Are e-cigarettes safe? A very important question, given how useful e-cigarettes are proving to be as a means to quit smoking! You may have seen articles in the media about vaping injuries, and still many sites on the internet are touting e-cigarettes as unsafe and, in some cases, no better than smoking. Is there any truth to these statements? Let’s investigate!
WHAT IS AN E-CIGARETTE?
An e-cigarette, or ‘electronic cigarette’, is a cigarette looking device that uses a battery to heat what is known as ‘e-liquid’ or ‘vape juice’ into an aerosol, which is then inhaled by the user. The term e-cigarette is often used to encompass all forms of vaping device, from the cigalike devices to pod vapes, vape pens and the large vape mods. The e-cigarette was invented by Hon Lik, a man from China whose father smoked tobacco and died from a smoking related illness. As a smoker himself, Hon Lik developed the e-cigarette as a way to consume nicotine without all the toxic chemicals.
HOW DO E-CIGARETTES WORK?
The function of an e-cigarette, or other vape devices, is to heat e-liquid into an aerosol which can be inhaled; an action similar to smoking cigarettes. The idea is that the battery in the e-cigarette heats up a ‘coil’ which in turn quickly heats the vape juice, which is vaporized and inhaled where nicotine gets absorbed in the lungs. Whether you are using a low powered e-cigarette or a variable wattage sub-ohm device, the principle is the same, just the experience differs.
WHAT IS AN E-LIQUID?
Electronic cigarettes use ‘e-liquid’ as the medium to contain the nicotine - it is made with vegetable glycerine (VG), propylene glycol (PG), flavourings and nicotine. This is the mixture that gets vaporized and inhaled. The important thing about e-liquid is that it doesn’t contain the thousands of harmful chemicals found in tobacco products, of which over 60 are known to cause cancer.
In the UK, all nicotine products are subject to a high standard of regulations, and e-liquids are no different. This regulation prohibits use of certain chemicals that can be used in the e-liquids, like diacetyl, which is the chemical causing a stir in the headlines in the US where the lack of regulation has lead to the inclusion of such chemicals in some of their e-liquids, which in turn appears to have caused the vaping injuries we see in the media. Diacetyl was found to cause the condition known as ‘popcorn lung’ - this was first observed in popcorn factories that used diacetyl as flavouring, hence the name ‘popcorn lung’.
According to Cancer Research UK, a study was conducted in the US in 2016 that investigated whether e-liquids available at the time contained diacetyl, and found that 39 of the 51 liquids tested did contain some level of diacetyl - the idea that e-cigarettes cause popcorn lung came from this study. The important thing you should remember is that UK and EU regulations prohibit the use of diacetyl - so brands like SMOKO are 100% diacetyl-free!.
E-CIGARETTES VS SMOKING
Despite the fearmongering from the media that are holding on to these instances of vaping injury caused by poor regulation in other countries, Public Health England’s estimates put e-cigarettes at 95% less harmful than smoking traditional tobacco cigarettes!
In terms of nicotine delivery, cigarette smoke is very efficient. E-liquid aerosol is less damaging to the lungs, which means the nicotine delivery isn’t as aggressive as tobacco smoke. This seems like a fair trade, given how damaging we know tobacco smoke to be.
MYTHS AND MISCONCEPTIONS SURROUNDING E-CIGS
As previously mentioned, the media have latched onto stories of vaping injury that are coming out of the United States - instances of popcorn lung caused by diacetyl found in the vape juice is a common one, but some vapers have taken to mixing other chemicals in their e-liquids; like tetrahydrocannabinol - or THC, the psychoactive chemical found in cannabis. Vitamin E acetate has then been added to dilute or thicken the liquid, and while vitamin E has not been proven to directly cause lung disease, it has been linked to some of the serious lung injuries and deaths from vaping products.
According to a 2019 report from the Royal College of Physicians, approximately 3.6 million people vape in the UK, and as of that time, no deaths or cases of lung disease had been reported to the EMCDDA - the European Monitoring Centre for Drugs and Drug Addiction - the authority that collects this kind of information.
Public Health England’s 2021 evidence update on vaping in England tells us there have been 3 deaths linked to vaping products in the UK, of which only one qualified as EVALI which is short for - ‘e-cigarette or vaping product, use-associated lung injury.’
WHY ARE E-CIGARETTES RECOMMENDED AS A MEANS TO QUIT SMOKING?
As far as stopping smoking is concerned, e-cigarettes are proving to be invaluable as a smoking cessation tool, even though they are not included as an official form of Nicotine Replacement Therapy, or ‘NRT’ for short. This means they are not available on prescription from the NHS, because vaping isn’t 100% risk free - but it is worth knowing that forms of NRT come associated with risks, and often it is the nicotine that presents this risk.
A study published by the New England Journal of Medicine in 2019 examined the abstinence rate in a randomised trial of 886 subjects, comparing forms of NRT with e-cigarettes. The results showed that 9.9% of the NRT group were abstinent at 1 year, compared with 18.0% in the e-cigarette group. The study concluded that when all subjects are provided behavioural support, e-cigarettes were more effective for smoking cessation than the forms of NRT currently on the market. I strongly suspect that this is because both products provide the nicotine for the physiological part of the addiction, but vaping mimics the action of smoking too, satisfying the habitual part of the addiction. There are also less strict guidelines for e-cigarette use, which may favour cigarette users who are used to having the freedom to choose when they smoke instead of using a product that must be used in a certain way, a certain number of times, and can’t be used again for a given period of time.
DIFFERENT TYPES OF E-CIGARETTES
So - evidence is mounting in favour of e-cigarettes as a stop smoking tool. For any cigarette smokers whose interest has been piqued, the next question is: which vape device to go for?
There are a growing number of devices available, with 4 main subdivisions: the ‘cigalike’ e-cigarette - this is a small low powered device that uses prefilled cartridges; the vape pods - these are small devices that use a different style of prefilled cartridge, and some will let you refill; the vape pen - this is a device with a tank that is filled by the user, and may have limited power variability; and finally the vape mods, also known as ‘box mods’ or ‘sub-ohm’ devices, and these have the most customizability, from different types of coil, tank and drip tip (where you put your lips), to more control of the power output of the battery.
If convenience and simplicity is paramount, then a typical e-cigarette would be a good start. The users need a battery and a refill, and they are good to go. These are small and fit into a pocket without any hassle; carrying more refills is not problematic either. The vape pod systems are similar in this regard - small, convenient and hassle free, just put the pod in the battery and puff away!
The vape pen is a happy medium between an e-cigarette and a box mod. Some are slim, some a little wider, but here you have a battery attached to a coil with a tank and drip tip on top. The great thing about the vape devices with a tank is that you can use your own liquids - however you should make sure that your liquids are appropriate for the device - a high VG liquid needs more power to vaporise, so little details like that could trip you up, if you’re not careful.
The box mods tend to be used by veteran vapers - people that mix their own liquids, desire more vapour, or just enjoy the customisation - but these devices require much more maintenance.
ARE THERE RISKS USING AN E-CIGARETTE?
There are a few risks to be aware of when you start vaping - and the device can have a lot to do with these risks.
The box mod style unit should be well maintained - cleaning the tank when you change flavours, checking the state of the coil, checking the state of the battery, and filling the tank when you run out. Failure to check these parts could result in a damaged battery exploding, or metal from the deteriorating coil working its way into the liquid - things we definitely want to avoid.
One of the few vaping-related injuries that occurred in the UK was a battery short circuiting in a man’s pocket, resulting in very nasty burns. Keeping your e-cigarette in the same pocket as other metal objects like coins or keys could result in a short circuit, causing the battery to explode. So - make sure you have a travel plan for your e-cig! Get into the habit of storing it away in a pocket you don’t keep change or keys in. Better yet, keep it (and any spare batteries) in a protective case when you are on-the-go.
Vapers should also be aware of the effects of nicotine poisoning - it can be quite easy to vape to excess, given the luxury flavours and the nicotine content of the liquid. With cigarettes, there is a natural stopping point when the tobacco has burned up; this is not the case with e-cigarettes. You’d have to get through a whole refill or tank to reach a ‘natural’ end, and the concentration of nicotine in the e-liquid means that you may well find yourself suffering from symptoms of nicotine poisoning! These include: headache, nausea, vomiting, dizziness, a rise in blood pressure, abnormal heartbeat and dehydration, to name a few.
There are instances of people with a propylene glycol allergy, and so vaping an e-liquid with an even balance of VG to PG may cause a reaction. Symptoms of a PG allergy include sore and/or dry eyes, sore mouth, eczema, nausea or wheezing - so if you experience any of these symptoms, consider trying a lower PG liquid - like a 70/30 or an 80/20 balance - and remember there is the option of 100% VG liquids too - just make sure you have a device capable of dealing with 100% VG liquids!
ARE E-CIGARETTES SAFE CONCLUSION
Public Health England’s 2015 report on e-cigarettes concluded that e-cigarettes are significantly less harmful to health than tobacco, with their current best estimate at 95% less harmful! Are e-cigarettes 100% safe? No - but compared to tobacco smoking, e-cigarettes are a heck of a lot safer, when using regulated products. A study funded by the British Heart Foundation at the University of Dundee found that within one month of switching to vaping from tobacco, blood vessel health showed signs of improvement!
As a means to becoming smoke-free, vaping may not be as safe as the forms of Nicotine Replacement Therapy available, but even these products have time frames they suggest you finish in, but all the literature agrees that the risks of staying on the NRT are outweighed by the risks of continued tobacco use.
Current evidence suggests that using an e-cigarette is more successful as a stop smoking tool than the forms of NRT on the market when given behavioural support - so get in touch with your local stop smoking service today! Or if you are ready to try and quit smoking today, here are some of our most popular vape and e-cigarette starter kits!
*2022 Update - Now you can get a *FREE E-Cigarette starter kit when you buy a box of SMOKO E-Cigarette refills! *(Cigalike, one per customer)
