e-Smoking

We are pleased to introduce a new collaborator to farmacist.infoDelia Gologan.

I cannot describe Delia other than in subjective terms, but I will try a mini-biography. She was President of OSF (Pharmacy Student Organization of Cluj-Napoca), Secretary General and Vice-President of ANOSR (National Alliance of Student Organizations from Romania). After she finished her pharmacy studies in Cluj, she moved to Bucharest where she works as an expert in education policies for UEFISCDI (a government organisation for the funding of university reseach and education) and is enrolled in doctoral studies in political science (which I hope she will speak about on another occasion).

Today we present a very debated topic lately and she will try to explain  about electronic cigarettes and the legislation behind their use.

Electronic cigarettes: from Wooow to Nooo!

Here’s what we know about e-smoking from commercials:

Electronic cigarettes have the wow!

Electronic Cigarettes are “sexy, comfortable and attractive”

What does that say about them?

Since their conception, the electronic cigarettes (e-cigarettes) have been promoted as an alternative to smoking because they are:

  • Less harmful than traditional tobacco cigarettes;
  • Less debated by society;
  • Less regulated (allowing, at least in the first period of their occurrence, indoor public use);
  • Lacking the “burning” smell.

And have characteristics similar to traditional cigarettes:

  • They produce a large amount of vapor;
  • It gives the same feeling of a “throat hit”;
  • They have a flavor that can be customized by the user;
  • It doesn’t turn your teeth, nails and moustahce yellow -two of the unpleasant aspects of smoking.

Thus, e-cigarettes are popular among smokers, especially those who tried to quit smoking and couldn’t … Today, the e-cigarrete industry is worth billions and has millions of users worldwide (2 million in the UK alone).

But they are “healthier”?

Invented 11 years ago, in Beijing, e-cigarettes are now available in various sizes and a wide range (over 8000) of flavors (from the conventional – cherry, vanilla, grape, blackberry to roast beef or “unicorn milk”). The devices consist of a battery and an evaporator / cartomizor / clearomizor which converts the liquid nicotine into vapor that can be inhaled by the user.

Unfortunately there are no long-term or in vivo (the scientific way to say research in living organisms) studies about the side-effects of e-smoking. This is because of the short time of their existence (which has not allowed the luxury of long-term experiments) and on the other hand, because of the difficulty organizing these studies to separate the effects generated by the e- and traditional cigarettes – given the fact that e-cigarette users continue to smoke traditional cigarettes.

But we can look at the toxicological analysis of their content:

  • Liquid nicotine ;
  • Propylene glycol – used as a stabilizing agent. It has irritant properties but not at the quantities found in cigarette smoke. Although suspected of being carcinogenic, there is no clear evidence of carcinogenicity;
  • Spices;
  • Water.

In the tox report we can also find for e-cigarettes: formaldehyde, nitrosamines (substances associated with an increased incidence of various cancers), metals, carbonyl groups, volatile organic components and polycyclic aromatic hydrocarbons – but at a level of 1% of the traditional cigarettes (known to give over 5000 toxins).

Toxins eliminated by electronic cigarettes may increase the susceptibility to respiratory infections, reduces the immune response of the body (its reaction to viruses and bacteria) and are bad for the lungs. Therefore, both the Food and Drug Administration (FDA) and World Health Organization (WHO) consider these electronic cigarettes dangerous and demanded their withdrawal or prohibiting the use in public, declaring them unhealthy. Some states have limited and restricted the sale and use of these cigarettes or smoking them – Brazil, Norway and Singapore. Since 2016, electronic cigarettes will be checked and tested by methods similar to those used for drug approval, to ensure their quality and safety (until now only the safety of the device was beeing checked, not the active substances).

Other risks

There are a few risks mentioned: that a prolonged charging overnigh increases fire risk (especially when using inadequate chargers) and that they can download malware from your computer via USB, making them a good vector for malware.

The French authorities have expressed fear of a secondary market for electronic drug. The possibility of liquid cannabis increases the risk of increaseing illegal drug use.

Public policies

The popularity of these electronic cigarettes was determined. Aggressive marketing and successive restrictions applied to traditional cigarettes, has made the e-cigarettes industry boom in the last years.  But, in the years to follow, they are likely to become the subject of a stricter public policy regulation for the production, marketing and use.

One example is the European Directive 2014/40 / EU [1] of 3 April 2014 concerning manufacturing, presentation and sale of tobacco and associated products (which supplements Directive 2001/37 / EC) which provides a series of regulations with potential impact on consumer habits of electronic cigarettes. This directive states that nicotine for the e-cigarettes will only be available in bottles of 10 ml, with a concentration of approx 20mL / mg; evaporators maximum capacity can be 2 ml max; glass tanks or any other material that may break will be prohibited.

In Romania, the new Fiscal Code refers to the 2016 introduction of a tax of 0.5 RON/ ml applicable to electronic cigarettes (which will increase annually with inflation), against which the Romanian users protested on May 29, 2015 [2]. The National Broadcasting Council has taken a decision that prohibits the promotion of cigarettes and tobacco products on TV (to reduce the chance of smoking in adolescent populations).

Conclusions and Recommendations

While the transition from traditional cigarette smoking of cigarettes to the electronic alternative seems to make the users happy, not knowing its  long-term health effects, the healthiest alternative to smoking remains to quit altogheter.

It remains uncertain what are the recommendation about using these products. For now, we can conclude that it’s wise to use the ones made by well-known manufacturers, consult the content used by vaporized liquid (chemically) and the instructions to ensure safe use of these devices. The recommendation to keep them away from children’s access areas remains important to know!

The pharmacists (togheter with Delia of course 🙂 )

If you find this useful, share www.farmacist.info with your friends, family and collegues – anyone who needs advice or inspiration for a smart and healthy life! They will thank you for it!


 

References:

Alain Braillon, 2014. Electronic Cigarettes: From History to Evidence-Based Medicine. American Journal of Preventive Medicine, Volume 47, Issue 6, December 2014, Pages e13;

BMJ.RO, 2013. Tigarile electronice urmeaza a fi supuse reglementarilor uzuale pentru medicamente (articol disponibil la: http://www.bmj.ro/articles/2013/12/05/tigarile-electronice-urmeaza-fi-supuse-reglementarilor-uzuale-pentru-medicamente)

Hern, Alex for The Guardian, 2014. Health warning: Now e-cigarettes can give you malware (articol disponibil online: http://www.theguardian.com/technology/2014/nov/21/e-cigarettes-malware-computers);

Sean Smith for the Guardian, 2014. Whether they’re called ‘e-cigarettes’ or ‘vaporisers’ the market is heating up (articol disponibil online: http://www.theguardian.com/business/2014/jun/26/e-cigarettes-market-vaporisers);

Manuel Vazquez for the Guardian, 2014. E-cigarettes: is vaping any safer than old-fashioned smoke? (articol disponibil online: http://www.theguardian.com/society/2014/dec/13/e-cigarettes-vaping-safe-old-fashioned-smoke);

Reed, Jennifer L,; Gervais, Alan A; Reid, Robert D, 2013. Electronic cigarettes. Canadian Medical Association. Journal185.16 (Nov 5, 2013): 1427.

The Guardian, 2015. Vaping may not be as safe as smokers think, research suggests (articol disponibil online: http://www.theguardian.com/society/2015/feb/04/e-cigarettes-toxic-chemicals-research-finds-lung-damage);

Thomas E. Et all., 2015. Exposure to Electronic Cigarettes Impairs Pulmonary Anti-Bacterial and Anti-Viral Defenses in a Mouse Model. Published: February 4, 2015DOI: 10.1371/journal.pone.0116861 (disponibil online aici: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116861)

 [1] Text integral disponibil în limba engleză: http://ec.europa.eu/health/tobacco/docs/dir_201440_en.pdf

[2] Referințe: https://www.facebook.com/events/1585336031731489/

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