E Cigarettes and Nicotine

E cigarettes were developed to help smokers quit.  They were developed to mimic the hand to mouth action so to convince the brain that you are doing what you have always done when in fact you have cut out all the harmful toxins that are associated with tobacco.

Nicotine

There are some misconceptions regarding Nicotine and its use in the e cigarette, as some people are not aware of some simple facts.  Smoking illness is caused by toxins and tar found in cigarettes, not from nicotine.  It’s the smoke – the smouldering particles of organic material and hot toxic gases – that does the damage.  Professor John Britton, Director of the UK Centre for Tobacco & Alcohol Studies and head of the Royal College of Physicians Tobacco Advisory Group, compares the health risks of nicotine to caffeine.

“Nicotine itself is not a particularly hazardous drug” says Professor Britton. “It is something on a par with the effects you get from caffeine”. “If all the smokers in Britain stopped smoking and started using e cigarettes we would save 5 million deaths in people who are alive today.  It’s a massive potential public health prize.” (BBC, Feb 2013)

The long term effects of using E Cigarettes 

The long term effects are not known – they can’t be known with certainty until the long term has passed and data is available to study. The seminal study on smoking and health is called: Mortality in relation to smoking: 50 years observations on male British doctors because it takes that long to build up a comprehensive picture. E cigarettes have been in use for only a few years and their use is evolving all the time – we don’t even know yet if people will use them over several decades, as with smoking.  But this lack of knowledge about the future is common in policy-making.  The approach used relies on what we do know, which is far from nothing – rather than complaining that we don’t know everything.  Therefore, opponents of e cigarettes talk as though they have just arrived from Mars, but in fact we know quite a lot.  From what we do know, we can make a reasonable risk assessment.  So far, we can say:

  • We are certain that there is no combustion. This is the most important difference and matters a lot because it is products of combustion that do a lot of the damage in cigarette smoke
  • We can look for toxic substances that may cause serious disease over time – we find these are either not present at all, or present in very low concentrations compared to cigarette smoke or workplace limits
  • No serious acute effects have emerged (you would know about it if they had!) and most users report considerable improvement in short term health and wellbeing
  • This is not to say there are no grounds for concern – for example we might carefully study two potential sources of risk: (1) breakdown products arising from running at high temperatures; (2) the complex chemistry of natural flavourings. However, there is so far no credible theory that gives cause for alarm about these.

Nevertheless, we do know with certainty that smoking is harmful. There is a great danger that in restricting e cigarettes, because of uncertainty, we will end up smoking more which we are certain is harmful. So the so-called precautionary principle has to look not only at the risk of e cigarette use but also at the risk of restrictions on e cigarette use and the potential to cause more smoking as a result – it isn’t just a safe one-way cautious bet. The right way to handle the long term uncertainty is:

  • Keep studying the physics and chemistry of e cigarettes and liquids
  • Develop and test theories by which harm may be caused
  • Keep up epidemiological surveys on the user population
  • Set standards for products that make sure they are reasonably safe and of high quality
  • Be flexible enough to intervene and change policy to introduce restrictions if problems emerge
  • Recognise that any problems may be confined to narrow circumstances (particular flavours or devices) so target restrictive regulation on them – not the whole category
  • Remember that restrictions on e cigarettes may cause more smoking and thereby do more harm than good.

The really important factor to look at is that with the e cigarette people can decrease the levels of nicotine that they are using.  Some heavy smokers will start on the high nicotine level and over time will reduce the levels by lowering the nicotine level that they use.  Most e liquids will start at 20mg and then drop to 16mg, 8mg, 3mg and 0mg nicotine.  This is so people who vape can keep lowering the nicotine level all the way down to 0mg if desired, giving consumers the choice and products to be able to keep reducing their nicotine intake as they go along.

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