised and changed.

    The real question is whether the concept is correct: Is using nicotine delivered via vapour less harmful than via combustion? The answer is obviously Yes! Your focus should be: How can we make this as safe as possible and how can we get as many smokers as possible to switch? Anything else only serves to do one thing: protect tobacco sales and keep smokers smoking.

    You need to question which alternative is the moral and ethical one.

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