E-cigarettes: A secondary concern and a call for regulation

Pleasure and addiction.

E-cigarettes seem to be a way of reducing some of the harmful effects of normal cigarettes, as I outlined in a recent column. In these electronic devices a fluid is vaporized by a battery-powered heater, and the vapour is inhaled by the user. No tars or other cancer-inducing agents are produced. Understandably, this apparent increased safety of e-cigarettes has given rise to considerable interest. On the whole I feel these devices are a good thing.

Significant concerns remain, however, requiring careful government legislation. First of all, advertisers and marketers are targeting younger populations for these devices. Second, because children’s brains are still developing, these devices may cause problems we don’t realize yet. Finally, the liquid in e-cigarettes may contain dangerous amounts of nicotine; at this point the amount is not regulated.

Nicotine is the addicting agent in normal cigarettes that makes it difficult for people to stop smoking. Health Canada has banned including nicotine in the fluid used in e-cigarettes. For Canadians, e-cigarettes are technically only available with flavoured vapour containing no nicotine. They are used because of the pleasant flavour.

The reality, though, is that anyone who wants to get e-cigarettes containing nicotine will have very little difficulty. They are apparently widely available in the States and are a rapidly growing business even here in Canada (Google e-cigarettes on the internet).

What is in the fluid can be tailored to target particular populations; flavours that appeal to children can be added, such as bubble gum or candy. This is a concern as it may lead to a significant increase in the use of these devices among a population that we would like to keep away from the possibility of nicotine addiction.

As we do with alcohol, the access that children have to e-cigarettes can be limited by legislation. Only adults may buy alcohol; while the rules may not work perfectly, they speak to our concern about children’s alcoholic consumption. If the government decides to permit the sale of e-cigarettes containing nicotine, a similar restriction should be established. The developing brain reacts differently to nicotine, and we are not clear about the long-term consequences of early use.

Pleasure and addiction

A second concern has emerged with e-cigarettes. Unlike normal cigarettes, which are burned up when used, some e-cigarettes can be reused. For these versions you can buy a bottle of “e-liquid” to refill your e-cigarette. Currently, the content of e-liquid is not regulated, and the amount of nicotine can vary significantly. The total amount of nicotine in a single bottle is a particular problem.

Nicotine acts on the nicotinic acetylcholine receptor in the brain, and it is very potent. The average normal cigarette provides the user with about one milligram of absorbed nicotine, and for most people one (or two) cigarettes at a time is all they want. The activation of the acetylcholine receptor increases the activity of the brain’s pleasure neurotransmitter, dopamine, which makes nicotine addicting.

The concern with nicotine is that in higher amounts it can be fatal. There have been cases of people overdosing when smoking while also using a nicotine patch. Pharmacologists say that the lethal dose of nicotine is not too much higher than an amount that produces its positive effects. If a bottle of e-liquid were consumed as a liquid, the amount of nicotine in that bottle may be enough to be fatal. Spilling the liquid on skin could also be dangerous, as nicotine is absorbed into the body quickly.

This concern gets more serious considering that many varieties of the fluids used in e-cigarettes are flavoured, often with child-friendly flavours. Young children may not be aware of the danger in this nice-smelling and -tasting fluid. There have been increasing calls to hospital poison centers about children drinking e-liquid. The problem is made worse as there are no rules to control the packaging of the solutions (like child-proof bottles) or to regulate the amount of nicotine in the bottle.

Health Canada and the U.S. Food and Drug Administration need to provide a regulatory environment to make sure that the whole e-cigarette experience is one without these secondary consequences. One Christian perspective would maintain that it is the responsibility of the government to provide laws for the protection of its citizens. We should work together to make sure that good safety regulations are put in place to control what could become a very large industry.


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