Q: My friend told me to hide my e-cigs liquid nicotine filler from my kids, since it could be toxic to them. Is this true?
A: Electronic cigarettes (e-cigs) were created as a tool to deliver nicotine to smokers to help them quit smoking; this is a similar approach to nicotine patches and nicotine gums. E-cigs do this in a way that mimics smoking in that they are designed to look and be “smoked” similar to a cigarette; they have a battery that heats up an “e-liquid” that contains nicotine (which is extracted from tobacco), turning it into a vapor which is then inhaled. However, the World Health Organization in a July 2013 report noted that the use of e-cigs to help smokers quit has not been demonstrated, and they “strongly” advise against their use at the present time.
The idea of e-cigs is to deliver nicotine to smokers without also delivering some of the other harmful chemicals that are in cigarette smoke. However, there may still be harmful chemicals in e-cigs. A report by the FDA in 2009 identified hazardous carcinogens in certain e-cigs that they tested. So there may still be significant health and safety issues from the use of e-cigs. Other studies have identified breathing problems and other issues from the use of e-cigs.
Unfortunately, e-cigs are already being misused; some people who have never smoked cigarettes are actually starting to “smoke” using e-cigs. As these people become hooked on nicotine (which is addictive), some of them then progress to smoking cigarettes. Furthermore, flavored e-cigs may be enticing younger people to try. This may be true for children as well, especially when flavors such as milkshake, cookie, strawberry, cherry, vanilla and others that are now marketed are considered.
Unlike tobacco products, e-cigs may be legally sold to minors in some places. In fact, sales of e-cigs are expected to be over 1.5 billion (yes with a “b”) dollars this year.
Initially, e-cigs were disposable devices, but many of them are now refillable, utilizing e-liquid (purchased in stores or online) that contains nicotine to refill them. The e-liquid can be accidentally ingested or absorbed through the skin. If this occurs, the delivered nicotine dose can be quite high, causing adverse reactions.
Nicotine is a potent toxin, which is rapidly absorbed. Calls to poison control centers related to e-liquid exposure have skyrocketed in the last couple of years, and about half of the reports have been in children. That so many children are affected may be, at least in part, due to the fact that the e-liquid containers are not required to have childproof safety features.
Symptoms from nicotine toxicity may include nausea, vomiting and headaches. If the e-liquid comes in contact with someone’s eyes, it can be irritating and cause an inflammatory reaction. If high doses of nicotine are absorbed, cardiovascular symptoms (such as elevated heart rate and/or blood pressure), seizures and respiratory depression may occur. Death from absorption of very large doses is also a possibility.
E-liquids come in different concentrations, typically 1.5 to 2.5 percent, but higher concentrations, up to 7 or even 10 percent, may be available online. Unfortunately, the actual concentration and purity may or may not be what is advertised. Only e-cigs that are marketed for therapeutic intent are currently regulated by the Food and Drug Administration (FDA), and e-liquids are not presently regulated.
If you smoke, quitting is one of the best health decisions you can make. However, e-cigs have yet to be proven to be a useful quitting aid, and they are already being misused as an alternative way to smoke, with any hazards from their use still unknown. Add to that, the potential for getting children addicted to nicotine as well as the potential for accidental poisonings, and you can see that e-cigs may be a developing healthcare issue.
Hopefully, they will soon be regulated by the FDA. In the meantime, people should use considerable caution in making a decision whether or not to use e-cigs, and I would strongly urge people who do not smoke not to start, whether with cigarettes or e-cigs.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.