As a physician taking care of a largely HIV positive population in Baltimore, Maryland in the early 2010s, I was surprised to learn that many of my patients who were about my age or a few years older than myself were coming down with strokes and heart attacks. I still remember one gentleman who in his 40s had already had 3 heart attacks and was fortunate to live to tell the tale.
The point of this short tale is that tobacco use is still by far the commonest cause of preventable deaths in most communities including people living with HIV. The diseases related to smoking include heart disease, lung damage and strokes, as well as many cancers including lung, throat and bladder cancer to name just a few. In those days I quickly became the smoking cessation campaigner for our clinics. I did start a drive to get as many of our patients and clinic staff who smoked to quit the habit and some of our staff successfully quit the habit. Yes there were some strugglers. We systematically offered as many patients as possible supportive counseling and medication support to help them quit.
That was when I started getting questions about these nicotine devices which in those days looked very much like cigarettes but were said to dispense nicotine without the cancer causing tar compounds. My first reaction to these was to lump them in with cigarettes, because they looked too much like cigarettes to effectively help with the psychological part of dependence on nicotine from cigarettes. This question has been studied in different settings over the years and so far the evidence appears to suggest that they are inferior compared to other methods for those who want to quit smoking. There have been some studies that did suggest it did help some quit, but overall the results are inconclusive, so the research will go on, because that is what researcher do, they try to figure things out.
I remember being asked what we should do about people using those nicotine vapor devices in our clinic waiting rooms which were non-smoking areas. The answer was easy for me, “a blanket ban on anything that looks like smoking”, we could not make it our jobs to inspect everyone to determine which was tobacco and which was plain nicotine. Moreover at that time nobody knew how safe these devices were anyway.
Today, many cases of vaping related illness have been reported nationwide, according to the Center for Disease Control and Prevention (CDC) as at today there are close 1299 cases in 1 US territory, Washington, DC and all 49 states except Alaska and 26 deaths in 21 states.
US Map Showing States with Cases of Vaping Related Illness Reported to CDC
The deaths so far have not been identified as related to any specific constituent of these devices. Some of the reported deaths were related to cartridges that had Tetrahydrocannabinol (THC) the active hallucinogen in cannabis. Some have reported that high levels of Vitamin E in some cartridges were responsible for the reported vaping related illness, but this is still inconclusive.
There are many reasons why the health effects of these nicotine and other vaping devices are going to be difficult to effectively evaluate in large population studies.
- Doses would be difficult to quantity since these devices differ significantly in relative composition of the chemical components
- Companies in this market are numerous and their products have never been regulated in the past.
- In this unregulated market there are some unregistered producers doing their own thing in garages using constituents from our favorite mass production market China.
- Individual users are most probably not sticking to any specific manufacturer and may be unable to identify “bootleg” products and many are using regular cigarettes as well.
The products on the market today come from multiple manufacturers with a few unregistered manufacturers using constituents from different sources including China. Juul is the obvious leader in this market with $1.3 billion in revenue in 2018 and revenue forecasts of $3.4 billion for 2019. The products are reported by the producers to be targeted towards adult smokers looking for a safer option, however the explosive market growth is likely to be due to young adults and teenaged non-smokers attracted to flavors like mango, cherry, mint and fruit.
- Whilst some of these e-cigarettes may appear safer than regular tobacco for young non-smokers rates of nicotine addiction with these agents could be faster on account of the ease of nicotine delivery
- Parents should be more careful and get to know what their kids are doing, if your child has a credit card or debit card make sure you track what they are buying.
- Make sure to check all “USB flash drives” that your teens or young adults may be using since some may be vape devices.
- If you smoke be aware that using e-cigarettes may be safer than continuing smoking, but make sure you stick to cartridges from known companies that you have experience with. The safety of these devices is still not well characterized and though not guaranteed the big companies have an advantage in their products having been tested informally on more individuals.
I would like to end by saying that the safety of these agents are not fully understood though most believe they may be safer than regular cigarettes. At this time though studies do not support the use of these as smoking cessation products when compared to other products like nicotine patch, gum or medications like Chantix and Zyban.
If you want to quit smoking use the link below to go to the CDC website and use the resources for smokers.
Dr. Leonard Sowah is an Internal Medicine Physician in Baltimore, Maryland
Last updated on October 16th 2019