What a doctor learned from a visit to an e-cigarette store

From gas stations to grocery stores, slender cylinders of nicotine “e-juice” seem to be available everywhere. On my drive to work, in fact, 2 new e-cigarette shops have opened their doors in just the last 3 months. So I was not surprised to read a recent report suggesting a rise in the number of teens trying e-cigs.

E-cigarettes deliver nicotine by heating nicotine-containing fluid into a vapor that is inhaled. A user does not “smoke” an e-cig, they “vape.” The devices and e-juice are not regulated by the FDA, have no age limitations to purchase, and are outside of current tobacco tax codes. Not only does this create the trifecta of quick and easy business pop-ups, it also creates a huge concern among docs who care for kids. Most would agree that unregulated and easy access to nicotine — one of the most addictive stimulants on the planet – is not good.

I try to learn about new fads and trends, within reason, in order to more effectively coach my teen patients on healthier lifestyle choices. E-cigs are no exception. So for the sake of my own curiosity and honest education, I dropped into the newest vape shop near my office to learn from a user and expert.

The owner of the small shop was generous with his time and information. He shared his expertise of 3 years in vaping after a 10 year love of Marlboro reds. After full disclosure of my purpose and intent, he showed me the devices and explained how they worked along with the selection of e-juice flavors proudly made by his own hand.

As I chatted with my friendly e-cig enthusiast, one theme kept recurring. Despite the faddish popularity and more “mainstream” availability, the vast majority of his vaping clients have been using e-cigs for years. In fact, most of his customers were using the nicotine delivery device to replace former addictions to tobacco smoking. The owner himself started vaping to get off cigarettes, proudly claiming, “I’ll never touch another Marlboro, but I’ll never stop vaping.”

His offhanded comment pointed squarely to part of the e-cig debate. Although little reproducible research exists, common sense dictates that inhaling a vapor of inert agents holding a calculated amount of nicotine may be less harmful to the user than traditional tobacco smoking with all its known carcinogens. Those who vape believe it is a better alternative to tobacco smoking.

The problem, however, is that nicotine is nicotine is nicotine. Just like the experience of my vaping friend, regardless of how it is consumed, addiction often remains. The difference, however, is rather than sporting yellow-stained fingertips and chimney-like breath, addicted vapers carry hot pink bedazzled tubes filled with tutti-frutti laced liquid.

Current medical evidence cannot recommend one addiction over the other.

I as stood in the shop, I continued to listen to the kind man’s enthusiastic stories explaining his hobby and craft. He would frequently pause to inhale from the e-cig hanging around his neck on a light blue lavaliere. Vapor slowly, nearly constantly, listed from the corners of his mouth.

From the other side of his display counter, the exhaled vapor of polyethylene glycol was barely noticeable. Almost pleasant. A faint tutti-frutti was all I smelled.

That’s when it hit me.

Do I believe that e-cigs create a dangerous illusion that could create a new generation of nicotine-addicted? Absolutely.

Am I concerned that young people will be enticed to experiment with these gadget-like devices under the false pretense they are a “safe” smoking alternative, or use the device to consume other dangerous drugs?Absolutely.

But for a parent who has an existing psychological and physical addition to nicotine, would I rather them vape than smoke cigarettes around my young patients?

I might.

Natasha Burgert is a pediatrician who blogs at KC Kids Doc.

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  • castello

    You might? Orders of magnitude safer than smoking!

  • Frank Lehman

    And as a parent (or spouse or son/daughter or friend or whatever) of someone who has an existing psychological and physical addition to nicotine, would I rather them vape than smoke cigarettes ?

    I find it very easy to answer that question with one word: yes

  • Suzi Q 38

    I thought I saw a display of these at Costco….

  • Mark S.B.

    10 year from now we will hear these e-cigs cause some strange cancer.
    Its all the same no matter how you ingest it, nicotine is nicotine .
    Back many year ago the company I worked for had meetings on Friday.
    Then cigarette smokers where able to smoke in the meeting putting others at risk of second hand smoke and risk of lung cancer.
    When I was a kid I watched a uncle of mine die of lung cancer from smoking cigarettes. It scared me as a kid to see him suffer and scream from the pain. He made me promise I would never smoke, he kept a empty package of Lucky Strikes by his bedside and showed it to me every time I saw him.
    I will never forget the smell of that room he stayed in at my grandma’s house. That smell of rotting lungs when he coughed. Then it got to where he could not draw oxygen in his lungs and basically died from not being able to breathe.
    Do whatever is necessary to stop your intake of nicotine however it be.

    • Scott Ballentine

      Nicotine, as confirmed by the FDA and the CDC, does not cause cancer – it is a mild stimulant like caffeine. The cancer causing agents in Tobacco smoke come from the burning of the tobacco leaf itself.

  • reneeh63

    Has it been shown that second hand vape smoke contains significant amounts of nicotine? Has it been shown that this level of second hand nicotine is dangerous? Don’t condemn without advocating for research.

  • http://briarcroft.wordpress.com/ Emily Gibson

    As a physician, how can I ethically recommend this unregulated inhaled nicotine delivery system over other regulated nicotine replacement systems? Until e-cigarettes are studied extensively, tested over time and found not to have passive effects to others nor hazardous effects to the user (propylene glycol is certainly a toxin), they have no place in my smoking cessation recommendations. Of course vaporized substances other than nicotine are being sold to use in these devices, so this is yet another way for addiction to become socially acceptable and attractive for all ages. Just what society needs.

    • gwen rothberg

      Bear in mind there is a HUGE difference between the cartridge e-cigs (with blue tips or other light ups) that are made premixed in China and imported – vs. the vape sold and made here that contains exactly 3 ingredients. The cartridge e-cigs have already been evaluated extensively and have many of the same toxic compounds as traditional cigarettes, hence the desire by big tobacco to ‘own’ the technology of that delivery system. The mom and pop vape shops could stand oversight but generally I have found that they are vigilant about their juice, and we have yet to hear of any cases of bad juice outcomes. We need someone other than big tobacco to fund more research so we can see if this is really a viable alternative.

    • Eric Young

      Propylene glycol is a toxin? You may want to research that… Like the studies done by the CDC when they were developing aerosolized antibiotics in the event of a biological attack. Or all of the hospitals that use aerosolized propylene glycol as an antimicrobial… or the number of foods with propylene glycol as a preservative…
      I can tell you that I have not had a single respiratory illness since I started vaping 4 years ago. Not a single cold, cough, or sore throat in 4 years.

  • Scott Ballentine

    Healthcare regulation and ordinances – like banning smoking in public places – have been made after determination that there is a harm to the public. In the instance of smoking that harm was found to be secondhand and side-stream smoke. Neither is present in a harmful way with electronic cigarettes.

    I started smoking at 16 when an older friend that I hung out with started. I smoked a pack+ a day for 30 years with a few periods of non-smoking but those cessation attempts were invariably short-lived. I tried nicotine gum and the patch. Neither worked because they did not address the fact that I actually liked the sensation of smoking. The ritual of it – I smoked pipes and cigars occasionally over the years as well. Since I picked up my electronic cigarette I have not touched a cigarette. Not only have I stopped smoking but my wife, my adult daughter and several friends have stopped smoking. Vaping has not only saved my life but it has saved my family.

    I urge you to not give in to the pharmaceutical industry and various ‘health groups and foundations’ who have a large financial stake in smoking prevention. They try to stop electronic cigarettes because e-cigs interfere with these group’s financial bottom line.

  • Alex Carlson

    Nicotine is not measurable exhaled from a vaper. You ingest more nicotine from eating a potato or tomato or any plant in the night-shade family than you do in a room full of un-ventilated vapers.

  • TOM K.

    If you want to find something more adaptive & dangerous for youngsters, look no further than your medicine cabinet. Or for adults for that matter. With all those nasty side effects.

  • civisisus

    Given the extraordinary volume of e-cig enthusiasts showing up to post comments about this KevinMD article, I’m just gonna go ahead & surmise that at least a few entries come from people with a pecuniary motive as well as a healthiness testimonial regarding the product.

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