How Does the FDA's OK on e-Cigs Affect You?

Smoking cigarettes was once considered a harmless habit if you can believe it. In fact, if you had a sore throat and a cough, one popular brand promised “no throat irritation” and “no cough” because the tobacco was “toasted” for a “smoother smoke.” No, really.

In a classic case of science catching up with the marketing efforts of tobacco manufacturers to tell us otherwise, we now know that cigarette smoking kills more than 480,000 Americans. The leading cause of preventive death in the United States, tobacco smoking causes about one in five deaths each year.

Against this backdrop, the Food and Drug Administration’s (FDA) recent authorization of the first e-cigarette worries public health advocates. They say there’s no long-term health data about the potential ill effects of regular e-cigarette use or vaping.

They’re also troubled the FDA’s authorization sends the message that vaping, or inhaling foreign nicotine and other substances into the lungs, seems to suggest there’s little health risk with the practice. This may encourage people who have never smoked in any form to experiment with vaping.

Arguably, the gravest concern public health experts share is that the FDA’s authorization may not only send nicotine addiction rates soaring but also push e-cigarette users to seek other nicotine-delivery products, such as traditional cigarettes, pipes, pipettes, and smokeless tobacco to get their nicotine fix.

Cigarette smoking rates among youth and adults remain at all-time lows. But, for U.S. youth, that comes with a caveat: according to the Centers for Disease Control and Prevention (CDC), tobacco product use among U.S. youth is increasing due to increased e-cigarette use.

The lungs aren’t designed to inhale nicotine, oil, or the hundreds of unknown chemicals found in e-cigarettes, and certainly not the hundreds of cancer-causing chemicals in cigarettes, says Piedade Silva, MD, medical director, pediatric medicine, with Lee Physician Group.

“We’ve known for many decades that tobacco in cigarettes causes cancer, emphysema, and a host of other respiratory illnesses,” Dr. Piedade says. “The problem with the newer e-cigarettes is that we don’t know what specific illnesses they cause. With these hundreds of cases of severe respiratory problems causing teenagers and adults to be hospitalized, we can assume that they can have no positive health effects.”

Nicotine delivery — and addiction

The FDA authorized three electronic nicotine delivery system products: an e-cigarette and two tobacco-flavored e-liquid pods. Smoking cessation expert Eliseo Rangel, regional program manager with the AHEC Tobacco Training and Cessation Program at Nova Southeastern University agrees with the FDA’s description of the authorized products as “nicotine delivery systems.”

“These products are nicotine-delivery systems,” Rangel says. “That’s all they are. They were solely developed to bring nicotine into the user’s bloodstream. The concern around these types of products is we don’t know what the long-term effects of vaping nicotine are. But we do know nicotine is incredibly addictive.”

The e-liquid pods carry a nicotine strength of 4.8 percent nicotine, about equal to a pack of cigarettes. Rangel notes, “That’s why these products and others like it come with the FDA warning label that they contain nicotine and that they are highly addictive.”

Rangel clarifies that the FDA authorizes the marketing of these products, but it does not endorse their use.

In its own words, the FDA’s authorization “permits the tobacco products to be sold in the U.S., it does not mean these products are safe or FDA approved.”

It’s a fine point but a vitally important one. Simply put, Rangel says,"We know vaping exposes users to fewer potentially harmful chemicals than with traditional cigarettes, but we don't know exactly what chemicals are in e-cigarettes."

“What about the long-term effects of these ‘fewer toxins’?” he asks. “We don’t yet have the data of studies that have been conducted for years to know. Also, that high level of nicotine in these products increases the risk that first-time users, who are mostly kids experimenting with vaping, could become addicted.”

The dangers of nicotine on the brain

When a person inhales the vapor of tobacco and other nicotine products, it produces an adrenaline rush. The rush is pleasurable but also increases a person’s blood pressure, breathing, and heart rate.

Nicotine also can harm adolescent brain development, which continues into the early to mid-20s, Rangel notes.

A report of the Surgeon General on e-cigarette use among youth and adults found both “preadolescence and adolescence are developmental periods associated with increased vulnerability to nicotine addiction. Exposure to nicotine during these periods may lead to long-lasting changes in behavioral and neuronal plasticity,” the study reported.

In other words, the study found nicotine may cause significant and lasting damage to adolescent brains more than adult brains.

This especially worries Rangel.

“Most people, especially young people, tend to underestimate nicotine's addictiveness,” he says. “The effects of nicotine on the brain, along with their experimentation with e-cigarettes, could lead many adolescents developing a lifelong addiction. It can be a slippery slope from vaping to smoking regular cigarettes.”

Indeed, a U.S. study that followed adolescents between 12 and 15 showed that adolescents who used e-cigarettes before trying any other tobacco products were more than four times as likely to be smoking traditional cigarettes within a couple of years compared to those who tried any vapes, according to Reuters.

What’s the evidence that vaping helps adults quit regular cigarettes?

The FDA considered the risks and benefits to the population as a whole, including users and non-users of tobacco products. Its review included the available data on the likelihood that young people would use these products.

In its authorization, the FDA determined the potential benefit to smokers who switch completely or significantly reduce their cigarette use would outweigh the risk to youth. As if hedging its bets, the FDA also stated it may suspend or withdraw a marketing order for any reason if the agency determines the continued marketing of a product is no longer appropriate for the protection of the public health.

And although they’ve been marketed as an aid to help you quit smoking, the FDA hasn’t approved e-cigarettes as smoking cessation devices. Most people who intended to use e‑cigarettes to kick the nicotine habit ended up continuing to smoke both traditional and e-cigarettes, studies report.

“These devices replace one method of delivery with another without addressing the real problem, which is nicotine addiction,” Rangel says. “There is plenty of evidence to show that most people become dual users in their attempt to quitting smoking while using electronic devices. And that’s concerning as well.”

Some people try to cut back on smoking cigarettes or work toward quitting smoking completely by e-cigarettes, smokeless tobacco, or other tobacco products in addition to regular cigarettes, a practice that Rangel calls “dual-use.”

“Dual-use is not an effective way to safeguard health,” he says. “Because smoking even a few cigarettes a day can be dangerous. If you’ve never smoked or used other tobacco products, including e-cigarettes, don’t start.”