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Ask the Pharmacist: Electronic cigarettes

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HARTFORD - Electronic cigarettes were introduced in the United States in 2007 with sales topping $1.5 billion in 2014.  Sales are expected to grow by 25% per year until at least 2018.  Since they do not contain tobacco, they are assumed to be safer than cigarettes and some people assume that they are safe.  While people cannot smoke indoors in many locations, people assume that the second hand vapor is safe and poses no risks.

With regular cigarettes, users burn tobacco and breathe the smoke into their lungs.  Cigarette smoking increases the risks of cancer, heart disease, and stroke.  An electronic cigarette has nicotine in a cartridge with propylene glycol or glycerol to liquefy it and sometimes has a flavoring.  When the person breathes in, like they would from a cigarette, the electronic cigarette heats up the liquid nicotine, turns it into a vapor, and the person breathes it in.  The difference between an electronic cigarette and nicotine gum, patches, or inhalers is that is feels like a real cigarette in your hand, the nicotine rushes into your system much faster than with gums or patches, and the person can blow out the vapor like with a real cigarette.

Do E-cigarettes only deliver nicotine?

No, there are many substances in an e-cigarrette and some of them can be toxic if you inhale too much of it.  The good news is that it doesn’t have hundreds of toxic chemical found in cigarettes and the concentrations of nitrosamines, toluene, formaldehyde, and silicates are between 15 and 1800 times lower than in a cigarette.  However, since heat is used to vaporize the nicotine, the concentrations of toluene, formaldehyde, and silicates are higher than with other forms of nicotine replacement.  The heating unit also had metals that get heated up releasing heavy metal including lead, cadmium, nickel and mercury.  Concentrations of heavy metals are in the range thought to be safe for daily exposure but are 3 times higher than with other nicotine replacement therapies.  Keep in mind that this would be an exposure in addition to what you normally ingest at work and at home so in some people it can push them over the acceptable level in aggregate.

So it seems like e-cigarettes may be safer than regular cigarettes but not as safe as FDA approved nicotine replacement therapies?

That is a critical take home message.  E-cigarettes have the potential to be much safer than a regular cigarette but if you are quitting smoking, other nicotine replacement therapies seem safer at this time.  If you are not interesting in stopping daily exposure to nicotine, some people find e-cigarettes to be a more palatable substitute than other nicotine replacement therapies and in that way, they are likely a safer alternative.  However, no one should start using any nicotine replacement therapy if they are not currently addicted to nicotine.  Nicotine is highly addictive and may not be safe for long term use, especially in children.  In a study published in 2006 in the journal Obstetrics and Gynecology, women who chewed nicotine gum during pregnancy had a higher risk of having children with birth defects compared to other nonsmokers.  What is troubling is that children are increasingly using e-cigarettes with 3% of middle schoolers and 10% of high schoolers are using e-cigarettes.

Dr. Michael White, Dept. of Pharmacy Practice, UConn School of Pharmacy