As science and medicine advanced knowledge of the harm from smoking cigarettes, usage and sales decreased, which has led to changes in the options for nicotine delivery systems. In this new landscape, electronic cigarettes have gained the most popularity.
Between 2010 and 2013, e-cigarette usage among U.S. adults more than doubled, according to the Centers for Disease Control and Prevention; more than 20 million American adults are estimated to be using or at least have tried them.
The cigarette smoking rate among youths is at an all-time low. While that's something to celebrate, the bad news is that e-cigarette usage has more than doubled in two years in this population, too, the CDC reports.
STILL THE NICOTINE ...
Though they do not contain tobacco, e-cigs contain nicotine, the most addictive component of traditional cigarettes and one of the most addictive drugs around.
“It is a CNS (central nervous system) stimulant. It can stimulate the heart as well as cause dependence and tolerance,” said Dr. Ammar Ghanem, a pulmonologist with St. Joe Medical Group. He is also an internal medicine and sleep medicine specialist.
For the nicotine dependent, cravings for the substance can cause anxiety, irritability, restlessness, difficulty concentrating, compulsiveness, depressed mood, frustration, anger, increased hunger, insomnia and constipation or diarrhea. Many teens are already wrestling with self-esteem, compulsiveness and depression. The just-released 2015 Kids Count in Indiana Data Book reveals high school-age youths in this state have the second highest rate in the nation for attempted suicide.
Indiana prohibits sales of tobacco and e-cigarettes to youths under age 18, but Bill Stanczykiewicz, executive director of Indiana Youth Institute, said, “When you go online, you just need to click on something that you are age 18 and older. It's still easy for kids to obtain this product.
“Our brains are not fully developed until we are in our early 20s. Nicotine does impact the developing brain, he added.
HABIT BREAKING OR HABIT FORMING?
E-cigarette marketers maintain using them will help people break the tobacco cigarette habit. Sounds good in theory, but is it realistic?
“More and more of my patients are using e-cigarettes,” Ghanem said. By the time smokers are referred to him, most already have some level of chronic lung disease; they are encouraged and given strategies to quit smoking, he said. Yet he said the majority of his patients who are using e-cigarettes are choosing them “as an alternative to cigarettes to circumvent the smoke-free zones,” not to stop smoking altogether.
Of great concern is that teens who have never smoked traditional cigarettes are taking up e-cigs. According to the CDC, more than 250,000 youths who self-reported in 2011 that they had never smoked a cigarette said in a 2013 survey that they had used e-cigarettes. Because e-cigarette liquids often contain flavorings that vary from watermelon to cappuccino or pina colada, it creates further youth appeal.
Because e-cigarettes are refillable, law enforcement officials around the nation are raising concerns that other drugs, such as a liquid form of marijuana, can be added to the e-liquid cartridge.
“Teenagers can be especially at risk for abusing these products,” Stanczykiewicz said, noting, “If you sued the entire (e-liquid) canister at one time, it would be the same as smoking 1 1/2 packs of cigarettes at one time.”
When patients ask Ghanem if e-cigarettes are safer than traditional ones, he responds, “We just don't have enough evidence yet.” Several studies give support that they may help reduce cravings for tobacco cigarettes.
One United Kingdom study found e-cigarette users were more likely to quit compared to smokers who used traditional nicotine replacement therapies such as nicotine patches. It should be these studies were limited in numbers of participants and many depended on self-reporting.
On the flip side, evidence is mounting on the harm or potential harm in e-cigs, from formation of formaldehyde released by high-voltage e-cigarettes to detection of toxic metals and nicotine residue left on surfaces in areas were e-liquids were vaporized. Other research gives evidence that e-cigarettes may impair the immune system and further increase susceptibility to bacteria and cancer in already compromised lungs of tobacco smokers.
“E-cigarettes are not completely free of carcinogens and toxins,” Ghanem said, but because e-liquid manufacturers do not have to list all the substances in the liquids, the jury is still out on what harms they may hold. As what eventually occurred with cigarette smoking, “Recommendations can change as more evidence comes out.”
Jennifer L. Boen is a freelance writer in Fort Wayne who writes frequently about health and medicine. This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of The News-Sentinel.
Learn moreThe FDA in April issued proposed rules that would regulate e-cigarettes as tobacco products. This “deeming rule” would also extend the FDA's regulatory authority over cigars, pipe tobacco and hookah tobacco. After a lengthy period of public comment acceptance and review, the agency scheduled three public workshops to gather scientific information and stimulate discussion among scientists on e-cigarettes. The second of three workshops is March 9-10. Focus is the impact of e-cigarettes on individual health.
To see post-session webcasts of this and other FDA public meetings on the e-cigarette issue, visit http://tinyurl.com/n8q2zbu.
Indiana General Assembly addressing e-cigarettes
Senate Bill No. 539 requires entities that manufacture, bottle or store e-liquids to have a permit issued by the state alcohol and tobacco commission. This would apply to entities both in and out of state. The bill also requires e-liquid manufacturers to obtain permits and establishes penalties for manufacturers who do not comply with terms of the permit.
If the proposed legislation becomes law, e-liquids could not be sold to minors, and retailers could not sell liquids purchased from entities that do not have a state permit or that have been altered or tampered with. Permit holders could bring civil actions for violations of the e-liquids law.
The bill has passed out of committee and will have a second reading in the senate today. The bill's author, Sen. Carlin Yoder, R-Middlebury, expects to introduce an amendment to the bill on today. Final vote in the Senate on the proposed legislation is anticipated to come later this week.
— By Jennifer L. Boen