Nicotine3Dan2I was horrified to see e-cigarettes associated with the word ‘healthy’ in a store near me recently. They are not. It is undisputable that nicotine is highly addictive and that there is a risk of poisoning with its use. The question is does this harm outweigh the benefits if e-cigarettes reduce smoking? The evidence that e-cigarettes do lead to a long term reduction in smoking and lung cancer and not to an increase in nicotine addiction and in smoking has yet to be seen so we can't say at this stage. Because of their hazardous and addictive content, E-cigarettes regulations should make sure that the product is properly labelled and packaged to protect children and other vulnerable groups.

(Photo- Nicotine molecule, Credit: Fuse809 at English Wikipedia)

Nicotine is a stimulant and a depressant. Nicotine in high doses can result first in stimulation- nausea, vomiting, high blood pressure seizures then by a depressant effect – slow heart rate, hypotension, and even coma. It is easily absorbed through skin. The nicotine in an e-cigarette cartridge can range from 6 to 24 mg of nicotine, but sometimes can contain more than 100 mg. (0.5-1.0 mg per kg of weight of the person is enough to kill). 24 mg is enough to kill a small child (WHO figures). It seems to me that with a liquid formulation you have accidents waiting to happen.

The harm of e-cigarettes is illustrated by a paper from the CDC that says calls about e-cigarettes to US poison centres now account for over 200 calls per month in 2014 rising from one a month in 2010. Traditional cigarette calls account for 300-500 calls a month with more in summer months and don’t appear to have decreased as e-cigarette use has risen.

The e-cigarette calls are more likely to be associated with adverse effects, most commonly nausea and vomiting (57.8% versus 36.0%) and they involve both children under 5 (51%) and adults over 20 (42%) while traditional cigarette calls were primarily about children. With traditional cigarettes the most common event appears to be ingesting a cigarette (94.9%). With the e-cigarettes, ingestion is still most common at 68.9% of calls but patients were also inhaling the nicotine (16.8%) or and being exposed through skin (5.9%) and eye contact  (8.5%).

A rise in poisonings has also been recorded in the UK and in Sweden according to the Guardian. And  according to the Times of Israel, at least one child has died from an overdose. 

The CDC says “the public should be aware that e-cigarettes have the potential to cause acute adverse health effects and represent an emerging public health concern.” 

Labelling regulations and tamperproof packaging could prevent some of these poisonings by raising awareness of users to the risks and making it harder for children to access the liquids. The EU has already produced some regulations banning higher nicotine devices, and preventing advertising in line with other tobacco products which will come into force in 2016. That is a step in the right direction. The FDA is still considering regulation.

CABI's Global Health database is accumulating records on e-cigarettes and public health. To sign up to a newsletter and to try the database visit Global Health Knowledge Base.


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