Dr. Richard Hurt: Prudence demands restrictions on e-cigarettes
As a practicing physician, I have devoted much of the past 30 years to studying and treating patients with nicotine addiction. At the Mayo Clinic Nicotine Dependence Center, we have developed a model of treating tobacco dependence, which has been emulated around the country and in many other parts of the world.
We have received many questions about "e-cigarettes," which probably are better designated as electronic nicotine delivery devices. E-cigarette use has exploded in popularity here in Minnesota and elsewhere, with many people saying they're using them to quit or reduce their smoking.
The ultimate role e-cigarettes will play in helping smokers stop smoking conventional cigarettes is simply not known yet. Initial studies have drawn different conclusions about their effectiveness as an aid to help people stop smoking, with the most credible suggesting they may not be especially useful for this purpose.
E-cigarettes have not been approved by the FDA and no treatment protocols exist for using them to help smokers stop. Moreover, promotions for the devices (which in many cases are made by the same tobacco companies that sell conventional cigarettes) advocate that they be used recreationally or as a way around smoke-free policies.
Time will tell if they may someday be a tool for helping smokers quit, but for the moment there is not scientific consensus around that point.
Research on the effects of inhaling e-cigarette vapor also is in its early stages. Studies done so far suggest that vapor is indeed less harmful than the smoke of combustible cigarettes, but it's worth pointing out that it is not as safe as breathing clean air. Studies have found metals and toxic chemicals in the vapor.
There's no regulation of e-cigarette manufacture, and because individual shops may use different "recipes" to make the solutions, it's impossible to speak definitively about what chemicals they contain. And of course, because they are so new to the scene, any long-term effects of breathing the vapor can't be known yet.
In the Minnesota Legislature, lawmakers have proposed updating the statewide smoke-free law so that it applies to e-cigarettes. This move is a scientifically prudent one, and is consistent with what we do know about e-cigarettes.
First, while many smokers say they are using e-cigarettes to try to quit, in fact at this time we know that most e-cigarette users are also still using combustible tobacco products, too. The relationship between smoking and e-cigarettes is not yet fully understood, but research shows dual use of different types of tobacco products can make it more difficult — not easier — to quit.
Smoke-free policies such as the Freedom to Breathe Act, on the other hand, are proven to move smokers away from tobacco, by making tobacco use less convenient and quitting more desirable.
Second, allowing e-cigarette use in public creates a positive association around smoking-type behaviors not seen in our state since the smoke-free law was passed seven years ago. This is of special concern when it comes to children.
There has not yet been sufficient study on the role e-cigarettes may play in youth tobacco initiation, but we know they do have appeal for kids. Data from the CDC show a recent uptick of e-cigarette use by school-aged students who do not smoke, and an even larger one by youth who use both combustible and e-cigarettes.
The fact that e-cigarettes are sold in candy flavors (a ploy that we know, from secret tobacco industry documents released through the Minnesota tobacco lawsuit, was deliberately used to hook children on tobacco in the past) makes this even more worrisome. Obviously, children becoming addicted to nicotine is something any reasonable person should want to prevent.
It likely will be years before scientific consensus around e-cigarettes is reached. In the meantime, keeping them out of public spaces where clean air is protected is a reasonable, justified approach.
Dr. Richard D. Hurt is a professor of medicine and emeritus director of the Nicotine Dependence Center at Mayo Clinic.