The health effects of using electronic cigarettes are currently unknown. Several studies regarding the long-term health effects of inhaling nicotine vapor are currently in progress.
Please note the following health issues for electronic cigarettes:
- keep out of reach of children
- if you feel unwell please seek medical help immediately
- if swallowed seek medical advice immediately for health issues
- some people have an adverse/over sensitive to nicotine – please stop smoking and seek medical advice immediately
- in case of contact with eyes please rinse immediately with plenty of cold water and seek medical advice
- do not smoke whilst pregnant
- do not smoke if you have an ongoing medical condition
- all our products carry a warning label – please adhere to it
- if necessary please take a copy of the warning leaflet to the doctor
- if you have lost your warning leaflet please print off this screen
Food and Drug Administration (US)
In May 2009, the US FDA’s Division of Pharmaceutical Analysis tested the contents of 19 varieties of electronic cigarette cartridges produced by two vendors (NJoy and Smoking Everywhere). Diethylene glycol was detected in one of the cartridges manufactured by Smoking Everywhere. In addition, tobacco-specific nitrosamines (TSNAs) were detected in all of the cartridges from one brand and two of the cartridges from the other brand. The study found that the actual nicotine levels did not always correspond to the amount of nicotine the cartridges purported to contain.
The analysis found traces of nicotine in some cartridges that claimed to be nicotine-free. Further concerns were raised over inconsistent amounts of nicotine delivered when drawing on the device.
In July 2009, the FDA issued a press release discouraging the use of electronic cigarettes and repeating previously stated concerns that electronic cigarettes may be marketed to young people and lack appropriate health warnings.
In response to the FDA study, the Electronic Cigarette Association said that the testing was too “narrow to reach any valid and reliable conclusions.” The FDA’s study was reviewed in July 2009 by scientific consulting firm Exponent, Inc., in a report commissioned by the manufacturer of one of the electronic cigarettes tested by the FDA. Some of the criticisms in Exponent’s report are poor standards of documentation and analysis. Exponent lists previous studies that have detected TSNA levels in FDA-approved nicotine replacement therapy products comparable to those the FDA detected in their study, and objects to the FDA making no comparisons to such products in their analysis of electronic cigarettes. Ultimately the review concludes that the FDA’s study did not support the claims of potential adverse health effects from the use of electronic cigarettes.
American Association of Public Health PhysiciansThe American Association of Public Health Physicians has come out in support of electronic cigarettes. The AAPHP recommends that the FDA reclassify the electronic cigarette as a tobacco product (as opposed to a drug/device combination) and believes that the effects of second-hand smoke will be significantly decreased using electronic cigarettes.
Health Canada
On March 27, 2009, Health Canada issued an advisory against electronic cigarettes. The advisory stated “Although these electronic smoking products may be marketed as a safer alternative to conventional tobacco products and, in some cases, as an aid to quitting smoking, electronic smoking products may pose risks such as nicotine poisoning and addiction.”
World Health Organization
The World Health Organization proclaimed in September 2008 that it does not consider the electronic cigarette to be a legitimate smoking cessation aid, and demanded that marketers immediately remove from their materials any suggestions that the WHO considers electronic cigarettes safe and effective.
The WHO states that to its knowledge, “no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy. WHO does not discount the possibility that the electronic cigarette could be useful as a smoking cessation aid.” WHO Tobacco Free Initiative director ad interim Douglas Bettcher states, “If the marketers of the electronic cigarette want to help smokers quit, then they need to conduct clinical studies and toxicity analyses and operate within the proper regulatory framework. Until they do that, WHO cannot consider the electronic cigarette to be an appropriate nicotine replacement therapy, and it certainly cannot accept false suggestions that it has approved and endorsed the product.”
In 2010 the Tobacco Regulation meeting scheduled and held in Uruguay was under heavy pressure to come out with negative warnings about electronic cigarettes. The pressure came from signatories to the treaty who had banned electronic cigarettes, mainly Canada, Brazil, Thailand, Hong Kong and Saudi Arabia.
The Secretariat of the meeting refused and stated that electronic cigarettes do not violate articles 9 and 10 of the framework convention for tobacco control regarding COMPOSITION (toxins, carcinogens, harm to self) or EMISSIONS (Second hand smoke or harm to others). The secretariat stated that the problems regarding electronic cigarettes relate to regulatory issues and not to the work that the convention is tasked with. In the memo they also mentioned that they can be considered medical product only IF the marketer wanted to make medical claims, otherwise they are a tobacco product.
Health New Zealand Ltd. studyIn 2008, Dr. Murray Laugesen, of Health New Zealand, published a report on the safety of Ruyan electronic cigarette cartridges. Ruyan funded the research, but both Dr. Laugesen and the WHO claim that the research is independent.
The presence of trace amounts of TSNAs in the cartridge solution was documented in the analysis. The results also indicated that the level of nicotine in the electronic cigarette cartridges was not different from the concentration of nicotine found in nicotine patches. John Britton, a lung specialist at the University of Nottingham, UK and chair of the Royal College of Physicians Tobacco Advisory Group said “if the levels are as low as in nicotine replacement therapy, I don’t think there will be much of a problem.”[18] The study conducted detailed quantitative analysis and concluded that carcinogens and toxicants are present only below harmful levels. The final conclusion of the safety report is: “Based on the manufacturer’s information, the composition of the cartridge liquid is not hazardous to health, if used as intended.”
Boston University School of Public Health study
A study done by researchers at the Boston University School of Public Health in 2010 concluded that electronic cigarettes were safer than real cigarettes and may aid in breaking the habit of smoking. The researchers said that while further studies on electronic cigarettes are needed, “few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns.” Electronic cigarettes were found to be “much safer” than traditional tobacco ones, and had a level of toxicity similar to existing nicotine replacements
In the report, the amount of carcinogens in electronic cigarettes was found to be up to 1,000 times fewer than regular cigarettes. It also said early evidence shows that electronic cigarettes may help people to stop smoking by simulating a tobacco cigarette.
Harm Reduction
Manufacturers promote electronic cigarettes as a safer alternative to smoking cigarettes by claiming that most of the harmful material produced by the combustion of tobacco in traditional cigarettes is not present in the atomized liquid of electronic cigarettes. Despite claims that electronic cigarettes are safer, because they contain no carcinogenic substances, manufactures include warning labels with their products, because they contain nicotine.
According to Cancer Research UK, “For a smoker, the health hazards of continuing to smoke greatly outweigh any potential risks of using nicotine replacement therapy”.
It may be worth noting, however, that while electronic cigarettes are purported to deliver nicotine to the user in a manner similar to that of a Nicotrol inhaler, no electronic cigarette has yet been approved as a medicinal NRT product or provided the necessary clinical testing for such approval. Moreover, doubts have been raised as to whether electronic cigarettes actually deliver any substantial amount of nicotine at all.
Though manufacturers have marketed electronic cigarettes as a way to curtail an addiction to nicotine, international health organizations have stated they may not be marketed as a cessation device.
A number of regulatory agencies have issued warnings regarding the health effects of these products. The recently formed Electronic Cigarette Association aims to eliminate unsubstantiated health claims made by electronic cigarette companies, and those companies that wish to participate in the association must agree to refrain from making such claims.
In a recent online survey from November 2009 among 303 smokers, it was found that e-cigarette substitution for tobacco cigarettes resulted in reduced perceived health problems, when compared to smoking conventional cigarettes (less cough, higher ability to do exercise, and a better sense of taste and smell).
Legal Status by Country
Because of the relative novelty of the technology and the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation and public health investigations are currently pending in many countries.
In China the sale and use of electronic cigarettes is legal. But tobacco cigarettes are so cheap that relatively few Chinese are using e-cigs.
In United Kingdom the sale and use of electronic cigarettes is legal, and they are sold in many pubs where they can also be used indoors.
In South Korea the sale and use of electronic cigarettes is legal, but heavily taxed.
In New Zealand, the Ministry of Health has ruled that the Ruyan e-cigarette falls under the requirements of the Medicines Act, and cannot be sold except as a registered medicine. Ruyan has obtained registration and sale is currently allowed in pharmacies
In Denmark, the Danish Medicines Agency classifies electronic cigarettes containing nicotine as medicinal products. Thus, authorization is required from the retailer before the product may be marketed and sold. The agency has clarified, however, that electronic cigarettes that do not administer nicotine to the user, and are not otherwise used for the prevention or treatment of disease, are not considered medicinal devices. The use of electronic cigarettes has not been prohibited in Copenhagen Airport, but at least one airline (Scandinavian Airlines) has decided to ban their use on board flights.
In Norway electronic cigarettes and nicotine can only be imported from another EEA-country (f.ex. the UK) for private use. I.e. what is allowed in another EEA-country is automatically allowed all over the EEA (Norway is a EEA country, not EU). So, obtaining electronic cigarettes for personal use is permitted from any country within the European Economic Area.
At present, the contracting parties to the EEA Agreement are the EU and its 27 members plus Iceland, Liechtenstein and Norway. See European_Economic_Area.
In Finland, as of July 2008, cartridges containing nicotine are illegal to sell or to purchase with intent to sell but are not illegal to purchase from overseas sources for personal use. However, obtaining products within range of the European Economic Area is permitted.
In Australia, “According to a spokesperson for the Federal Department of Health and Ageing, every form of nicotine except for replacement therapies and cigarettes are classified as a form of poison.” However, in the state Victoria, Australia, “A spokeswoman for the Therapeutic Goods Administration said there were no laws preventing the importation of such products (e-cigarettes) bought over the internet for personal use, unless prohibited by state and territory legislation.”
In Brazil electronic cigarettes sales, importation or advertisement of any kind are forbidden. Anvisa, the Brazilian health and sanitation federal agency, found the current health safety assessments about e-cigarettes not to be yet satisfactory to make the product eligible to be approved for commercialization.
In Canada, as of March 2009, imports, sales, and advertising of Nicotine containing electronic cigarettes are banned, otherwise non nicotine containing products are legal and allowed for sale and advertising. In March 2009, Health Canada also advised Canadians not to purchase or use any electronic smoking products. Health Canada cited the Food and Drugs Act, stating that electronic smoking products containing nicotine require market authorization before they can be imported, marketed, or sold. No market authorization has been granted for any electronic smoking product.
In Netherlands, use and sale of electronic cigarettes is allowed, but advertising is forbidden pending European Union legislation.
In Panama, importation, distribution and sale has been prohibited since June 2009. The Ministry of Health cites the FDA findings as their reason for the ban.
In Singapore, the sale and import of electronic cigarettes, even for personal consumption, is illegal. This is due to some law they have regarding fake products, and they consider Electronic cigarettes a fake cigarette
European Union
Directive 2001/95/EC(6) on general product safety applies in so far as there are no specific provisions with the same objective in other EC law. This directive provides for restrictive or preventive measures to be taken if the product is found to be dangerous to the health and safety of consumers.
Whether ecigs could be regarded as falling under Directive 93/42/EEC on medical devices depends on the claimed intended use and whether this intended use has a medical purpose. ”It is for each national authority to decide, account being taken of all the characteristics of the product, whether it falls within the definition of a medicinal product by its function or presentation.“
United States
The Food and Drug Administration (FDA) has classified electronic cigarettes as drug delivery device and subject to regulation under the Food, Drug, and Cosmetic Act (FDCA). As a result, they require market authorization prior to importation and sale into the country. This classification was overruled by Judge Richard J. Leon citing that “the devices should be regulated as tobacco products rather than drug or medical products” “. Leon continued, saying “This case appears to be yet another example of F.D.A.’s aggressive efforts to regulate recreational tobacco products as drugs or devices”.
However, in March 2010, a US Court of Appeal Stayed the injunction until the appeal is heard. The FDA argued the right to regulate electronic cigarettes based on their previous ability to regulate nicotine replacement therapies such as nicotine gum or patches. Further, the agency argued that tobacco legislation enacted last year “expressly excludes from the definition of ‘tobacco product’ any article that is a drug, device or combination product under the FDCA, and provides that such articles shall be subject to regulation under the pre-existing FDCA provisions.”
The appeals court heard oral arguments on September 23rd 2010. On December the 7th, The appeals court ruled against the FDA in 3-0 unanimous decision, clearing the way for marketing of electronic cigarettes worldwide. The FDA is now in the unenviable position of having broken Judge Leone’s ruling before the judgment on the injunction by the appeals court, and will have to settle with njoy rather than go back to the district court for the balance of the case and end up publicly rebuked by the judge. The judge had issued a ruling that Electronic cigarettes are Tobacco products, and they ignored it and issued warning letters to the five manufacturers.
In addition to this, states have begun to consider either including electronic cigarettes in bans that affect tobacco or banning their sale entirely. California Governor Arnold Schwarzenegger vetoed a bill that would ban the sale of electronic cigarettes within the state on grounds that “if adults want to purchase and consume these products with an understanding of the associated health risks, they should be able to do so.”
Further, the state of New Jersey has recently sought to include the electronic cigarette under the New Jersey Smoke Free Air Act. One of the main justifications New Jersey Assemblywoman Connie Wagner seeks to use is the flavoring of electric cigarettes. On September 22, 2009, under the authorization of the Family Smoking Prevention and Tobacco Control Act, the FDA banned flavored tobacco (with the notable exception of menthol cigarettes) due to its potential appeal to children.
Ms. Wagner advocates that the use of flavorings such as chocolate could encourage childhood use and serve as a gateway to cigarette smoking. In addition to New Jersey, New Hampshire, New York and Pennsylvania have begun efforts to restrict electronic cigarette use in various forms.
New Hampshire’s reform campaign fits into its own dynamic and unique category. In New Hampshire a group of students, partnered with a group called “Breathe New Hampshire” petitioned the state government to ban the sale of electronic cigarettes to minors. While sale of electronic cigarettes to minors remains legal, some worry that electronic cigarettes will serve as a gateway to smoking cigarettes. One teen involved in the legal proceedings claims that her peers will see electronic cigarettes as similar to “having a new cell phone. It’s cool. It’s electronic.”
Arizona has a planned ban of selling electronic cigarettes to minors. In Washington State, the King County board of health has banned smoking of electronic cigarettes in public places, and prohibited sales to minors.
