Will the FDA Crack Down on E-Cigarettes?
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Cigarette smokers in the United States have been under steady attack. To smoke is no longer considered glamorous, cool or socially acceptable. Smokers are confronted and shamed by non-smokers and have been banished to huddle and inhale in remote locations far from public view. A series of state laws prohibit smoking in almost all workplaces, restaurants and bars. The most common exceptions to smoking bans are casinos, strip clubs and brothels. Signs outside of buildings order smokers to stand a specific distance away from the entrance.
Last May, New York City banned smoking in parks, beaches, boardwalks and pedestrian plazas. Mayor Bloomberg said, "When you ask people in our parks and beaches they say they just don't want smokers there."
Smoking cigarettes, which are still legal, has become as stigmatized as smoking crack. An addiction that was once ubiquitous and promoted is now routinely demonized.
As a result of public health campaigns waged over decades against the lies of the tobacco industry, the number of smokers in the United States has declined. Still, according to the Centers for Disease Control, 443,000 Americans die prematurely from smoking-related illnesses and secondhand smoke. The World Health Organization reports that tobacco kills nearly 6 million people worldwide every year.
Currently, about 45 million Americans smoke tobacco. Seventy percent say they would like to quit and every year 40 percent do for at least one day. The 80 percent who quit relapse within one month and each year only 3 percent of those who quit are successful.
To help people quit, a number of nicotine replacement products are available: gums, lozenges, inhalers, nasal sprays and transdermal patches.
The electronic cigarette (e-cig) is the newest nicotine delivery device and has been available since 2008. Electronic cigarettes look and feel like cigarettes but with one crucial difference: They don’t contain tobacco. Smoking-caused disease is a consequence of repeated exposure to carcinogens in tobacco smoke, not to the ingestion of nicotine.
About 2.5 million people use e-cigarettes in the U.S., according to an estimate by the Tobacco Vapor Electronic Cigarette Association. The number of e-cig smokers is sure to grow as they become more widely available and the cost drops. The price of a starter kit ranges from between $60 to $100. Cartridges of liquid nicotine, one equals one pack of cigarettes, costs about $2.
Big Tobacco views e-cigarette companies as a threat to its profits and is moving to buy them up. Forbes reports that Lorillard, the third largest tobacco company, just bought Blu Ecigs for $135 million. The company earned $30 million in revenue in 2011 and the electronic cigarette market as a whole, generates between $250 million to $500 million. With a long track record of addicting people to tobacco through aggressive marketing campaigns, deception and disinformation, the danger is that these corporations will do the same with e-cigarettes.
The battery operated e-cigarette is easy to use. An atomizer heats and vaporizes a cartridge filled with nicotine, which is inhaled by the user. The water vapor that is exhaled has no odor because there is no combustion. The e-cig contains five ingredients: nicotine, water, glycerol, propylene glycol and flavorings like cherry and vanilla. Both glycerol and propylene glycol are used in other nicotine replacement products.
An important debate has been ignited over the safety of the e-cigarette.
Several years ago, the Federal Drug Administration found trace amounts of toxic ingredients in several samples and attempted to regulate e-cigarettes as drug-delivery devices. A federal judge ruled in 2010 that the FDA lacked the authority. Now the FDA is moving to regulate them as tobacco products. This is nonsensical. The e-cigarette is a drug delivery device and not a tobacco product. And in a confusing move, the FDA has seized shipments of electronic cigarettes on the grounds that they are illegal drug-delivery devices.
Researchers at the University of Athens found in a small study that e-cigarettes might damage the lungs, but that they didn’t harm the heart. The study also concluded that the electronic device caused breathing problems or "significant airway resistance" after 10 minutes of use in eight non-smokers and 11 smokers with normal lung function.
Jean-Francois Etter, a physician on the Faculty of Medicine at the University of Geneva, wrote in an article for the Society of Addiction Medicine:
“Even though e-cigarettes were invented almost a decade ago, relatively few research reports have been published. Researchers have lacked curiosity. Research is needed urgently in vitro, in animal models, in clinical and in public health settings to document the safety, toxicity, efficacy and public health impact of these products. Randomized trials are under way and will soon show whether e-cigarettes help smokers to quit…”
Another major concern is that teenagers will become addicted to nicotine. E-cigarettes are available online without proof of age, unlike tobacco products.
E-cigarettes can be used in one of two ways. The first is to taper down and quit using nicotine completely. Nicotine cartridges are available in different strengths: 24mg, 18mg, 12mg, 6mg and 0mg.
The second is to maintain the addiction to nicotine and it is this use of e-cigarettes that has become controversial. Proponents of abstinence-only want all drug users to quit. They view nicotine maintenance as a crutch and the person as weak and unmotivated to stop. For decades, similar accusations have been made against methadone maintenance, even though it is a successful treatment for opiate addiction.
The fiction writer and proud e-cigarette smoker Lionel Shriver wrote in the UK Guardian: “With e-cigs, it seems you haven't 'really quit,' even if you've really quit tobacco, the very substance that sheepish smokers yearn to eschew. In desperation, rabid anti-smokers deride e-cigs as stupid-looking and pathetic. Apparently we're in danger of 'renormalising smoking' after having lavished endless initiatives on making smoking socially unacceptable among all but a sad, quivering few.”
Compare nicotine use to another addictive substance used daily with no stigma: Caffeine. It would be unthinkable for millions of people to start the day without a cup or two or three of coffee or tea. There is a reason Starbucks is located on every block: The quick, easy, and friendly maintenance of caffeine addiction (free Wi-Fi, too). Throughout the day and evening, the caffeine-addicted sip from cans of Coca-Cola, Diet Pepsi and Monster Energy and munch on caffeinated snack foods like Crackheads Espresso Bean Candies, Hyper or Hershey chocolate bars.
Nicotine addiction isn’t any different. Millions of people want and need to use the drug to feel “normal,” to relax and to reduce anxiety. It is also a highly addictive drug -- more addictive, some experts say, than opiates like heroin. But with legal access to pure nicotine, the harms of addiction can be minimized.
Nicotine also has many positive effects on the brain. Numerous studies have shown that nicotine enhances mood, memory and concentration. Nicotine increases the release of dopamine and serotonin, two essential neurotransmitters. A lack of dopamine or serotonin is a common cause of depression and studies are being conducted that use nicotine patches to treat it.
As a group, 80 percent of people with schizophrenia smoke heavily, they have abysmally low rates of cessation and are at higher risk of developing cancer. What researchers now know is that schizophrenics are self-medicating to improve deficits in cognition, information processing, auditory stimuli and conversely, to reduce the side effects of anti-psychotic medications.
Neurologists have found that nicotine helps improve attention, memory and motor speed in patients with Parkinson’s disease, attention deficit-hyperactivity disorder and Alzheimer disease.
E-cigarettes have the potential to prevent hundreds of thousands of smoking-related deaths every year and are clearly less dangerous to use than tobacco. Nicotine is also a medicine that deserves to be studied and more widely prescribed to treat disease.
E-cigarettes are a proven way to reduce the harms of smoking. It shouldn’t matter if the goal is to quit nicotine, continue using it, or if you are a schizophrenic trying to silence the voices, a teenager with ADHD, or a person just looking to relax.