E-Cigarettes 95% Safer Than Smoking – Public Health England Research and Recommendations

A recent study published by Public Health England has started virally circulating the web in the past 24 hours.  Many news sites have picked it up (I personally first saw the article tied from a Reuters article).  While it has been reposted/shared/mentioned all across social media, I decided to take an in-depth read into the actual article, not just the short news clips and posts that people have been sharing.

As an avid electronic cigarette user/enthusiast and former smoker, the actual data in this study interested me.  What I found was a very balanced and scientific paper, with multiple reasonable suggestions for policy changes within the UK.

TL;DR – E-Cigarettes are by far much safer than traditional cigarettes.  Smoking rates have dropped and continue to trend down in both adults and youths.  Secondhand/ambient vapor is not harmful in any way or leads to absorption of nicotine to bystanders.  Licensing/registration of electronic cigarette products seems to be not commercially attractive and isn’t recommended at this time.  Nicotine poisoning is much harder than previously thought.

The first 13 pages of the study are the highlights and the bigger points.

The rest of the paper is the meat of the research.  The study goes into multiple statistics regarding smoking patterns since electronic cigarettes were introduced to the market, usage by adults and youths, references to previous studies (and quickly disproving the more popular ones that claimed electronic cigarettes were unsafe), policy recommendations moving forward,  and many other studies done over the past few years.

8 key messages were outlined in the summary of the paper.

  • Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioural support.
  • Encouraging smokers who cannot or do not want to stop smoking to switch to EC could help reduce smoking related disease, death and health inequalities.
  • There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it. Despite some experimentation with EC among never smokers, EC are attracting very few people who have never smoked into regular EC use.
  • Recent studies support the Cochrane Review findings that EC can help people to quit smoking and reduce their cigarette consumption. There is also evidence that EC can encourage quitting or cigarette consumption reduction even among those not intending to quit or rejecting other support. More research is needed in this area.
  • When used as intended, EC pose no risk of nicotine poisoning to users, but eliquids should be in ‘childproof’ packaging. The accuracy of nicotine content labelling currently raises no major concerns.
  • There has been an overall shift towards the inaccurate perception of EC being as harmful as cigarettes over the last year in contrast to the current expert estimate that using EC is around 95% safer than smoking.
  • Whilst protecting non-smoking children and ensuring the products on the market are as safe and effective as possible are clearly important goals, new regulations currently planned should also maximise the public health opportunities of EC.
  • Continued vigilance and research in this area are needed.

These key summary points all show support for electronic cigarettes, that they are mostly healthy in comparison to tobacco cigarettes, and that further study should still be done.

There are also a few other summary points that weren’t mentioned in the key points above.  One of those points is that while there are no “licensed” products currently on the market, it points to the fact that licensing electronic cigarette products is not commercially attractive and not recommended at this time.  It’s very similar to what the FDA is currently trying to do and the PHE recommend that they do not follow the same path.  It’s a very interesting conclusion and might be very useful in helping fight the current pending FDA regulations.

As far as statistics for current smokers, the study shows that 1 out of 20 adults in the UK are currently using electronic cigarettes.  And of that number, 2/3 of smokers dual use (both smoke and use electronic cigarettes).  Personally, I was hoping that number would be smaller but many people transition at their own pace.  Another good conclusion is that they have not shown statistical data that electronic cigarettes are attracting people who have never smoked.  This has long been an argument by advocates against electronic cigarettes in the US and the data in this study disproves that.  Furthermore, smoking rates in both adults and youth has declined over the past few years and electronic cigarettes have helped make a decent dent in the numbers.  Lastly, there is no data that shows that Gateway Theory, or the theory that suggests using certain drugs leads to use of other harder drugs (or in this case leads to smoking) is strongly suggested to be abandoned until further field studies can be determined properly.  There is no data that shows that using electronic cigarettes leads to smoking.  Personally, I don’t see how it would as the taste alone comparatively would be an awful change.

Another health point brought up was in regards to ambient vapor or second hand vapor.  People can react very differently when they see a larger cloud of vapor heading in their general direction.  Some people it doesn’t phase them to going into a full coughing gagging fit.  The only people I’ve seen it actually affect is people with a very heavy asthma issue, and that’s after at least a couple minutes of exposure to large amounts of vapor (think a vape shop without proper ventilation).  From my own experience, people reacting this way are doing so from a mental point of view and think that the vapor emitted is no different than cigarette smoke.  Based on the study, there are no identifiable health risks to bystanders and the nicotine levels themselves in ambient air is negligible.

The study addresses recent studies that showed that electronic cigarettes potentially emit high levels of formaldehyde.  Happily, the study quickly points out that the results of these studies were misinterpreted and didn’t use real world testing procedures.  I’m very happy that yet another study has pointed this out and hopefully helps continue to shoot down the improperly done testing.  Though, people still claim that childhood immunizations cause autism even after the testing that showed this was proven to be falsified.

One more point addressed in this study covered fatal nicotine poisoning.  Typically, it’s been understood that ingestion of high levels of premixed nicotine could be very dangerous and sometimes fatal.  It’s been long understood that liquids that contain 30-60 mg of nicotine (or higher) could potentially be fatal if ingested or absorbed through the skin.  The study dove deep into this and realized that any actual scientific data regarding nicotine poisoning was very difficult to find.  The one study that was found was done back in the 1890’s and was only based on self-experimentation.

More recent studies have shown that even with ingestion as high as 1500mg nicotine resulted in vomiting and nausea, but recovery typically took place within a few hours.  One fatal case showed that almost 10000mg of nicotine was ingested and gastric content levels showed close to 4000mg present.  That is a huge number over where people typically think nicotine poisoning happens.  Either way, I still believe that safety should be followed when it comes to handling high nicotine liquid bases and premixes.  But, I wouldn’t worry too much if a couple drops gets on your skin.

I hope this analysis provided a good summary of the paper and provides each and every one of you with many good discussion points for the future.

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