Current research into the health risks of e-cigarettes lags behind their popularity. Although they are often marketed as a way to stop smoking, research suggests that e-cigarettes may not prove as effective for this purpose as other options.
An e-cigarette is a battery-powered smoking devices designed to look and feel like a traditional cigarette. A cartridge inside is filled with a liquid containing chemicals, and sometimes with nicotine and flavourings as well. The heating device in the e-cigarette transforms the liquid into a vapour that can be breathed in. (For this reason, the term ‘vaping’ describes the process of using an e-cigarette.) To date, no standards or labelling requirements for e-cigarettes exist. It is hard to know what the liquid in them might contain.
Like a traditional cigarette, some e-cigarettes deliver nicotine. The experience of smoking one is very similar. Companies that make e-cigarettes market this product as a smoking cessation aid. In many studies, smokers reported using e-cigarettes to quit or cut down smoking.
However, the evidence on whether e-cigarettes are actually effective for this purpose is controversial. At least one study showed that e-cigarettes and nicotine patches have a similar success rate for smoking cessation. Other studies of e-cigarettes show a significant reduction in exposure to tobacco smoke.
However, many smokers wind up using both tobacco and e-cigarettes. Some smokers used e-cigarettes primarily when smoking was not permitted. This may encourage the behaviours that go along with smoking, without which users might otherwise quit.
In Canada, e-cigarettes that contain nicotine are regulated under the Food and Drug Act. They must be identified as a new drug by Health Canada before being imported, marketed, or sold. As none of these products have received market approval, the selling of e-cigarettes that contain nicotine in Canada may be subject to compliance and enforcement actions.
E-cigarettes that do not contain nicotine, and do not make health claims, are legal. Still, Health Canada has issued advisories about these products. As e-cigarettes have not been tested, the warnings say that they may be harmful and addictive. As well, Health Canada advises keeping e-cigarettes away from children to prevent poisoning and choking.
The Canadian federal government has not imposed any restrictions on using or selling e-cigarettes and accessories in Canada. However, some cities and provinces (including Nova Scotia, Ontario, British Columbia and Manitoba) regulate these products. The restrictions are similar to those on traditional cigarettes.
Since an e-cigarette does not burn tobacco, it does not produce the same amount of tar and carbon monoxide as a traditional cigarette. However, users and bystanders can still inhale an unhealthy dose of chemicals.
A review of the literature shows that toxic substances found in e-cigarettes are much lower than what is found in traditional tobacco cigarettes. Still, no data is available on the long-term health effects of breathing in e-cigarette vapour.
In contrast, plenty of studies exist on the substances found in or generated by e-cigarettes. The research shows these substances are extremely hazardous to the lungs. For instance, the vaporization process used by e-cigarettes may create formaldehyde and acetaldehyde. Exposure to these chemicals is linked to lung cancer. A few studies showed the presence of toxic metals like nickel, chromium, zinc, lead, copper and iron in the aerosol of e-cigarettes. Nickel and chromium were at higher concentration than in normal cigarettes.
Flavours in e-cigarettes also pose a concern. For instance, a butter-flavoured chemical named diacetyl has been found in some flavoured e-cigarettes. It can cause irreversible lung disease commonly known as ‘popcorn lung.’
The rise in e-cigarette use could potentially lead to smoking behaviours and nicotine use being considered normal again. Young people, the highest users of e-cigarettes, may be most at risk. If young non-smokers who take up this habit begin smoking traditional cigarettes, it could reverse the decades-long trend of reducing smoking rates. One study in Ontario found that the use of e-cigarettes is common among adolescents. Trying something new is what appeals to these teens, rather than the health benefits of stopping or reducing smoking. Two U.S. studies of adolescents and young adults showed significantly increased tobacco use among those who used e-cigarettes, compared with those who had never used them.
When it comes to e-cigarettes, proceeding with caution is wise. Consider the lack of evidence on safe long-term use of e-cigarettes, and the strong data that shows their use is rising. Laws to prevent minors from purchasing these products would be a common-sense first step. Bystanders also need to be protected from inhaling second hand vapour. Applying legislation across Canada that introduces these safeguards makes sense. In the meantime, know that using e-cigarettes comes with risks. If you are a smoker, do not hesitate to talk with your health care provider about smoking cessation alternatives.