Is it a Catch-22 or a smoke screen? Are e-cigarettes the most promising product to come along to help smokers quit their nicotine addiction, or are they a clever, new way to get non-smokers hooked? Or, are they both?
At this point, no one can say for sure, but there appears to be an informal and growing consensus that electronic cigarettes represent a real health benefit for longtime smokers. That's because e-cigs do not contain tobacco and the many harmful substances that are released and inhaled when cigarettes are smoked. At the same time, there is concern that too little is known about possible negative health effects on e-cig users and bystanders of chemicals that are released when their vapor is inhaled.
That is an important health issue, but the purpose of this column is to discuss addiction. In that regard, again because of the newness of the product, there is too little information to know if e-cigs, as widely touted, can actually help smokers break their nicotine addiction. Even more significantly, as the Food and Drug Administration says on its web site, "It is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death."
As public health campaigns against tobacco products have sharply reduced sales of tobacco products in the United States, e-cigarettes have quickly blossomed into a $2-plus billion industry that shows no signs of slowing down.
Cities and states have scrambled to pass laws regulating where e-cigs can be used. New York City bans using them wherever smoking is banned. (You must be 18 to buy them.) In an effort to provide uniformity to the law, the FDA is poised to extend some or all of its regulations for tobacco products to electronic cigarettes. That has a lot of smokers upset, saying the government shouldn't make it harder for people trying to quit smoking by vaping -- the term for using e-cigarettes.
E-cigs use a battery to heat and vaporize nicotine that is mixed with water, flavoring and a base (two types) to carry the mixture. Unlike traditional cigarettes, cigars and pipes, there is no combustion -- the source for the health problems. For e-cig users, it's more like inhaling fog, with a shot of nicotine (in varying doses), while enjoying the same hand-to-mouth, tactile experience of lighting up. Smoking without the smoke.
Again, that sounds like a sensible way to help longtime smokers avoid the serious health risks associated with using combustible cigarettes, while still getting their nicotine fix. It says nothing about that fix -- the addiction to nicotine. Some studies have raised concerns about the addictive power of the nicotine used in e-cigs, even at lower doses.
Meanwhile, many anti-smoking groups and health experts pose this question: If e-cigarettes are being sold as a way to reduce the harm of smoking tobacco for longtime smokers, why are they also being marketed in such a way as to attract thousands of young users who have never smoked traditional cigarettes? (It is worth noting that big tobacco companies are also big sellers of e-cigarettes.)
The fear, cited by the FDA as well as public health advocates, is that electronic cigarettes may act as a gateway product, luring young users into trying tobacco products.
A recent report in the Journal of the American Medical Association lends weight to that fear. The report noted that, in a recent study, 16 percent of 10th-graders reported using e-cigarettes. The study said that the group of teenagers included those who had smoked before (43 percent) and those who had not and that, in follow-up studies, the teens who had never smoked before were more likely to try smoking traditional cigarettes after trying e-cigs. Curiosity? Suggestibility? Peer pressure? Being a teenager?
Among those who suffer from it and those who treat it, there's a saying: Addiction is a disease of more. In other words, if I can feel this good with just a little nicotine, how good can I feel with even more? Or, if this is such a cool experience -- making believe I'm smoking even though I'm not inhaling any nicotine -- how cool can it be with the real thing?
Sukhwinder Singh and his wife, Satnam Kaur, own Smokers Heaven, an e-cigarette shop in the Town of Wallkill in upstate New York. He says 75 percent of his customers are trying to quit smoking. "They're trying to go from smoking thousands of chemicals, to one, nicotine." He says many have been advised by their doctors to switch to e-cigs.
Singh says he only sells flavorings made in the United States (not China) because there are more controls on the ingredients, another concern for the FDA. "I don't push nicotine on anyone," he adds, saying that he tries to steer younger non-smokers who are curious about the product to non-nicotine mixtures. He and his wife sample the choices of hundreds of appetizing-sounding flavors -- without nicotine -- so they can tell their customers what they are like.
The fact that e-cigs are also cheaper than combustible cigarettes -- many more puffs per buck -- adds to the argument that they are a sensible, harm-reduction, health product. But the FDA says there is as yet no proof of that. If they came under FDA control, e-cig makers would have to pass scientific muster to gain approval for sale. That could be expensive and time-consuming.
But even if producers eventually do offer scientific evidence of harm reduction, e-cigs are still delivery devices for a highly addictive substance -- nicotine. For this reason, the FDA is being urged, at the very least, to make e-cigarettes subject to the same regulations that prohibit companies from advertising and marketing tobacco products in ways designed to appeal to young consumers.