E-cigarettes seem to be a very popular product these days, so I thought I’d do a bit of research to figure out what the heck an e-cigarette is and to try to answer the question, “Are e-cigarettes safe?”

It appears that the primary reason people use e-cigarettes is to avoid smoking, either as a way to get their nicotine in areas where smoking is prohibited, or as a means to try to quit smoking.  E-cigarettes are not FDA regulated as a drug because they are not marketed as a drug to help quit smoking.  This has several consequences, foremost of which is that if you buy e-cigarettes you really don’t know with confidence that what you are getting is nicotine, how much nicotine you are getting, and what non-nicotine contaminants the e-cigarette cartridges contain.  To be fair, I guess this is less of a crap-shoot than smoking cigarettes where you know there are lots of other inhaled chemicals, toxins and carcinogens along with the tar and nicotine.

In the simplest sense e-cigarettes are just a device that vaporizes a solution of a liquid like propylene glycol or glycerin mixed with nicotine and often other flavoring compounds. This allows the vapor to be inhaled and the nicotine absorbed into the blood stream just like the nicotine in tobacco smoke.  Some e-cigarettes are disposable but most are reusable and are used with a cartridge of nicotine solution which when empty can be replaced by a refill cartridge.

The theory that e-cigarettes are safe is based on the assumption that by avoiding the smoke and known carcinogens in tobacco smoke the user is avoiding most of the risk of smoking cigarettes.  In fact there is no solid evidence that e-cigarettes are either safe or unsafe.  The liquid bases are commonly user are considered  “Generally Recognized as Safe” by the FDA.  E-cigarettes are also considered to be far less dangerous as sources of second hand exposure because there is essentially no sidestream smoke being dispersed into the environment.

E-cigarettes are most popular as a means of quitting or reducing smoking, or by smokers as a way to get their nicotine without smoking.  There is no well controlled and peer-reviewed study of the safety or efficacy of e-cigarettes as a smoking cessation tool.  The FDA considers them a tobacco product.  An FDA analysis did find in an analysis of several e-cigarette products various tobacco-specific carcinogens as well as in at least one product diethylene glycol, an antifreeze product that has been found as a counterfeit substitute for glycerine in other products like toothpaste which has killed users in other countries.

So what do I think of e-cigarettes?  I think there are better ways to quit smoking.  If a smoker wants to use e-cigarettes as a way to transition from tobacco to non-smoked nicotine and then to quit smoking I cannot say that this is a bad choice, but rather that I think there are better choices.  Part of the reason to use nicotine replacement systems is to break the habit of smoking, and it seems counter-intuitive that switching to an e-cigarette which is the closest simulation of smoking of any of the nicotine replacement products is the best choice to help  in that process.  With other products like patches or gum the user quits the physical and mechanical activity of picking up a cigarette and inhaling the nicotine yet avoids nicotine withdrawal.  With e-cigarettes the user simulates smoking and gets nicotine.

It does concern me that e-cigarettes are marketed with flavors that seem to target non-smokers.  I doubt most smokers would choose cherry-vanilla flavor e-cigarettes.  Hopefully there is not a burgeoning population of e-cigarette addicts starting this habit because they believe it is safe and find the flavors complement their latte or are a good substitute for high-calorie treats.

So, are e-cigarettes safe?  Undoubtedly no, but.  The “but” is included because when compared to cigarette smoking nearly anything is relatively safe.  Although there is no data to prove it, I suspect that smoking e-cigarettes is far less dangerous than smoking tobacco cigarettes.  My guess is that the risk of cancer is much lower, the risk of COPD at least moderately lower, but the risk of cardiovascular disease probably not much lower.  Of course this is just my hypothesis, and it will likely take large retrospective studies over many years to sort out the real issues.  We live in interesting times.

Edward Pullen is a family physician who blogs at DrPullen.com.