You're not hearing the whole truth about e-cigarettes

I recently had my first close encounter with an e-cigarette in the wild. Waiting for the show to start at a club in San Francisco, the lady in front of me dug around in her purse and pulled out a small device that I thought was a bullet pipe for smoking pot. But when she lit it up, a pleasant smell—a little like bubble gum—began to waft from the gadget to my nostrils. It was kind of nice.

I could see the tip of the device lighting up as she puffed luxuriously, holding the chamber up high in front of her, exhaling toward the ceiling. I was even moved to comment on how nice the smell was. The woman volunteered that she had just discovered e-cigs and was thrilled to be able to “smoke” indoors. After some chit-chat, she offered me a drag, and being the curious sort, I readily accepted.

I quit smoking three years ago, but I can still remember the kick. And my entire e-cig experience, however quickly it passed by during that brief club encounter, gave me the same feeling—both mentally and physically—that cigarettes used to give me. Except there was no nasty taste in my mouth afterward. And no nasty smell on my clothes later.

From that one brief experience I learned some important basics about e-cigarettes. And after spending time with the literature, reviewing a few clinical studies, hanging out in an e-cig forum, and talking to a doctor, I uncovered some interesting facts they don’t tell you in all the slick marketing materials.

The basics

1. E-cigs are less imposing than cigarettes: Even though I liked the smell of the e-cig next to me in the club, other people might not. The scent of a fruit- or candy-flavored vapor might make some people gag. Such reactions are subjective, of course, but it can’t be denied that the vapor from e-cigarettes hangs in the air for a shorter period of time than real cigarette smoke does. Tests have shown that e-cig vapor hangs around for less than 10 seconds, whereas you can smell cigarette smoke a block away. So even if you hate the smell of e-cigs, you won’t have to wait long for it to dissipate.

Some of the fanciest people in the world use e-cigarettes.

2. It’s perfectly legal to use e-cigs indoors: E-cigarette users blow out vapor instead of tobacco, and there’s no law against blowing vapor out of your nose and mouth, so antismoking edicts really don’t apply. Most of the rules prohibiting e-cigarette smoking come from the owners of bars and restaurants who don’t like it for one reason or another. Apparently, the club I went to had no such rule.

3. E-cigs closely replicate the feeling of smoking a real cigarette: The e-cig I tried was made of hard plastic, but it was painted white and tan just like a real cigarette. It felt warm between my fingers, and the tip lit up when I took a puff.

Then, the biochemical effects started. A volume of warm vapor entered my mouth, and felt just like cigarette smoke when I inhaled it. A satisfying plume of smokelike vapor came out of my mouth when I exhaled.

The e-cigarette closely approximates the experience of smoking.

Pharmacologically speaking, the effects of e-cigs are exactly the same as those of smoking, says Bay Area clinical pharmacy coordinator Dr. John Qaqundah. “Tachycardia, or rapid heartbeat, ensues. The user gets a quick feeling of pleasure and well-being caused by heightened dopamine release in the brain.” Exactly.

Looking deeper

4. The act of smoking an e-cig has its own name: It’s called “vaping.” The term fits because you inhale vaporized nicotine into the mouth and lungs—nothing burns and there’s no carbon release. If inhaling smoke is “smoking,” inhaling vapor is “vaping.”

5. E-cigs are crazy popular already, and becoming more so: The electronic cigarette was invented in the 1960s in China by a company called Ruyan, but it didn’t really take off until about a decade ago. E-cigarette sales hit $1 billion worldwide earlier this year, analysts say, after totalling just $500 million in sales last year. Although that amounts to only 1 percent of the sales of traditional cigarettes, the number of consumers who say they’ve tried e-cigs is growing fast. The Centers for Disease Control and Prevention said that 6 percent of all consumers had tried e-cigarettes by the end of 2011, and that number is probably far higher now.

6. E-cigs are more like Nicorette inhalers than cigarettes: Each e-cigarette holds a battery, a vaporization chamber with a heating element (sometimes called an “atomizer”), and a cartridge usually filled with liquid nicotine. The cartridges come in various flavors, such as kiwi and bubble gum, and the cigarettes range in size from that of a traditional cigarette to a small metal pipe that resembles a marijuana bowl or the end of a woodwind instrument.

7. You can select your own nicotine level: E-cigarettes don’t all deliver the same amount of nicotine—it depends on the liquid cartridge. Cartridges of “juice” vary in the amount of milligrams of liquid nicotine they hold, offering anywhere from 6 to 32 milligrams. Some are comparable to the amount of nicotine in a regular tobacco cigarette; others are closer to that of a light or ultralight cigarette. Cartridges that contain liquid without nicotine are available to users who want the sensory experience but not the head rush.

RJ Reynolds is behind the Vuse brand of e-cigarettes.

8. An e-cigarette habit is almost as expensive as a cigarette habit: Typical e-cigarette starter kits cost between $40 and $130 and contain the e-cigarette, a charger, and a few cartridges. The Tobacco Vapor Electronic Cigarette Association estimates the cost of replacement cartridges at about $600 per year, compared with the more than $1000 a year it costs to feed a pack-a-day tobacco cigarette habit. Cartridges appear to last as long as a 20-pack of cigarettes, and replacements sell for $2 to $10, although you can buy cartridges on Amazon for close to a dollar.

9. E-cigarettes are largely unregulated: E-cig manufacturers have no obligation to send their products to the U.S. Food and Drug Administration for approval, nor do they have to send data from clinical trials to the FDA. Nobody really knows the long-term effects of breathing vaporized pure nicotine, so the FDA currently has no grounds to restrict the practice. The agency says only that it can’t vouch for the ingredients the manufacturers are putting into e-cigs, and that some of them might cause long-term health problems.

It’s widely expected that the FDA will eventually regulate e-cigarettes, but for now it only forbids e-cigarette makers from advertising the product as a way to help people quit smoking. Meanwhile, states are moving toward passing their own restrictions on the use of e-cigarettes.

10. Some e-cigarettes have weird chemicals: About 250 e-cig makers from all over the world crowd the marketplace now, and they use all kinds of ingredients in the substance that vaporizes as a carrier for the nicotine. The most controversial chemical used in e-cigs is propylene glycol, which has been used in hospital air-sanitation systems since 1942. Various studies have revealed that some e-cigarettes contain diethylene glycol, used in antifreeze. However, some e-cigs are “green,” meaning that they use vegetable glycerin instead of the lab-made stuff.

11. E-cigarettes probably aren’t a good way to stop smoking: That idea just hasn’t been borne out by the science yet. A 2013 study that appeared in the British journal Lancet suggests that e-cigarettes are statistically equally effective to patches at getting people to quit—that is to say, not very effective. In the study, 21 of 289 smokers quit after using e-cigarettes, compared to 17 of 295 with the patch.

Health-care professionals in the United States are highly suspicious of all the talk about e-cigs as being a great way to quit smoking. Many experts believe that, at best, e-cigs provide a long-term substitute for cigarettes, and not a very healthy substitute at that: Although e-cigarettes remove the carcinogens that are in real cigarettes, they still contain the nicotine.

Despite the results of the Lancet study, the majority of the research on smoking cessation points to patches and gums as the best tools available right now.

“If people are serious about quitting, they will use patches or gums,” Qaqundah says. “The reason is that you get a sustained release of nicotine with patches or gums. With e-cigarettes you get a quick rush of nicotine in the body that dissipates quickly, so they may provide the same quick fix as a real cigarette without reducing long-term craving.”

12. For kids, e-cigs might be a gateway to smoking: Most states place no restrictions on the sale of e-cigarettes to minors, especially online. A 10-year-old can buy e-cigs if he has the money. Some people are worried that with flavors like “Bubble Gum” and “Cotton Candy,” kids might be attracted to them, and end up smoking real cigarettes. A national survey by the Centers for Disease Control and Prevention found that double the number of high-school students had used e-cigarettes in 2012 than in the year prior. Approximately one in five middle-schoolers who have tried e-cigarettes have never had a conventional cigarette.

Blu
The Blu brand of e-cigarettes is owned by Lorillard, the maker of Newport cigarettes.

13. Some unsavory people are behind e-cigarettes: The biggest names in Big Tobacco are promoting e-cigarettes in the United States. Phillip Morris (Marlboro), RJ Reynolds (Camel), and Lorillard (Newport) sell the MarkTen, Vuse, and Blu brands of e-cigarettes, respectively. These companies also have the deep pockets to buy the magazine ads, television spots, and billboards you’ve likely seen. Since they’re not hampered by the same laws that govern cigarette advertising, they can market e-cigs to whom they want and in whatever format they want.

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