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How Harmful are E-Cigarettes?

Under the Family Smoking Prevention and Tobacco Control Act of 2009, the FDA was given authority to regulate the manufacturing, distribution, and marketing of tobacco products, which as of May 2016 now includes E-cigarettes.

How Harmful are E-Cigarettes?

In early May of 2016 the Food and Drug Administration announced it would soon be regulating E-cigarettes under the same authority they use to regulate cigarettes and other tobacco products.  The first regulations went into effect on August 8, 2016.  Under those regulations the sale of E-cigarettes were banned for customers under the age of 18, banned to be sold in vending machines, and retailers, manufacturers, importers, and distributors could no longer give away free samples.

Over the next couple of years, E-cigarettes will have to include warning labels on their products and list all harmful chemicals contained in the vaporized liquid.  They will no longer be able to advertise their product as a safer alternative to cigarettes and they will have to submit new product applications in order to stay on the market after August 8, 2018.  The FDA has the authority to regulate E-cigarettes as a tobacco product even though they don't actually contain tobacco.  They do, however, contain nicotine which is derived from the tobacco plant.

Under the Family Smoking Prevention and Tobacco Control Act of 2009, the FDA was given authority to regulate the manufacturing, distribution, and marketing of tobacco products, which as of May 2016 now includes E-cigarettes.  Smoking of E-cigarettes, or vaping, has become popular among individuals who are trying to give up smoking tobacco cigarettes.  E-cigarettes are seen as a preferred option of nicotine replacement for many smokers because it mimics the action of smoking better than other types of nicotine replacement such as patches, lozenges, and gum.

E-cigarettes are often marketed as being safer than cigarettes because they contain no tar, don't burn anything, and contain only a fraction of the harmful chemicals that are in tobacco smoke.  A study done in the United Kingdom recently determined that the vapor from E-cigarettes was 95% less harmful than tobacco smoke.  Early studies show that smokers who switch to E-cigarettes are able to quit smoking at rates that are on par, or slightly better than other forms of nicotine replacement therapy.  So if E-cigarettes are less harmful than traditional tobacco products and help people quit smoking, how come the FDA is cracking down on how they are marketed and sold?  Why are E-cigarettes classified as a tobacco product when nicotine patches, lozenges, and gum are FDA approved nicotine replacement medications?

One of the main differences between E-cigarettes and other forms of nicotine replacement therapy is how they are marketed.  Traditional forms of nicotine replacement therapy are sold in drug stores, targeting only people who presently use tobacco products, and are intended for temporary use to help smokers permanently quit tobacco products.  Vaping equipment and E-cigarettes are sold in tobacco shops and vape shops as well as traditional drug stores and convenience stores.  Vaping has become a culture unto itself.  And the new vaping culture is attracting not only current smokers, but former smokers, teens, and young adults.

One of the most alarming trends in vape use is that over a five year period, the number of high school students vaping increased by over 900% (from 1.5% of students in 2011 to 16% in 2015).  Because E-cigarettes are seen as being a safer and more desirable alternative to smoking, they are also attracting new and younger users.  Because of this, the FDA felt they had to step in so they could more strictly regulate how these products are marketed.

The overall trends show that smoking is on the decline for both teens and adults, and has been for decades.  Numbers that indicate a dramatic increase in use by teens of a product that contains nicotine, the addictive substance in tobacco, could be indicative of a looming public health crisis.  Nicotine itself is not harmless.  It is a natural poison that can be used as a pesticide.  It has also been known to poison young children who have accidentally ingested the liquid.  E-cigarettes also contain propylene glycol, a chemical used in antifreeze, as well as other harmful chemicals.

Because E-cigarettes are so new, the long term effects of their use are unknown.  It is also unknown what health benefit they will have for smokers who switch to vaping.  What is known is that 70% of smokers who try vaping either go back to smoking full time, or continue to smoke tobacco in combination with vaping.  It is also known that smokers who switch to E-cigarettes don't often break free of their addiction to nicotine, they simply replace tobacco with an electronic nicotine dispensary system (ENDS).  In this way, electronic cigarettes are less of a nicotine replacement therapy and more of a permanent nicotine replacement. 

On the one hand, E-cigarettes could be a potential gateway for teens and young adults to eventually use tobacco.  On the other hand, if they are seen as a more appealing option of nicotine replacement than more traditional methods for smokers, then they have the potential to carry health benefits for current smokers.  For people who smoke, quitting tobacco is the single greatest way to improve their health.  Only time will tell if E-cigarettes have an overall benefit or detriment to public health.  Only time will tell if the FDA's classification of E-cigarettes as a tobacco product will cause more harm than good. 

The goal of the FDA and every healthcare provider in America, is to have tobacco use become a thing of the past.  What role will E-cigarettes play in that dream becoming a reality?  Only time will tell.

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