The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.
These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.
But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.
Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.
“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”
Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.
In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.
“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”
The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.
Without proper precautions, like wearing gloves while mixing e-liquids, these products “represents a serious workplace hazard,” he said.
The nicotine levels in e-liquids varies. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet. A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.
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Electronic cigarettes ‘don’t aid quitting’, study says
But some researchers argue that it is too early to dismiss potential health benefits.
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Ina Fassbender/Reuters/Corbis
Electronic cigarettes deliver nicotine without smoke, but their health advantages have been controversial.
The controversy over electronic cigarettes has been reignited today with the publication of a study claiming that they do not help smokers to quit their habit.
Whether or not ‘e-cigarettes’ are an effective aid in the cessation of smoking has become a major issue for the rapidly growing industry that produces the devices, and for the tobacco researchers struggling to assess their impact. There is widespread agreement that inhaling from an e-cigarette, where a heating element vapourizes a liquid containing nicotine, is not as harmful as smoking a conventional cigarette, and proponents say that the products could save millions of lives. But some researchers and tobacco-control activists fear that the devices could make tobacco use seem socially acceptable again and may not assist people in actually reducing their addiction.
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E-cigarettes affect cells
Questions raised over health effects of devices.
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Electronic cigarettes have been investigated to assess their effects on gene expression.
Electronic cigarettes can change gene expression in a similar way to tobacco, according to one of the first studies to investigate the biological effects of the devices.
Presented at the American Association for Cancer Research annual meeting on 6 April in San Diego, California, the research looked at human bronchial cells that contained some mutations found in smokers at risk of lung cancer. The cells were immortalized, grown in culture medium that had been exposed to e-cigarette vapour and their gene expression profiled.
The researchers found that the cells grown in medium exposed to the vapour of e-cigarettes showed a similar pattern of gene expression to those grown in a medium exposed to tobacco smoke (S. J. Park et al. Clin. Cancer Res. 20, B16; 2014).
The changes are not identical, says study researcher Avrum Spira, who works on genomics and lung cancer at Boston University in Massachusetts. But “there are some striking similarities”, he says. The team is now evaluating whether the alterations mean that cells behave more like cancer cells in culture.
The work is at a very early stage and therefore cannot establish that e-cigarettes can cause cancerin vitro, let alone in vivo. “They may be safer [than tobacco], but our preliminary studies suggest that they may not be benign,” says Spira.
E-cigarettes are extremely controversial. Because they vaporize liquid containing nicotine, rather than burning tobacco, some researchers believe that the devices could greatly reduce the damage done to health by smoking; others, however, argue that they are simply ‘renormalizing’ smoking.
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