The Risky Unknowns of Electronic Nicotine Delivery Systems

They look like cigarettes, but they smell fruitier and appear less dangerous. Electronic Nicotine Delivery Systems (ENDS) — which include e-cigarettes, electronic hookahs, hookah pens, and personal vaporizers — contain chemicals or “juice” with various amounts of nicotine, propylene glycol and/or glycerin, unknown flavoring, fragrances, and occasionally, bright coloring.

ENDS manufacturers have marketed their products as safe tobacco cessation tools, especially since they don’t produce tar or expose users to carbon monoxide. But whether ENDS are truly “safe,” or even work as tobacco cessation aides, has been the topic of recent studies and debates.

According to Cheryl Horn, RRT, CTTS-M, tobacco treatment specialist with ProMedica Tobacco Treatment Services, the biggest concern is how ENDS are reversing decades of work in the tobacco education field and a future for a nicotine-free society.

“Once again, smoking is being glamorized, using the same advertising tricks that were used in the 1940s when experts made false claims about the health benefits of various brands of cigarettes.”

Horn gives her input on some of the controversy surrounding ENDS, including the use of ENDS as smoking cessation aids and the perceived safeness of the products.

An ENDS to smoking?

Smoking is not just an addiction; it’s a habit that’s difficult to quit.

“The goal of smoking cessation is to learn new patterns, replacing old habits with new activities,” Horn says. “Whether e-cigs accomplish this is being debated.”

Consider the average “pack-a-day” smoker. This person takes approximately 200 puffs a day, repeating the same movement 1,400 times per week. So when a smoker decides to kick the habit, they often miss having something to do with their hands. A smoker may feel more comfortable holding something, such as a straw, pencil, or even an e-cigarette. The latter can satisfy the physical cravings with small doses of nicotine.

Horn is the first to admit that some people have found that ENDS helped them quit smoking. But others have complained that they felt like they were drowning when they tried ENDs. Some even said that ENDS made them nauseous or had no effect at all.

“Early research on the effectiveness of ENDS as a smoking cessation therapy have been disappointing,” says Horn. “Many users of electronic cigarettes have become dual users. That is, they continue to both smoke tobacco and use ENDS.”

For smoking cessation products to be most effectively and safely used, they need to be used according to instructions developed for each product through scientific testing, according to the World Health Organization. There are no scientifically proven instructions for using ENDS as replacements or to quit smoking at this time.

Safety Issues for Children & Teens

For tobacco treatment specialists like Horn, the idea that ENDS are safe for tobacco users and their families is troublesome. Nicotine is dangerous and addictive, no matter what the source, Horn explains.  And these claims are especially harmful for children and teens.

“E-cigarette liquid is toxic,” Horn says. “And since nicotine can be absorbed through the skin, emergency room visits for children with nicotine poisoning are sky rocketing.”

From September of 2010 to February of 2014, the Centers for Disease Control reported 2,405 e-cigarette exposure calls, 51% of them related to children under age 5. Exposure risks came primary from the nicotine liquid, including ingestion, inhalation, and contact with eyes and skin. Common health effects to the liquid include vomiting, nausea and eye irritation.

As for teenagers, Horn says the students she works with are attracted to the space-age look of ENDS, the selection of candy flavors, and the ability to blow smoke rings.

“A majority of teens report hearing that e-cigarettes are just water vapor and harmless flavorings, similar to what you find in gum,” Horn says.

But what makes an e-cigarette taste like strawberries? It’s certainly not real berries. According to Horn, there are too many unknowns about the chemicals found inside ENDS and what they may do to your body over time.

“One thing I like to do is show my students a real lung. They are amazed at how lightweight and delicate lungs are,” Horn says. “Lungs have very limited ability to repair themselves. Unknown chemicals, sticky fluid and heated chemicals don’t belong in there. Only air belongs in your lungs. And since you need your lungs to breathe every minute of every day, why would you take a chance on damaging them, forever making breathing exhausting or painful?”

The World Health Organization confirms that as ENDS do not generate the smoke that is associated with the combustion of tobacco, their use is commonly believed by consumers to be safer than smoking tobacco. This illusive “safety” of ENDS can be enticing to consumers; however, the chemicals used in these products have not been fully disclosed, and there are no adequate data on their emissions.

Key Takeaways

Anyone serious about quitting smoking for good should rely on the trusted, proven methods of tobacco cessation experts and programs.

“We now use combinations of safe and effective medications to make a tobacco user as comfortable as possible as they quit,” Horn says.

Tobacco cessation efforts may include:

Using nicotine inhalers: For smokers who miss the hand to mouth movement of smoking, these may satisfy both physical and psychological cravings.

Switching up your routine: In order to prevent relapse, tobacco users need to learn new ways of coping with cravings, stress, problems, and social activities that involve tobacco.

Seeking support: Nobody has to quit alone, and it’s easy to slip back into old habits when you don’t have outside motivation. Additional support from a group or individual consultation is recommended for best results.

Find a support group and learn more about ProMedica’s smoking cessation programs.