Last week, the City Council held hearings on whether e-cigarette users should be allowed to “vape” in indoor public spaces. Rather than wait for the U.S. Food and Drug Administration to rule one way or the other on the possible dangers of e-cigarette vapor, the Council is mulling whether it should be included with cigarette smoke as a potential hazard. If so, these products will be included in the city’s 2002 Smoke-Free Air Act, which banned smoking in restaurants and bars.
After looking carefully at the research, I say, good. Regulations on e-cigs, which deliver heated nicotine directly into the lungs, cannot come soon enough.
The key question facing the City Council and FDA as they deliberate over the health effects of e-cigarette vapors is this: Are these products ultimately meant to help smokers quit, or are they are just adding a new way for smokers’ to get a nicotine fix?
The answer, so far, is the latter. In the only well-designed published trials studying e-cigarettes, over 90% of users added e-cigarettes as a second product but did not subtract tobacco cigarettes. In other words, they did not, in fact, quit smoking.
No doubt this is something the tobacco industry looks on as a promising development. After all, they can now potentially sell two products to each customer instead of one.
But wait. There would seem to also be some promising news from the perspective of those who would like to quit. Recent evidence published in the medical journal The Lancet suggests that e-cigarettes have about the same potential to help smokers quit as using a nicotine patch alone.
More smokers in the study said they like e-cigarettes than patches. Smokers cut down more on smoking tobacco cigarettes over a six-month period when using e-cigarettes in the study (57%) than when using the nicotine patches (41%).
Also discovered by the researchers — e-cigarette users were also about four times more likely to use e-cigarettes over a longer period of time than nicotine patch users.
This could mean e-cigarette users are sticking with them longer to help them quit.
Good news? No. Because when it comes to actually quitting, e-cigarettes did not prove statistically better than a nicotine patch alone in helping smokers stay smoke-free. The numbers of patch users (5.8%) and e-cigarettes users (7.3%) who actually quit smoking after six months were, in reality, quite low.
The authors of the Lancet research are hopeful e-cigarettes can help smokers, but note they are not a “magic bullet.” In fact, new social media approaches are achieving much more impressive and promising rates of quitting.
The real tradeoffs between patches and e-cigarettes are likely to be that patches are easy to come off for most people — while e-cigarettes may be almost as addictive a product as actual tobacco.
Indeed, the addictive potential of e-cigarettes may become even more potent over time as the technology to deliver nicotine into the lungs becomes more efficient.
The troubling truth is this: The long-term health effects of inhaling heated nicotine, and the solvent propylene glycol, and other chemicals in e-cigarettes, directly into the delicate tissue of the lungs remain unknown.
Every struggling smoker, and new e-cigarette user, will face a dilemma of whether they are adding e-cigarettes in an attempt to control smoking or as a way to quit smoking for good. These products are called “e-cigarettes,” and as long as they are not regulated you will never know just what the person next to you in a public space is inhaling and exhaling.
An e-cigarette should be treated like a cigarette until it proves itself to be a better medicine to quit than those already on the market.
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