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E-Cigarettes: Some Additional Thoughts 

May 29, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

Earlier this month, the Risky Business column, E-Cigarettes: Is It Safe for Our Kids to Vape?, outlined the latest statistics about the significant increase in the use of e-cigarettes among teens. The article also discussed recent efforts to regulate these products on a regional and national level. A number of health-related organizations have expressed concern about the harmful effects of e-cigarettes on our youth, especially from inhaled nicotine. These organizations include the Centers for Disease Control and Prevention (CDC), the National Institute on Drug Abuse (NIDA), the Food and Drug Administration (FDA), the American Academy of Pediatrics, the American Academy of Family Physicians (AAFP), and others.

“Bad News” from a Reader

In the first negative comment ever received from a Risky Business reader, someone sent the following email: “Get your facts straight. To stop vaping will cause many people to die. I hope you can sleep at night, knowing that you are fighting for big tobacco to win.” Several comments: the facts are correct and there is insufficient scientific evidence to warrant the use of e-cigarettes as a smoking cessation device. Most important, the Falmouth Prevention Partnership is dedicated to working in our community to help prevent substance abuse among kids and teens, including the use of tobacco products and exposure to nicotine.

Smoking is the leading preventable cause of disease, disability and death in the United States, resulting in more than 480,000 premature deaths every year and accounting for about one in every five deaths. Helping people to stop smoking is a challenge because of the addicting effects of nicotine. Some proponents of e-cigarettes claim that vaping is a safer alternative and may help people stop smoking regular cigarettes.

In a press release from the American Academy of Family Physicians published on May 12, Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, noted that "The question is not if e-cigarettes are bad for your health, but if they are better for you than tobacco. E-cigarette manufacturers are advertising them as an aid to quitting smoking. So far, evidence does not support this assertion, but the data are too limited to make a definite recommendation against."

Further, if a patient wanted to start using e-cigarettes to help quit smoking, Dr. Frost said she would strongly discourage that because information is emerging that e-cigarettes are bad for patients' health and do not help them quit. "I would inform them that by trying e-cigarettes, they could actually cause themselves more harm.”

On April 28 the AAFP and 30 other health-related organizations sent a letter to President Obama urging him to get a quick resolution to having the FDA regulate e-cigarettes along with other tobacco products. According to the letter, “In the absence of regulation, we have seen irresponsible marketing of unregulated products such as cigars and electronic cigarettes, often using tactics and sweet flavors that clearly appeal to youth. It’s no wonder use of e-cigarettes by youth has skyrocketed. This process has already taken far too long. We cannot afford more delays that allow tobacco companies to target our kids with a new generation of tobacco products.” Read the entire letter and the list of participating organizations. 

Nicotine Is Dangerous

The American Association of Poison Control Centers (AAPCC) has reported 3,783 exposures in 2014 and 975 exposures in the first quarter of 2015 related to e-cigarettes and liquid nicotine. The majority of the cases occurred in children younger than six years old. An exposure means that someone has come into contact with the substance in some way, for example, by ingesting, inhaling or absorbing liquid nicotine through the skin or eyes.

According to the American Academy of Pediatrics, “because liquid nicotine comes in a variety of bright colors and in flavors appealing to children such as cotton candy and gummy bear, it is no surprise that these products have found their way into the hands of children.” Further, the Academy notes that one teaspoon of liquid nicotine could be lethal to a child, and smaller amounts can cause severe illness, often requiring trips to the emergency room. Despite the dangers these products pose to children, there are currently no standards set in place that require child-proof packaging.

And, just skin contact with concentrated liquid nicotine can cause symptoms of nicotine poisoning, such as nausea and vomiting, dizziness, abnormal heart rhythm, elevated blood pressure and seizures.

Nicotine Is Addictive

The majority of e-cigarettes have some level of liquid nicotine as the key ingredient. Nicotine is addictive, and teens, because their brains are still developing, are especially vulnerable to the effects of nicotine. Nicotine can alter brain development and functioning in adolescents, and increase their risk of addiction to other substances. 

Nicotine acts on the part of the brain that regulates feelings of pleasure, which is similar to that seen with other drugs, such as prescription pain medication and heroin.

A Needed Discussion

As editor of the Risky Business column and this website, I have received several anonymous emails about the previous article on e-cigarettes. I welcome an open dialogue about this issue and the need to make sure that our kids and teens are not harmed by these devices.  

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