eCigarettes and vaping
What are e-cigarettes?
E-cigarettes are battery-operated devices that resemble tobacco cigarettes, cigars or pipes except that they do not contain tobacco. The device allows users to inhale nicotine and other chemicals in a vapour form rather than smoke. There are also a number of non-nicotine devices that contain a variety of ingredients and flavours like fruit, sweets, coffee or alcohol flavours.
Some devices resemble conventional cigarettes, cigars or pipes where others look like everyday items such as pens, USB memory sticks, and larger cylindrical or rectangular devices.
E-cigarette products can be bought online from overseas, which raises safety concerns about the lack of regulation governing their manufacture and distribution. Most countries have no regulations governing e-cigarette design and product approval. There have been frequent reports about nicotine poisonings as well as injuries and property damage arising from product malfunctions.
E-cigarettes are sometimes mistaken for approved nicotine replacement therapy as some manufacturers market them as devices designed to help people overcome tobacco dependency. E-cigarettes may be used as a quitting aid in the future, but at the moment there is no conclusive evidence about its effectiveness. There is also very little known about the other chemicals found in e-cigarettes, and how it affects the smoker as well as bystanders.
Electronic cigarettes, electronic nicotine delivery systems (ENDS), e-cigs, ecigarro, electro-smoke, green cig, smartsmoker.
How are they used?
E-cigarettes contain nicotine solution, flavour and other chemicals in a disposable cartridge that can be replaced or refilled. E-cigarettes use heat to transform nicotine solution into vapour which is inhaled.
People may use e-cigarettes for various reasons including:
- to help them reduce or quit smoking
- to avoid disturbing other people with smoke
- in smoke-free places
- to cough less, improve their breathing or physical fitness
- for the flavour or sensation of inhalation.
Do they help people quit smoking?
As yet, there is very little available research that indicates if e-cigarettes can help people quit smoking as the results of studies on individual brands vary. While it has been suggested e-cigarettes may offer a safer alternative to smoking, other research points to a potential rise in smoking rates by re-normalising smoking, reducing a smoker’s motivation to quit or indirectly encouraging non-smokers to take up the habit.
There is also the risk that smokers may become dual users of both e-cigarettes and tobacco cigarettes. There is currently no evidence to support the use of e-cigarettes as an effective form of smoking cessations, for this reason the Therapeutic Goods Administration (TGA) is yet to approve e-cigarettes as a quit tool.
Are they safer than traditional cigarettes?
Research into health risks associated with smoking e-cigarettes is extremely limited. However, there are known risks associated with nicotine exposure on brain development meaning that pregnant women and adolescents should avoid smoking them. They should also not be smoked around children. There are also risks linked to nicotine poisoning via ingestion and skin contact.
Concerns have been raised about the appeal of flavoured e-cigarettes among children and adolescents, in countries where data is available concerning trends are being noted in the uptake of e-cigarettes in adolescents and children.
While it is thought that e-cigarettes may pose less harm than conventional cigarettes because they do not contain tobacco, significant differences in product designs and individual smoking patterns make it difficult to determine the potential level of nicotine toxicity in e-cigarettes.
Manufacturer quality is not guaranteed, and can be highly variable. Nicotine labelling on e-cigarettes and e-liquids has also been demonstrated to be inconsistent. Labels have also incorrectly denied the presence of nicotine and other potentially toxic chemicals.
The limited research to date does not distinguish between the many brands and models containing different e-liquids, batteries, heating elements, nicotine concentrations and flavourings. Nor differentiate between the chemical compositions of e-liquid and aerosols that users inhale.
There are safety concerns from prolonged exposure if smokers inhale vapour many times a day for many months.
E-cigarettes contain chemicals that may be acceptable for use in foods and cosmetics but it is unclear if the vapours are safe when inhaled into the lungs though research suggests that long-term inhalation of these agents directly into the lungs, is likely to pose a risk to health.
Some e-cigarettes contain propylene glycol and glycerol (purified vegetable glycerine) that are potentially toxic and may cause mouth and throat irritation. Some e-cigarette manufacturers now use distilled water and glycerine instead of propylene glycol vapour in an attempt to address such safety concerns. E-cigarettes may also contain toxins such as formaldehyde and heavy metals, such as chromium, aluminium, arsenic, copper, lead, nickel and tin, all of which cause adverse health effects, including cancer. In some cases, these metals have been detected at levels similar to, or greater than those found in tobacco.
Over 200 cases have been reported in the US and UK of e-cigarettes overheating, catching fire or exploding, causing serious and in some cases life threatening injury, disability and disfigurement.
While the risks of passive smoke to bystanders are considered to be lower with e-cigarettes than conventional cigarettes. Studies have demonstrated that e-cigarettes expose both users and bystanders to particles that can cause adverse health effects, especially to those who have existing chronic disease. The WHO has warned that any level of exposure to these particles may be harmful and should be reduced. Exposure to heavy metals such as nickel and silver may be greater than in conventional cigarettes.
eCigarettes and the law
Currently, it is illegal to sell, use or possess electronic cigarettes that contain nicotine. In the meantime, it might be possible to import nicotine for use in an e-cigarette if people are able to comply with the Therapeutic Goods Personal Importation Scheme that, among other things, requires a medical prescription. Some doctors, however, might not be willing to prescribe a product that remains unapproved in Australia.
Also, consumers should always double check with relevant government departments before ordering nicotine products online to see if there are any legal restrictions prohibiting the importation, or use, of nicotine products in their state or territory.
In most cases it is legal to sell electronic cigarettes that do not contain nicotine provided the products are not promoted with ‘therapeutic’ claims stating they can assist people to quit smoking tobacco cigarettes.
As it is illegal to sell a product that resembles a tobacco product in South Australia, New South Wales and Western Australia, many e-cigarette brands are likely to fall in this category.
Queensland and New South Wales, the only states with laws specifically targeting the sale and use of e-cigarettes, prohibit the sale of e-cigarettes to minors or displaying the products in retail stores. In Queensland and Victoria, e-cigarettes are also banned in smoke-free places. The restrictions also extend to non-nicotine products and will also apply to any nicotine product approved by the TGA in the future.
Last Reviewed: 04/09/2019
Your Doctor. Dr Michael Jones, Medical Editor.
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