Some of the concerns about smoking include cancer, nicotine, tar and carbon monoxide.  I have had several patients recently ask me if e-cigarettes would help them quit smoking tobacco, so I started looking into the data (and there’s lots of it out there – both pro and con).  Obviously, this is a very complicated topic and this blog entry should not serve as your only source of information.

Smokeless cigarettes have been around for years.

As reported recently in Consumer Reports, E-cigarettes are pitched as a smart alternative to tobacco cigarettes that are safer and a good bridge to quitting smoking, and even House Speaker John Boehner (R-Ohio) has reportedly been seen using one.

Although they were first marketed in the 1960s, the industry really caught on in 2005 when China started exporting them, and the demand has grown steadily since then to about $1.5 billion in 2013.

The device works through a battery that is activated when a person draws on the pipe.  This heats a nicotine cartridge, which then turns the nicotine into a vapor that is inhaled.  The user then exhales a cloud that quickly evaporates.

What does nicotine do?

The reason cigarettes are highly addictive is nicotine.  Nicotine is a stimulant that makes the blood vessels in the body constrict.  When this happens, it becomes difficult for the blood to travel though out the body.  The heart is forced to work harder to pump the blood.  The longer a person smokes, the greater the risk that the smoker will develop heart disease or high blood pressure, both of which can cause a heart attack or stroke.  The average cigarette in the United States contains about 9mg of nicotine. However, this is not the amount of nicotine that is ingested by the smoker. Cigarettes are burned and the smoke is inhaled by the person, so the nicotine is absorbed through the smoke. The amount of nicotine that actually enters the body in this manner is typically less than 1mg.

Nicotine can not only cause back pain but also prevent spinal injections from working as well as they do in non-smokers

There is growing evidence that the nerve pain that comes with sciatica and bulging discs is due to a reduced blood supply to the nerve.  So, since nicotine is a potent constrictor of blood vessels, the nerves have even more difficulty getting oxygen and nutrients.  This makes it much harder for epidural steroid injections to do their job and delays healing.

Tar is a sticky brown substance that irritates the windpipe and damages the tissue of the lungs,  It stains the teeth and keeps food from tasting as good as it does for people who do not smoke.

Carbon monoxide is a gas that takes the place of oxygen in the smoker’s blood.  When this happens, the smoker becomes very tired.

Safety concerns of e-cigarettes

While E-cigarettes don’t have tar or carbon monoxide in them, they might contain other worrisome chemicals.  A 2009 study by the Food and Drug Administration detected a dangerous chemical called diethylene glycol, which is used in antifreeze, in two brands of e-cigarettes.  And in some cases, it’s unknown what is used in the flavors of some cartridges.

E-cigarettes have some other safety concerns as well.  As reported in the New York Times in March 2014, there is unease over the use of the concentrated liquid nicotine vials to fill the e-cigs.  These liquids are apparently not regulated by federal authorities and pose specific risks to children.

Medical studies support both sides

So, with that background information, let’s look at whether these e-cigarettes can help smokers kick the habit.  In short, there are studies supporting both sides, so the jury is still out.  On the plus side is a study out of University College London in the UK, published in the journal Addiction, found that, among people who are trying to quit without professional help, those who use electronic cigarettes are 60% more likely to succeed, compared with those who use willpower or nicotine replacement therapies.

On the con side, there was a New Zealand study published in The Lancet of 657 smokers, e-cigs were about as effective as nicotine patches in helping people stop smoking after 6 months.  And a study from the University of California at San Francisco studied 40,000 youth around the country, and found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit.

What about carcinogens?

Lastly, there is the issue of carcinogens, which are any substances that are directly involved with causing cancer.  According to the Journal of the National Cancer Institute, there are 20 known carcinogens in tobacco smoke that convincingly cause lung tumors in laboratory animals or humans.  Nicotine is not yet considered to be one of those carcinogens.  If fact, the FDA recently relaxed restrictions on many nicotine products in November 2013.

So what about e-cigarettes?  Are they are safe?  There are many who say there is no cancer risk with using them since they are smokeless.  But, a recent paper in the journal Oncotarget details how nicotine is proving to be a formidable carcinogen.  In this research, compiled at Virginia Tech, the investigators caution that nicotine-infused cessation products may not be the safest way to help smokers quit.

What do the numbers on the nicotine cartridges mean?

Most cartridges come in 24mg/ml, 18mg/ml, 12mg/ml or 6mg/ml strengths.  But sometimes the liquids have a percentage on them.  That means, if the bottle says 1.2%, the solution contains 12mg/ml.  So, a 10ml bottle of 1.2% solution contains 120mg of nicotine.  And if you’re counting drops, there are roughly 20 drops in 1 ml.

So, in summary, it is evident that more research is needed.  Until then, my advice would be to work with your physician to come up with a plan that will work the best for your situation.  And, if you do use e-cigarettes, be careful when choosing the strength of nicotine cartridge.