Antidote: Are e-cigarettes safe?

Marc Siegel, MD
Marc Siegel, MD

Are e-cigarettes safe? Do they work?

First, are they safe? E-cigarettes are problematic for teens. According to the Centers for Disease Control, e-cigarette use among high schoolers is now 10%—double the rate of a year ago—with 80% of those e-cigarette users also smoking tobacco. Dr. Tom Frieden, head of the CDC and a top expert in preventive health, told me that e-cigarettes can be a gateway drug, with nicotine addiction leading to more tobacco use.

On top of this problem, liquid nicotine is now being sold in different flavors online, at much higher concentrations than is found in an e-cigarette, which generally has nicotine levels in the 1.8% to 2.4% range. But vaporworld sells a gallon of liquid nicotine at 10% concentration for only $195, and Liquid Nicotine Wholesalers charges $110 for a liter at the same concentration. With this high concentration, experts say that just a tablespoon could be enough to kill. Nicotine is a potent neurotoxin which can be ingested or absorbed through the skin, leading to seizures, vomiting, rapid heart rate and death. The number of poisoning cases linked to e-liquids was 1,351 in 2013, up 300% from the year before.

So clearly, there is a rising concerning over the safety of nicotine liquids as well as the threat of nicotine addiction. But this is not the same thing as saying that e-cigarettes are not useful for smoking cessation.

Vaping, which is the process of drawing the nicotine/propylene glycol vapor from an e-cigarette into your lungs, simulates the process of smoking, and a recent study in the prestigious journal Lancet suggested that it was at least as effective as the nicotine patch at quitting smoking. This makes sense to me since it not only provides the nicotine without the toxic tar and other noxious chemicals of a cigarette, it also tackles the oral fixation.

I believe that in the right hands, e-cigarettes can be an effective tool for quitting smoking, perhaps the best we currently have available. But because of the risks of addiction and even poisoning that I have outlined above (though e-cigarettes continue to have much lower percentages of nicotine than the online liquids), I believe a physician should be guiding a patient's e-cigarette use.