E-cigarettes not the answer to quitting smoking

Weedless Wednesday encourages smokers to use safe methods

E-cigarettes not the answer to quitting smoking
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Winnipeg Health Region
Published Wednesday, January 18, 2012

People call them the "answer" to a lifetime of addiction to smoking cigarettes. But as today marks Weedless Wednesday, smoking cessation experts continue to question the safety of electronic cigarettes.

Proponents say e-cigarettes help them to cut down on the health risks, eliminate the odour of burning tobacco, and cut down on the amount of nicotine they get with each inhalation.

Despite the claims by the manufacturers that these devices are useful in helping people ease their smoking habit, health-service providers do not recommend their use. Instead, they turn their patients onto nicotine replacement (patches, gum, inhalers and lozenges), other cessation drugs (Champix and Zyban), and behavioural therapy.

E-cigarettes are also not legal in Canada. As of March 2009, the import, sale, and advertising of electronic cigarettes containing nicotine was banned in this country. E-cigs which do not contain nicotine are legal and may be sold and advertised.

Health Canada advises Canadian consumers to not purchase or use any electronic smoking products, citing prohibition of electronic smoking products containing nicotine in the Food and Drugs Act (FDA) in the United States. Thus, no market authorization has been granted for any electronic smoking product.

Yet e-cigarette kits are both sold online through Canadian websites, and in stores in Winnipeg, all of which contain nicotine. Smokers tout them to other smokers, and there are online bulletin boards talking about how to get around the fact that Canada Customs will confiscate these packages at the border.

"I've seen flyers taped to streetlights, telling people how to buy them. There's a shop on Portage Avenue where I've seen them advertised," says Margie Kvern, Program Specialist with Tobacco Reduction, in the Population and Public Health Program with the Winnipeg Health Region. "Smokers need to know that e-cigarettes have not been tested for safety. Using them is like using a drug that hasn't gone through controlled studies for safety."

If you haven't encountered them, e-cigarettes often look like a cigarette or cigar, sometimes with a light on the end that glows. Others look like pens, magic markers or computer memory sticks. They run on a small battery and are reusable. Also known as e-sticks, the device uses heat or ultrasonics to vapourize a propylene glycol or glycerin-based liquid solution into an aerosol mist. The smoker inhales nicotine, and exhales vapour, instead of tobacco smoke.  

They were invented in 2003 by Chinese pharmacist Hon Lik and introduced to the market the following year. The company he worked for, Golden Dragon Holdings, changed its name to Ryan (meaning "to resemble smoking"), and started exporting its products in 2005 and 2006, before receiving the first international patent in 2007, according to the European Patent Office.

Because of their newness to the market, science hasn't caught up with whether they are safe to use. Health-care providers don't know if they are a safe alternative to regular cigarettes, or if they are a bid by Big Tobacco to continue having people buying their product.

"There isn't enough evidence one way or another about whether e-cigarettes work to reduce addiction or whether they're even safe to use," says Kvern. "E-cigarettes are marketed as being great. But those are unsubstantiated claims with no scientific evidence."

Tobacco Reduction specialists like Kvern worry whether the devices will lead to people chain-smoking them and using them indoors. Another concern is whether non-smokers and children will be attracted to using them, due to the novelty, claims of safety, and because they come in yummy flavours like bubblegum, brandy, coffee and cola.

"There are concerns about second-hand smoke, too. There's no clear evidence on what's in that vapour, and whether this will have a second-hand smoke effect on other people," she said. "There's the question of whether these things should be allowed indoors in public places."

Unlike tested nicotine replacement therapies approved for use, such as the patch, gum and drugs such as Champix, the contents of e-cigarettes are not legislated by law, other than a requirement that the nicotine content be listed.

In May 2009, the FDA's Division of Pharmaceutical Analysis tested the contents of 18 varieties of electronic cigarette cartridges produced by two vendors: NJoy and Smoking Everywhere. They found known cancer-causing agents in a number of the cartridges, and also that the actual nicotine levels did not always correspond to the amount they purported to contain.

"One high-nicotine cartridge delivered twice as much nicotine to users when the vapour from that electronic cigarette brand was inhaled, than was delivered by a sample of the nicotine inhalation product (used as a control) approved by FDA for use as a smoking cessation aid," read the report. Following the testing, the FDA issued a notice discouraging the use of electronic cigarettes.

Other health-related agencies around the world are pondering whether the devices can help people reduce their addiction to tobacco. Research carried out at the University of East London on the effects of the use of an electronic cigarette to reduce cravings in regular tobacco smokers showed there was no significant reported difference between smokers who inhaled vapour containing nicotine, and those who inhaled vapour containing no nicotine.

The Winnipeg Health Region offers smoking cessation support and supplies patients with nicotine patches and gum while they are staying in region hospitals.

There's also the Kick Butt! stop-smoking program at the Wellness Institute at Seven Oaks General Hospital. The program includes five hours of behavioural health coaching and counselling with a registered social worker specializing in smoking cessation. The program also includes a three-month membership to the onsite medical fitness facility and a medical consultation with a doctor.

"Our message for those trying to quit smoking is that nothing is a silver bullet. Your best chance is to combine medication with behavioural counselling," said Kvern. "You need to eliminate the triggers that cause you to smoke, be it stress, boredom or your general environment. That takes time and planning, and the health benefits of stopping smoking makes it very much worth the effort."

Weedless Wednesday is part of National Non-Smoking Week, held Jan. 15 to 21. The week encourages smokers to look at smoking cessation methods by talking with their health-care provider.

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