E-cigarettes ‒ A smoking problem?

E-cigarettes are showing up everywhere. From our local pharmacies to pop-up ads on the web, both users and the media extol their benefits as cigarette replacements and smoking cessation devices. These products first entered the North American market in 2007 and have been steadily increasing in popularity to the point where sales are projected to reach $10B by 2017. The growth potential is so great that traditional cigarette manufacturers are entering the marketplace and buying up many of the smaller manufacturers.

E-cigarettes are electronic devices that provide metered doses of a liquid mist to the user. The main ingredient of the mist is propylene glycol in combination with nicotine and/or flavouring compounds. In Canada, the nicotine-containing products are prohibited from sale, although they are available through international web vendors, and are easily accessible in the United States. The flavour-only products are generally available in Canada. The World Health Organization is concerned that e-cigarettes could undermine hard-fought gains in tobacco control, and anti-smoking advocates indicate that the use of flavoured e-cigarettes by children may influence them to take up smoking cigarettes later in life.

The challenge is that there are limited data to substantiate any of the claims made about e-cigarettes. From a risk perspective, a 2009 analysis conducted by the US Food and Drug Administration of two brands of e-cigarettes demonstrated that these products had trace levels of carcinogenic nitrosamines in over half the samples. The concentrations of carcinogenic nitrosamines were 100 to 1000 times lower than in tobacco smoke, and the manufacturers claim that such levels are comparable to levels found in approved smoking cessation devices and would not affect human health. Similarly, the evidence concerning the effect of inhalation of propylene glycol is limited and concerns have been expressed about manufacturing quality-control practices. Most concerning is the fact that there have been few controlled studies demonstrating the efficacy of e-cigarettes as smoking cessation devices despite widespread anecdotal reports.

This paucity of reliable evidence favours a prudent approach to managing the sale of e-cigarettes in Canada. As such, it will continue to be the position of CPHA that the existing controls on their sale should be maintained pending the development of additional information concerning the health risks associated with the nicotine-containing product, and e-cigarettes’ efficacy as a smoking cessation device. There is also a critical need for additional information on the social implications of e-cigarette use.

CPHA will maintain a watching brief on e-cigarettes and provide updates as new evidence merits.