Crutch or cure: issues surround use of e-cigarettes

By Stephen Rickerl/Fremont Tribune
The meteoric rise in popularity of e-cigarettes has some people scratching their heads as to whether the tobacco-less devices are a new tool in smoking cessation or a Trojan horse that could undo decades of anti-smoking campaigns.
Electronic cigarettes are devices that primarily consist of a battery, heating coil, wick and tank or cartridge that holds flavored liquid and nicotine. As a user puffs on the e-cigarette, the battery heats the coil and the liquid is turned essentially into a vapor that is inhaled like a traditional cigarette.
But e-cigarette users don’t consider themselves smokers, they’re “vapers,” and they don’t smoke – they “vape.” Many of the devices look more like a lightsaber than a Lucky Strike.
Even though the products do not contain tobacco, and do not use combustion to deliver nicotine to the user, there are a number of issues, questions and criticisms surrounding the use of e-cigarettes.
Among the unknowns are whether e-cigarettes are a solution or part of the problem, the answer to which would likely depend on who you ask.
The Fremont Area Medical Center does not support the use of the products as a tool to quit smoking because they are not FDA approved.
Dr. James Sullivan of Fremont Family Care, a clinic associated with FAMC, said smoking is a great health hazard and doctors like it when people are thinking of ways to quit. But he, as a member of the medical community, has a couple of issues with the devices.
First, he said, the devices are unregulated, and outside of strict FDA oversight and testing, there is no way to be certain how much nicotine is being delivered to the user. Another issue Sullivan has with the devices is that the liquid nicotine, the addictive part of smoking, can have harmful health effects – especially in young people and in high doses.
In traditional smoking cessation programs, nicotine in gum or patches slowly weans the user off the drug.
“The e-cigarettes design is basically the same thing, ‘let’s replace the toxic nature of smoking and inhaling that and give you back the nicotine while you quit,’” Sullivan said. “The problem is you don’t know what dose of nicotine you’re getting by inhaling it.
“We need to know a reliable dose that is getting in. For that reason we are reticent to use it,” he added. “I don’t know if a lot of people are quitting, because nicotine is the addictive part. So people are just now using e-cigarettes instead of regular cigarettes, so they’re not using it as a tool to quit, just as a replacement.”
Other criticisms of the devices have included the fact that there are no laws in place banning the sale of the products to minors, and the e-juice — the liquid containing the nicotine — comes in a range of flavors from traditional tobacco to gummy bears, caramel and root beer.
In 2010 the FDA, based on limited studies of samples, issued warning letters to electronic cigarette distributors for various violations of the Federal Food, Drug and Cosmetic Act including “violations of good manufacturing practices, making unsubstantiated drug claims and using the devices as delivery mechanisms for active pharmaceutical ingredients.”
In reporting its results of those limited studies “FDA found significant quality issues that indicate that quality control processes used to manufacture these products are substandard or non-existent. FDA found that cartridges labeled as containing no nicotine contained nicotine and that three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff.”
The American Lung Association in a public health statement said there are 250 different brands of e-cigarettes for sale in the U.S., and those brands are likely to have a wide variation of chemicals that each contain. The lung association said an FDA study in 2009 found detectable levels of toxic cancer-causing chemicals, including an ingredient used in anti-freeze.
Because of potential unknown risks, many school districts and public bodies are enacting policies to treat e-cigarettes like traditional cigarettes.
The Fremont Board of Education at its October meeting voted to approve the first reading of a policy that would treat e-cigarettes the same as traditional, or “burn” cigarettes – effectively banning their use on school grounds. The new policy is expected to pass a second and final reading at the board’s November meeting.
“I think from a school district’s perspective the reason we included them is we felt like they could be a distraction from the learning taking place in the classroom and also in the school,” said Mark Shepard, executive director of business and support services at Fremont Public Schools. “Our concern in adding it to the policy is it’s basically modeling a behavior that students should not be engaged in.”
Chad Burns, owner and CEO of American Vapor — a new e-cigarette store in Fremont — agrees that minors shouldn’t use the product and will not sell to minors, but disagrees with the findings of the incomplete FDA study.
“Right now our state doesn’t regulate (sales to minors). We can sell to anyone legally, morally we do not,” Burns said. “We self-regulate. If you’re not able to buy cigarettes, you’re not able to buy this. It’s 18 and older period. That’s self-imposed, but morally it’s the right thing to do.”
Burns said his business also self-regulates when it comes to the quality and consistency of e-juice.
“Everything we purchase is made here in the U.S. and we know where it is coming from. Most of them are local producers and we know what they’re doing,” Burns said. “Everything that we purchase, we purchase at zero nicotine and then we are right there when they add the nicotine, and it’s all computerized. You punch in how big of a bottle you’re putting the nicotine into and how many milligrams of nicotine you want in that bottle. The computer puts in the exact amount – to the drop.”
Burns said he would welcome FDA regulation of the industry.
“It would be a good idea because there are some shops out there that aren’t following the same standards,” he said. “Personally I want to know what I’m vaping, I don’t order anything offline – even for my personal use. We don’t like the companies that aren’t regulating because they’re giving us a bad name. And as this industry progresses, the weak will be weeded out of the herd.”
Shane Ekdahl, owner and business manager of American Vapor, said the store has been open two weeks and in that time business has been steady.
“People are just bringing their friends in by the droves,” he said. “It’s unreal.”
Ekdahl said about 20 percent of their customers are experienced vapers, but the other 80 percent are traditional smokers new to vaping.
Matt and Brandy Tulak said they smoked 14 and 17 years respectively. Neither has picked up a cigarette since they began vaping a week ago.
Matt Tulak said he was always the smoker who talked about quitting but never did. In vaping he sees the opportunity to satisfy his nicotine cravings without taking in additional chemicals associated with traditional smoking.
“You’re not getting all the nasty chemicals you’re getting from the cigarette,” he said. “I was getting to the point where I was wheezing at night going to bed. Now I don’t wake up in the morning and have that heavy chest,”
Brandy Tulak said they vape now because they like it better than smoking. They don’t smell like cigarettes and their sense of taste and smell are improving. She said she also likes that she can customize her device.
“You can customize your vapers to make them pretty, to speak to what you like,” she said. “With a cigarette you get stench, yellow teeth, wrinkles all that nasty stuff – and it’s not pretty.”
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