One can hardly blame American journalist and author, Fletcher Knebel  for his oft-quoted quip that “smoking is one of the leading causes of statistics”. We are continuously updated on the latest dangers associated with tobacco products. But what about e-cigarettes? Are they any safer?

According to a recent statement by the World Health Organization,¹ e-cigarettes – or so-called electronic nicotine delivery systems (ENDS) – have varying amounts of nicotine and harmful emissions. “There is no doubt that they are harmful to health and are not safe, but it is too early to provide a clear answer on the long-term impact of using them or being exposed to them,” the statement says. Specifically, WHO cites the risks to adolescents, given the continuation of brain development until the mid-20s, and also the highly addictive nature of nicotine and the role of ENDS as a gateway to conventional cigarettes, cigars or hookahs. Passive exposure to ENDS chemicals is also a concern noted by the WHO, as is the risk of injury where the liquid is swallowed or absorbed through the skin.  

The burning question is whether ENDS cause lung injuries. According to the WHO statement, 2,409 cases of hospitalisation and 52 confirmed deaths were attributable to ENDS in the US by December 10, 2019. At least five other countries have begun investigating the potential link between ENDS and lung injury. Indeed, the statement notes that ENDS have been banned in more than 30 countries worldwide, while others are considering bans to protect young people. The WHO supports the regulation of ENDS, including the disruption of their promotion and uptake, the prohibition of false or unproven claims, the protection of existing tobacco-control efforts, the banning of the use of ENDS in indoor public and workplaces, and the appropriate taxation of ENDS products where they are used. Moreover, around 15,000 unique flavours are used in ENDS, including those of bubble gum and cotton candy, clearly designed to attract young people. As such, the WHO asserts that “governments should restrict ENDS advertising, promotion and sponsorship so young people, other vulnerable groups and non-smokers are not targeted”.

Notwithstanding all of this, do ENDS help patients to quit smoking? Not according to the WHO, which asserts that there is insufficient evidence to support these products for smoking cessation. Indeed, there already exist a variety of other, safer, proven, licenced products such as nicotine replacement patches and gums, and medication to help reduce cravings, along with telephone helplines and other behavioural strategies. The WHO continues to monitor the situation and produces a biennial report entitled the WHO Report on the Global Tobacco Epidemic.

Closer to home, the Healthy Ireland Survey (2019)² tells us that 5% of the Irish population use e-cigarettes, while a further 12% have tried them. The report details how 10% of current smokers use these devices, along with 13% of ex-smokers. As e-cigarettes are not medical products per se, they are not regulated by the Health Products Regulatory Authority (HPRA). At present, government policy does not identify any role for e-cigarettes in the control of tobacco usage in Ireland.³ To complement Fletcher Knebel’s views on smoking, perhaps we simply need more statistics. Either way, it would appear that e-cigarettes – or ENDS – may not be as safe as once assumed. With World No Tobacco Day approaching on May 31, 2020, this sentiment is worth inhaling.

References

1. World Health Organization. E-cigarettes. Jan 20, 2020 (https://medium.com/@who/e-cigarettes-how-risky-are-they-de469b1cd334)

3. Healthy Ireland Summary Report 2019. Government Publications. ISBN 978-1-4468-8037-1 

3. www.hse.ie/eng/about/who/tobaccocontrol/e-cigarettes/