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What Are E-Cigarettes – Risks, Regulations & How They Work

By Michael Lewis

e-cigaretteElectronic cigarettes – colloquially known as “e-cigarettes,” and initially introduced into the United States in 2007 – target smokers who are increasingly forbidden to indulge their habit in public places. Sales reached $500 million in 2012 and are expected to double to $1 billion in 2013, and double again in 2014.

Despite the growth year-to-year, total sales for e-cigarettes are just a fraction of the total tobacco product sales in the U.S., projected to reach more than $106 billion in 2015 with a total global market of almost $890 billion.

What Is an Electronic Cigarette?

An e-cigarette is a nicotine delivery device designed to resemble and mimic the visual appearance of an actual lit tobacco cigarette. The nicotine is delivered to the user in the form of a vapor, rather than in the smoke of combusted tobacco. As a consequence, an e-cigarette eliminates the harmful chemicals associated with cancer and heart disease. The same mechanism is used in nicotine replacement therapy inhalers.

For years, tobacco companies have been under attack from medical groups, public health authorities, and anti-smoking advocates, subjecting their products to higher and higher taxes and fees which currently account for more than 50% of the average retail price for a pack of cigarettes. In 2011, the Federal Government, state governments, and local municipalities collected more than $44.5 billion in tobacco taxes. As a result of the taxes, smoking restrictions, and restrictions on marketing, tobacco use in the U.S. has fallen steadily since 2000 to 19% of the adult population.

The big tobacco companies, seeking to protect their markets with a new, potentially socially acceptable alternative to traditional cigarettes, either currently or will shortly offer an e-cigarette version. Lorillard (the third largest U.S. tobacco company) acquired the “Blu” brand of e-cigarettes in 2012, while Altria (the nation’s largest tobacco company) and Reynolds America will introduce e-cigarette versions in 2013. As this new nicotine delivery system has grown in popularity, it has come under attack by anti-smoking advocates and health officials who would prefer to eliminate tobacco products completely.

The Dangers of Cigarette Smoke

According to the Centers for Disease Control, smoking is one of the most dangerous activities in which you can engage, accounting for one of every five deaths in the U.S., or more deaths than HIV, illegal drugs, alcohol, automobile accidents, and murder combined. No serious scientist today disputes the harmful, eventually deadly impact of tobacco smoke.

Most researchers agree that the most harmful effects of smoking result from the ingestion of the smoke itself, a toxic mixture that results from the tobacco combustion process. Combustion transforms the 2,500-plus chemicals in the tobacco plant into more than 4,000 chemicals in the smoke, more than 70 of which are carcinogenic. The smoke itself contains partially-burned organic particulates (commonly referred to as “tar”), carbon dioxide, and nicotine.

Virtually all health experts agree that eliminating the smoke from smoking by ending the combustion of tobacco would significantly reduce the well-documented health risks, from lung cancer to cardiovascular disease. According to Dr. Jed Rose, director of the Duke Center for Nicotine and Smoking Cessation Research who has invented a new smoke-free inhaler for nicotine replacement therapy, “We think most problems in cigarettes – carcinogens and so forth – come from things in smoke other than nicotine. We avoid them by giving nicotine without all of those problems.”

In an article for The Republic, Tom Glynn, director of the American Cancer Society’s International Cancer Control, agrees, saying e-cigarettes that do not burn tobacco to release nicotine are almost certainly less harmful than smoking cigarettes, although he points out that no one knows the long-term effects of inhaling pure nicotine into the lungs.

e-cigarette

Understanding Nicotine

Like caffeine, nicotine is a naturally occurring liquid alkaloid, and is found in the nightshade family of plants, predominantly in tobacco and, in lower quantities, tomatoes, potatoes, eggplant, spinach, and green peppers. In higher quantities, nicotine is highly toxic and is used in natural pesticides.

According to an article published in “Pediatrics,” approximately 7,000 children younger than age six are poisoned each year by eating tobacco products, although poisoning by eating tobacco rarely results in death. About 100 kids under the age of 14 die each year in the United States from accidental household poisonings, and are much more likely to have consumed other household poisons or prescription drugs than tobacco – in fact, more than 50% are due to common products around the house, and 44% are from medications. Nevertheless, parents should be vigilant when children are around any tobacco products due to its potential harm.

Nicotine can be absorbed in the body by smoking, chewing, sniffing, or through skin contact. Once in the bloodstream, it moves almost immediately to the brain. However, nicotine doesn’t stick in your body for long, having a half-life of about 60 minutes. After six hours, only about 3% of the chemical remains in the body. This is one of the factors that stimulate addiction – the pleasurable effects of nicotine wear off quickly, encouraging another hit to re-create the feelings of well-being and alertness.

How Nicotine Works in the Body

Nicotine activates cholinergic neurons in the brain, stimulating increased release of several chemicals:

  • Acetyicholine. This neurotransmitter delivers signals from your brain to the muscles, improving reaction time and the ability to pay attention. As a consequence, some people feel like they can work better.
  • Dopamine. The release of dopamine in the reward pathways of the brain creates pleasant, happy feelings and is the basis for nicotine addiction. We feel good for a while and we want to repeat the experience.
  • Glutamate. Glutamate enhances the connections between sets of neurons which is the basis for memory. It also reinforces continued use by creating a memory loop of the good feelings you have and the desire for nicotine.
  • Endorphins. The body’s natural painkillers, endorphins are chemically very similar to synthetic painkillers such as morphine, and lead to feelings of euphoria.

As a consequence  of its physiological effects, nicotine has been shown to have beneficial effects for patients who suffer from neurological diseases such as Alzheimer’s disease, Tourette syndrome, Parkinson’s disease, some forms of epilepsy, depression, OCD, and ADHD. According to Schizophrenia.com, some studies suggest that schizophrenia sufferers have benefited from nicotine use. According to Norman Edelman, chief medical officer for the American Lung Association, nicotine suppresses food cravings and increases a person’s metabolism, which is why many ex-smokers gain weight.

The Addictive Quality of Nicotine

Regardless of any benefits, nicotine is highly addictive physiologically and psychologically. Furthermore, the body becomes highly tolerant of the effects so that you need more and more to meet the same degree of stimulation and relaxation. The Commissioner of the FDA, Dr. David A. Kessler, testified before the House Subcommittee on Health and the Environment on March 25, 1994 that the tobacco companies deliberately manipulate the nicotine content and other chemicals in cigarettes to reinforce its addictive qualities in order to boost sales.

Fortunately, withdrawal is relatively painless unlike other common addictive substances, the symptoms (irritability, anxiety, depression, and cravings) and physiological changes usually subsiding largely within three to seven days. Nonetheless, the addictive properties of nicotine alone are sufficient for some opponents to call for the ban of nicotine use in any form. For example, the Christian Science Monitor advocates that the Federal Government ban the sale of e-cigarettes within the U.S. on the basis that a powerful addiction of any type is inherently wrong, and that the government should “assert that each individual has a right to be free of addiction.”

How E-Cigarettes Deliver Nicotine

Nicotine in a tobacco cigarette is delivered to the smoker though the smoke of burning tobacco, and contains all of the other harmful substances previously mentioned. E-cigarettes do not burn tobacco, but work by heating up liquid nicotine, distilled water, vegetable glycerin, and flavoring that smokers inhale as a vapor. Users call this process “vaping,” and refer to their equipment as “personal vaporizers.”

how ecigs work

The e-cigarette product is similar, if not identical, to the same mechanism utilized by nicotine replacement inhaler devices, although the latter rarely includes such physical effects as a cigarette shape and color, a glowing tip, and a visible vapor resembling cigarette smoke. According to Benjamin Wallace of New York magazine, E-cigarette marketers understand that “as much as cigarette smokers crave nicotine, they yearn for other things, too: the hand-to-mouth motion, the primordial pleasure of sucking on something, the organoleptic experiences of flavor and mouthfeel and ‘throat hit,’ the visual cue of exhaled smoke, the ritual of ignition, the embattled/defiant camaraderie of the smoke break.”

Costs of Cigarettes, Nicotine Inhalers, and E-Cigarettes

Electronic cigarettes come in a range of prices, depending on the manufacturer, model, and style. A typical starter kit contains the e-cigarette device, a battery, and several cartridges which are available in a variety of flavors and nicotine strength. Each cartridge is about the equivalent of a single pack of cigarettes.

By contrast, an FDA-approved nicotine inhaler typically includes 42 cartridges, each equivalent to two cigarettes (about four packs). The inhaler is only available through subscription. The average retail price for an e-cigarette starter kit is $70 (equal to about five packs, or $0.70 per cigarette equivalent), a nicotine inhaler about $45 ($0.56 per cigarette equivalent), and the equivalent tobacco cigarettes (five packs) about $31, or $0.31 per cigarette. However, additional packs of five cartridges for the e-cigarette cost about $11 ($.11 per cigarette), or about one-third of the retail price of tobacco cigarettes.

FDA Regulation

History

E-cigarettes have been a challenge to the regulatory bodies in the United States. Initially considered unapproved drug/device combination products, shipments of e-cigarettes were either seized, detained, or refused admission to the country until 2010. That year, the FDA lost a court case following the seizure of several imported e-cigarette products under its authority to regulate drug delivery systems, the court ruling that e-cigarettes must be considered “tobacco products” unless they are marketed for therapeutic purposes. Even though laymen and commonly available literature about e-cigarettes frequently refer to the use of the product to cut down or quit smoking – a therapeutic purpose – manufacturers have diligently and stringently resisted any claims to that effect to avoid more stringent FDA regulation.

E-cigarette products were initially manufactured overseas in China with lax regulations and manufacturing conditions. This resulted in the presence of  harmful substances in the cartridges. Manufacturing moved to the U.S. to avoid seizure of imported products, and is currently considered much safer due to the involvement of the big tobacco companies. While the FDA has announced it will regulate e-cigarettes as a “tobacco product,” it has yet to issue any regulations.

One concern of e-cigarette opponents is that the devices will be a “gateway” to new consumer nicotine addiction, particularly young children attracted by the marketing and flavoring possible in the product. A Centers for Disease Control and Prevention (CDC) study reported that “E-cigarette experimentation and recent use doubled among U.S. middle and high school students during 2011-2012, resulting in an estimated 1.78 million students having ever used e-cigarettes as of 2012.” The study estimated that 160,000 of the users had not previously used conventional cigarettes, while the others had previously smoked tobacco cigarettes. The CDC recommends strategies to prevent marketing, sales, and use of e-cigarettes among youths.

The Regulatory Dilemma

Study after study has indicated that nicotine replacement therapy (using nicotine patches, lozenges, inhalers, and gum) increases chances of quitting smoking from 50% to 70%. The American Association of Public Health Physicians, viewing e-cigarettes as just another smoking cessation product, has concluded they might save the lives of four to eight million current adult American smokers.

At the same time, no one knows the long-term effects of absorbing nicotine for an extended period of time without the harmful elements contained in tobacco smoke. We do not know whether e-cigarettes will encourage new nicotine addicts or actually reduce the number of addicts by helping smokers quit in greater numbers. These open issues preclude an easy answer for appropriate regulation, leading objective observers such as Bloomberg View to advocate a middle-of-the-road approach to regulation:

  • Further studies to determine the safety of nicotine use by e-cigarettes
  • Usage restricted to adults, with limits on flavoring to discourage children to experiment
  • Reporting and labeling all ingredients in nicotine solutions
  • Limiting nicotine in cigarettes to non-lethal limits
  • Tax breaks if a smoking cessation benefit can be proven

The crux of the regulatory problem is agreement about the role government should take regarding the new e-cigarette:

  • On the one hand, there is widespread agreement that the devices are considerably less harmful than tobacco cigarettes for users and the public. Eliminating tobacco smoke eliminates most of the harmful health effects of nicotine addiction that are present in tobacco products.
  • On the other hand, nicotine is one of the most addicting substances on the planet. No one knows about the long-term effects of heavy nicotine use on the body, nor whether the new e-cigarettes will stimulate more people to quit smoking or encourage more use.

e-cigarette

Final Word

Should government ban e-cigarettes or discourage their use by heavy taxation and regulation on the basis that the government is protecting us from ourselves? This approach to alcohol led to Prohibition, which failed in the early 20th century. Or, should government simply ensure that the product is manufactured and sold under the safest conditions possible, trusting people to act responsibly much as we now do with alcohol and firearms? The decision will affect millions of citizens – smokers, tobacco industry employees, and future generations.

What do you think – should the e-cigarette product be heavily regulated, or encouraged as a safer legal alternative to nicotine addiction?

Michael Lewis
Michael R. Lewis is a retired corporate executive and entrepreneur. During his 40+ year career, Lewis created and sold ten different companies ranging from oil exploration to healthcare software. He has also been a Registered Investment Adviser with the SEC, a Principal of one of the larger management consulting firms in the country, and a Senior Vice President of the largest not-for-profit health insurer in the United States. Mike's articles on personal investments, business management, and the economy are available on several online publications. He's a father and grandfather, who also writes non-fiction and biographical pieces about growing up in the plains of West Texas - including The Storm.

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  • http://debtblag.com/ Debt Blag

    There’s a lot of good information in here. Thank you.

    I would feel more comfortable “trusting people to act responsibly” if they would also sign an affidavit that they wouldn’t accept federal health care if they do happen upon a surprise chronic illness.

    Other than differences in local externalities, is there any reason that this shouldn’t be regulated almost identically to cigarettes, pipe tobacco, and their other smoke-producing counterparts?

    • Michael Lewis

      It seems to me that taxation and regulation are better controls of vices than prohibition as we learned from alcohol. It seems clear that the e-cigarettes are no worse than tobacco cigarettes and may be a successful step-down method to quit smoking completely.

      I also agree that if you participate in a dangerous activity such as smoking (or a number of other activities including obesity) that is likely to have costly health consequences, you should be willing to bear the cost of that risk through higher insurance premiums.

      Thanks for writing.

    • tnpe6pgvm5

      Because:
      (a) it does not produce smoke (nothing is “burned”)
      (b) other than delivering nicotine, which is highly addictive but not a carcinogen, ecigs have no negative health effects for the user or the bystander.

      I’ll sign an affidavit if you do. I know you eat waaay too many cupcakes and live a life stressed out by things you don;t understand. And stress is the number one cause of modern illness, you know….

      • http://debtblag.com/ Debt BLAG

        Ha ha. There’s more sass in this reply than I’d expect out of a teenage girl. Maybe you SHOULD lay off the nicotine after all :)

        • Richard J. Mazahreh

          wow. I called him a schoolgirl in another post. Guess it wasn’t just me LOL

        • tnpe6pgvm5

          Name-calling is what immature people do when they know they are wrong but don’t have enough courage or self-esteem to admit it.

          For you Richard, you might want to change that line on your resume about “excellent communication skills,” because you sure ain’t got ‘em!

  • tnpe6pgvm5

    So, we know a couple of things from this article: smoking is incredibly dangerous for smokers and those unfortunate enough to be around people smoking. Nicotine is the addictive ingredient in tobacco. Nicotine replacement therapies (gum, lozenges, patches) and ECigs deliver nicotine to the consumer.

    Other than being highly addictive, nicotine itself is not a carcinogen and has no significant known negative health effects. It does, however, provide smokers an immediate alternative to smoking that they adopt much more readily than gum or lozenges.

    So tell me again why we would not be encouraging smokers to immediately move to ECigs to not only save their health but the health of those around them? Examining the “vapor” (not “smoke”) this device emits shows little more than water. How is that harmful, especially compared to the long list of carcinogens and toxins in tobacco smoke?

    In the absence of any real proof of harm, it seems to me any reasonable person would agree that ecigs should be embraced, not “regulated” out of irrational fear. Think how many lives could be changed for the better.

    • Michael Lewis

      I can’t disagree with your logic. It also seems to me that people and society would be better off if people used ecigarettes rather than smoking tobacco. I can’t imagine how nicotine could be more harmful than the smoke. I suspect it is a matter of money (how to tax) than the health factor that is creating opposition to ecigarettes.

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