What You Need To Know About E-Cigs

e-cigarette

 A cigarette that doesn’t burn or smoke: sounds healthier, right?

Nova Scotia is in a heated debate over electronic cigarettes, or “e-cigarettes”, an alternative to smoking traditional cigarettes that uses vapour instead of smoke to heat the “e-juice” it uses instead of the chemicals of normal cigarettes.

The introduction of this product has raised concerns in the medical community throughout Nova Scotia. Although proponents say that the vapour-delivered nicotine is healthier than smoking, both physicians and Health Canada do not see this product as a reasonable alternative.


Health Risks
In Canada, it’s illegal to sell e-cigarettes for nicotine use, make a health claim about the product, or sell nicotine cartridges/liquid to be used in an e-cigarette. The only e-cigarettes that do not violate the Food and Drugs Act are those that do not contain nicotine and do not tout health claims. However, some people are illegally accessing nicotine e-cigarettes and “e-juice” online. This can lead to negative health outcomes such as nicotine poisoning and addiction. 

Doctors are also concerned with the legal ingredients in e-cigarettes. The the long-term health risks of inhaling propylene glycol – the major ingredient in e-cigarettes – are unknown. Ingredients that replace nicotine in legal Canadian e-cigarettes are also not regulated and may be just as (or more) hazardous than nicotine.

Without understanding what nicotine and other chemicals present in e-cigarettes are capable of, e-cigarettes are not the best solution for trying to quit smoking.


Not Effective Cessation Aid
According to the World Health Organization (WHO), the safety of electronic nicotine delivery systems has yet to be scientifically demonstrated. 

Doctors are concerned that e-cigarettes are unproven cessation devices and should be required to undergo the same rigorous testing for safety/efficacy as other nicotine replacement therapy. Electronic smoking products may have harmful risks and side-effects, such as “nicotine poisoning and addiction” according to a letter sent from Health Canada to a local Nova Scotia smoke shop in New Glasgow.


Changing the Culture
In addition to potential negative health effects, Doctors are also concerned e-cigarettes will re socialize the act of smoking and lead non-smokers to try, not only unregulated e-cigarettes, but also traditional cigarettes.

In Nova Scotia e-cigarettes aren’t governed by the Smoke-Free Places Act, which prevents smoking in work and public places. The legislation has been instrumental in reducing smoking rates in the province through changing the culture surrounding smoking.

In addition, the often fruit-flavoured e-cigarettes could lure youth and cause otherwise non-smokers to develop a nicotine habit.


Quit Today – The Right Way!
It’s never too late to kick start your New Year’s resolution! As National Non-Smoking Week approaches (January 19 – 25), many effective cessation aids are available for Nova Scotians who need support to quit smoking. 

With strong winds, blizzards, and nasty winter conditions setting in, it’s less desirable for smokers to go out for a smoke. National Non-Smoking Week is the perfect time to explore options such as:

  1. Nicotine patches: Clinical trials have shown that the patch can, on average, double the success rate over placebo treatment. Sold without prescription, patches deliver small amounts of nicotine through the skin continuously. The dosages vary and diminish over an average of three months until the user is nicotine free. 
  2. Nicotine gum: Another non-prescription option. Nicotine gum simulates the highs and lows in nicotine levels of smoking with two – 10 pieces for most smokers. This aid is used for an average of three months and does not contain the harmful chemicals found in tobacco smoke. 
  3. Cold-turkey: Even with resources such as counselling, the support of family and friends, and addiction support groups, quitting smoking with no nicotine aids or gradual decrease can be a daunting (but extremely rewarding) challenge. Of the 68.5% of smokers who had tried the cold-turkey method in a survey of more than 8,000 adult smokers, an average of 25% succeeded quitting (compared to the average of 14% who succeeded using gradual methods).

There are many non-nicotine cessation aids that can help cold-turkey quitters such as exercise, hand-occupying activities such as blogging or knitting, chewing raw vegetables and small rewards for meeting non-smoking milestones. 

If you are considering any of the above options, be sure to discuss them with your doctor before you try them.

E-cigarettes are untested, unregulated and potentially unsafe for Nova Scotians. Despite the appealing idea of a product that can control addiction without health hazards, so far this product can’t deliver on those claims. 

Alternative aids to this device are effective for quitting smoking and have Health Canada’s approval and regulatory standards. This winter, step inside from the freezing smoke breaks and embrace a new year with a safe and healthy lifestyle.

 

Comments

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Submitted By: Richard Ivers

How about giving out some actual, unbiased science for people to read rather than pharmaceutical company dogma.
Go have a good read around this site for real science on e cigs folks – http://www.nicotinepolicy.net/
The site was set up by public health experts independent of pharmaceutical or tobacco company bias and who promote genuine science that lets the data speak without manipulation.

Submitted By: D J

Doctor’s of Nova Scotia Nicotine gum & patches worked so well for me they put me in the ER at a hospital ( sarcasm). Quitting cold- turkey never did work for me even with support and counseling. My Doctor fully supports me using E-Cigs and juice over the other dangerous ways to stop smoking. Please stop the mis-information & smear tactics and stop supporting big tobacco. It should be up to us the public to choose our own methods to help us stop smoking.

Submitted By: Cheryl Thomas

FALSE: “In Canada, it’s illegal to sell e-cigarettes for nicotine use, make a health claim about the product, or sell nicotine cartridges/liquid to be used in an e-cigarette. The only e-cigarettes that do not violate the Food and Drugs Act are those that do not contain nicotine and do not tout health claims. However, some people are illegally accessing nicotine e-cigarettes and “e-juice” online. This can lead to negative health outcomes such as nicotine poisoning and addiction.”

FALSE: “Ingredients that replace nicotine in legal Canadian e-cigarettes are also not regulated and may be just as (or more) hazardous than nicotine.” Nicotine from ecigs are not hazardous. https://www.youtube.com/watch?v=ZD7B9A_D8bQ&desktop_uri=%2Fwatch%3Fv%3DZD7B9A_D8bQ&app=desktop

FALSE: “In addition, the often fruit-flavoured e-cigarettes could lure youth and cause otherwise non-smokers to develop a nicotine habit.” http://www.ecigarettedirect.co.uk/ashtray-blog/2013/09/the-shocking-truth-about-children-and-electronic-cigarettes.html

FALSE: “In addition to potential negative health effects, Doctors are also concerned e-cigarettes will re socialize the act of smoking and lead non-smokers to try, not only unregulated e-cigarettes, but also traditional cigarettes.” http://tobaccoanalysis.blogspot.ca/2013/09/electronic-cigarette-experimentation.html

I smoked cigarettes for 40 yrs. and quit with ecigs now for 20 months. We in the community are really sick and tired of the same old unfounded scare tactics that are taking away a much healthier alternative

Submitted By: Jason minty

I can understand the fear of the unknown and assuming the worst case scenario for some people. Nicotine poisoning is a reasonable concern for people who are not responsible enough to be using the product. Alcohol poisoning would be a concern aswell but do niot see a ban on it anytime soon.

One main problem I have with this is making nicotine look like a bad drug when in reality it has benefits and side effect similar to that of caffeine. Should we ban caffeine products aswell? Nicotine is found naturally in common vegetables but tobacco has the highest concentration of it. Because of that nicotine is misconceived as bad for you due to its dirty old delivery system cigarettes. The tobacco is the hazardous part of smoking not the nicotine.
I also do not see people trying e cigs and going to tobacco instead, its like going from an mp3 player to a Walkman its just not a normal decision to downgrade to an outdated delivery system.

Personally e cigs have been my only savior to quitting smoking after many attempts over the past 20 years. Its been over 9 months tobacco free and have had no desire to go back, my health also is back to as if I never smoked.

E cigs may or may not be healthy for people but I can’t see it being anywhere near as bad for people as those death sticks I used to use. I can only give you the benefits and zero bad side effects I have had with e cigs and will let you decide what you want to believe.

Submitted By: john mathers

I haven’t had a cigarette since June 16th since starting on the ecigs and have cut my nicotine intake from 50-60 mg per day to about 18mg now. I have had only positive health affects and feel much better and don’t get out of breath anymore. I would recommend the e-cig as many people enjoy smoking and this IS a SAFE alternative. The contain propolene glycol, vegetable glycerin, nicotine and flavouring. Big tobacco is exerting pressure on our government but it won’t work. VAPE ON!

Submitted By: kim murray

The Governments around the world are not concerned about our health (if they were they would have banned cigarettes years ago)!! They are, along with the cigarette manufacturers and the drug companies are all about the “MONEY”
I smoked cigarettes for over 35yrs, now, I Vape!!! I feel so much better, my lungs are clear, I do not cough anymore, I have more energy and I have sooooo much more money in my pocket. You should be ashamed of yourselves your so greedy ..I will continue to Vape my E-cig with the perfectly safe nicotine in my juice .. I will not go back to smoking a cigarette!

https://www.facebook.com/photo.php?fbid=231587213684000&set=pb.145264215649634.-2207520000.1390409051.&type=3&theater

Submitted By: Charlene Haste

I wish the writer of this story had done some homework. First off, nicotine in the amount of 4 mg per (dose) — or per puff, is exempt from current Canadian law, (Schedule F, Section D), so in fact if no health claims or cessation claims are made, that makes it legal. Did you know that gum is sold in packages that are available in 4 mg patches containing 105 pieces (some bulk packages even contain more). That makes it a 4020mg over the counter?

Secondly there are studies. Please check http://ectaofcanada.com/info_results.php?cat=Studies tor some of the latest studies. The applause for these electronic cigarettes are not coming from any companies, but rather from the vapers themselves. No one is holding a gun to their head to use these. There hasn’t been LARGE marketing campaigns like you see with the pharmaceutical companies to get these into the hands of the public.

A new Study Finds that nicotine replacement therapy is ineffective for smoking cessation as seen here: http://tobaccoanalysis.blogspot.ca/2014/01/new-study-finds-that-nicotine.html … So keep that in mind, would you rather someone stay on tobacco or switch to something less harmful?

Renormalize smoking? I think it is the opposite, Electronic cigarettes demoralize smoking. They send a pretty clear message not to smoke.

Traditional NRT therapies that work? – Health New Zealand is a good example of what we should be doing with Electronic Cigarettes – Studies to get to the truth, and not cherry pic the stories, as when doing that you only follow the money tree. New Zealand’s latest study shows that e-cigs are on par with traditional NRT.

However Vapers don’t see this as a way to quit smoking, that is what every isn’t getting! Rather it is switching to a less harmful alternative. The anti-ecig propaganda reporters keep talking about long terms studies, why not look to the studies listed on ECTA’s site? Or better yet, talk to the Doctors that have taken an interest in studying and researching electronic cigarettes like Dr Konstantinos Farsalinos, Dr Michael Seagal, or Dr. Riccardo Pelosa before writing something from propaganda campaigns.

This article has no validity. Sure there always has to be more research, look at the recent information being exposed on Champix. However, it is a no brainer when comparing E-cigarettes to the side-effects known now about drugs like Champix.

I hope you revise this information. It is full of opinion and not factual.

Thank you!
Charlene

Submitted By: John Haste

I’m going to take this by section because it’s easier for me (maybe other as well) to digest.

Health Risks

“both physicians and Health Canada do not see this product as a reasonable alternative” – Based on what? Facts or studies? There are well over 100 different studies from around the world that make it not only a REASONABLE alternative but perhaps the one true harm reduction product that works. Any of those studies are readily available to anyone that might want to ask, consult with stakeholders or do even a little bit of research on the topic.

“In Canada, it’s illegal to sell e-cigarettes for nicotine use” – Absolutely a false statement, even in general terms. E-Liquid with nicotine is explicitly exempted from Schedule F/Prescription Drug List because it’s use is “in a form to be administered orally by means of an inhalation device delivering 4 mg or less of nicotine per dosage unit”. And if marketed/prompted/sold without therapeutic, medicinal or other health related claims they are nothing more than a Consumer Recreational Product.

“This can lead to negative health outcomes such as nicotine poisoning” – Ignoring the fact that the word “can” implies nothing mor than “cannot”, I encourage you to review an article from the Archives of Toxicology by Bernd Mayer (Department of Pharmacology and Toxicology, Karl-Franzens University Graz, Univ.-Platz 2, 8010 Graz, Austria) about nicotine poisoning (LD50 specifically) and the possibility of this being any real threat. I would post the link but some media forums restrict linking to external resources, so Google “How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century” and it will probably be the first link.

Further that with information provided by Christensen LB, van’t Veen T, Bang J. Three cases of attempted suicide by ingestion of nicotine liquid used in e-cigarettes, Clinical Toxicology. 2013; 51: 290.Clinical Toxicology vol. 51 no. 4 2013

Your statement is simply general, unfounded fear mongering and without evidence.

“The the long-term health risks of inhaling propylene glycol – the major ingredient in e-cigarettes – are unknown.” – I am absolutely stunned at this statement. We have been studying Propylene Glycol since the ’50s years and has been on the GRAS list for years! Propylene glycol and dipropylene glycol were first registered in 1950 and 1959, respectively, by the FDA for use in hospitals as air disinfectants! Please do your research!

I am actually having a difficult time reading the rest of the article after that, but I will continue…

“Ingredients that replace nicotine in legal Canadian e-cigarettes are also not regulated and may be just as (or more) hazardous than nicotine.” Again, I mention that “may” implies nothing more than “may not”… I will not argue the point about it not being regulated. It does need a degree of regulation and testing of E-Liquid which MANY are doing now is definitely needed.

Not Effective Cessation Aid

I want to start this section by saying they are NOT a Cessation Aid at all. They are Tobacco Harm Reduction that are suited as Recreational Consumer Products. END OF STORY

And there is that “may” word again…

Changing the Culture

Use of Electronic Cigarettes most certainly does not re-normalize smoking. It does exactly the opposied in that it normalizes NOT smoking. And as far as the children, yes we must think of the children, they are going to rebel and do “bad” things. We all did and that’s how we started smoking tobacco cigarettes in the first place. Would you rather they try a tobacco cigarette? Or an e-cigarette? Because they’re going to try at least one of them.

As for the child luring flavours… Let’s sit down and sip on our Cherry Vodka Tonics and have that discussion, shall we?

Quit Today – The Right Way!

Right on… People SHOULD quit smoking tobacco products, but “Quit or Die” does not work neither do the approaches you’ve listed, for most people. I’m just glad you did not mention the “one” that almost killed me (and many others). If it wasn’t for Electronic Cigarettes, I would still be a Tobacco Cigarette smoker and would have had to go outside for at least 4 cigarettes before posting this comment.

With that said, I guess there IS one significant side effect of using Electronic Cigarettes. The user just might not smoke tobacco cigarettes anymore. It happened to me…

Thanks and please do more research and use a broader scope of resources next time.
John

Submitted By: Bryden Ley

As a former resident of Nova Scotia this story makes me feel quite embarrassed. The amount of misinformation and fear mongering is astounding, and most of this is the same text almost word for word as many already out there in the media despite all of the anecdotal and scientific evidence that has come out to the contrary, I won’t attempt to refute this myself; but if you are reading this do yourself a favor and look into this beyond stories like this and find the truth there are large communities that are filled with knowledge and facts about the subject as well as many experts, doctors and scientists alike that have attested to the potential these devices have as harm reduction methods for people who are already addicted to cigarettes. It is NOT currently illegal to sell e juice containing nicotine, nor should it be. I have never smoked and i do not use e cigarettes but i have seen what these devices have done for people who did smoke and to try and take this away would be a terrible mistake. Please think before listening to this type of rhetoric, don’t take my word for it, research, find the information yourself, its all out there if you just take the time. Don’t vote against ecigs in anyway without knowing the whole story its peoples right to choose this as a way to quit smoking ive seen it work for hundreds of people, look for the proof, there are millions of people in north america who are living proof, ask, understand, educate yourself. Don’t destroy this hope without knowing the truth

Submitted By: Doctors Nova ScotiA

Hello Bryden Ley, thank you for your comment.

In Canada, under the Food and Drugs Act, it’s illegal to import market or sell e-cigarettes that contain nicotine unless they are approved as a new drug by Health Canada. The confusion is related to the reference to “4mg delivery.” When taken out of the context of the entire act it can be perceived that certain e-cigarettes are legal. However, every individual product must still be approved in the exact form that it would be sold in Canada. Therefore someone that would want to market a new nicotine inhaler of less than 4 mg would still have to get that individual product pre-approved. To date, no e-cigarette manufacturer’s product has received market authorization from Health Canada.

http://www.hc-sc.gc.ca/dhp-mps/prodpharma/applic-demande/pol/notice_avis_e-cig-eng.php

Submitted By: Doctors Nova Scotia

Hi John, thanks for your comment.

At this point not enough is known about e-cigarettes to be certain they are safe. In March 2009, Health Canada issued an Advisory to Canadians to not use e-cigarettes as these products may pose health risks and have not been fully evaluated for safety, quality and efficacy by Health Canada. Here’s a link to the document – http://www.hc-sc.gc.ca/dhp-mps/prodpharma/applic-demande/pol/notice_avis_e-cig-eng.php

The World Health Organziation has a similar belief — http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/
Here’s some data from the WHO around the unknowns about how much nicotine can be administered through an e-cigarette — http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/

Additionally, kids are particularly at risk of this. E-liquid should be sold only in child-proof bottles, given that swallowing a small amount of nicotine can be toxic, especially to children.

Submitted By: Doctors Nova Scotia

Charlene:

The WHO, Canadian Lung Association, and Health Canada have all raised concerns around e-cigarettes. The most recent peer-reviewed evidence based article indicated that The benefit of e-cigarettes have not been scientifically proven. To date, very few studies have assessed ECs/ENDS as a harm reduction and cessation aid, with conflicting findings. The research also indicated that the potential risks they pose for the health of users remain undetermined. Furthermore, scientific testing indicates that the products
vary widely in the amount of nicotine and other chemicals they deliver, and there is no way for consumers to find out what is actually delivered by the product they have purchased.

Here’s the study — http://docstore.ingenta.com/cgi-bin/ds_deliver/1/u/d/ISIS/76976727.1/iuatld/ijtld/2014/00000018/00000001/art00003/718D78C6437ED9E51390488625B6D02A0658F46534.pdf?link=http://www.ingentaconnect.com/error/delivery&format=pdf

Submitted By: Doctors Nova Scotia

Hi Kim, We’ve heard testimonials from people that demonstrate that e-cigarettes have helped some people to quit smoking but unfortunately they haven’t been proven to be effective at a population level. More research is needed in the area to fully understand their long-term health effects.

Submitted By: John Haste

Re: A few of the references you responded with below.
“The confusion is related to the reference to “4mg delivery.” When taken out of the context of the entire act it can be perceived that certain e-cigarettes are legal. ” — In 2006, Health Canada proposed an another amendment to include the “inhalation device” that delivers less than 4mg per dosage unit. It is not misperception, it is a legal loophole that HC (or anyone) did not foresee. Fortunately in the interests of Tobacco Harm Reduction, more and more of the “die” category of the “quit or die” have successfully been able to switch.

And because of the Exemption from Schedule F/Prescription Drug List it can not be considered a “New Drug” because it must first qualify as a Drug under Schedule F/Prescription Drug List from which it is exempted. Do you see the disconnect? At the end of the day, without health, cessation, therapeutic or other medicinal claim, less than 4mg per dosage unit products are exempted “in a form to be administered orally by means of an inhalation device delivering 4 mg or less of nicotine per dosage unit”.

“E-liquid should be sold only in child-proof bottles, given that swallowing a small amount of nicotine can be toxic, especially to children.” I COMPLETELY agree with this statement, but shouldn’t we also look at the quality of the “child-proofing” found on a bottle of bleach? Once you open it, there isn’t any… But that’s a different subject.

“At this point not enough is known about e-cigarettes to be certain they are safe.” Again, I state, there are well over 100 studies on these devices. In fact there is a STUDY of studies. All anyone has to do is ask or look for them. And I’m very well aware of Health Canada’s Advisory, but it’s an advisory without any meat. As for the WHO’s inability to determine “how much nicotine can be administered through an e-cigarette”. Guess what? There are studies available on that as we, to include a study on Blood Plasma Nicotine Levels over periods of time. Again, all of this information is available for anyone that looks for it.

If we “choose” not to acknowledge any of the available information, we are sentencing the “die” category of “quit or die” to do just that. There is without a doubt, and nobody can deny that there is MORE than enough evidence that Electronic Cigarettes are better than Smoking.

And who will benefit? The tobacco companies (from continuing to sell their cigarettes) and the pharmaceutical companies (from treating the dying patient) and the government (from the influx of money from tobacco and pharmaceutical companies). People are just going to die and I point at Health Canada as the executioner.

Thanks again as I do appreciate the debate. But I’m also right… 😉

John

Submitted By: Doctors Nova SCotia

We’re happy to see that this post has inspired a lot of comments, questions, and opinions. We’re pleased that a discussion is taking place.

While we’re doing our best to respond in the comments, we think it’s worth a post of its own. Please see our latest post, E-Cigarettes: What We Know and What We Don’t Know: http://www.yourdoctors.ca/blog/2014/01/24/e-cigarettes-what-we-know-what-we-dont-know

Submitted By: Jeff Davis

SMOKE NV makes e cigs. They are physician owned. They have applied to have their e cig products classed as “medical devices.” I hope they are trend setters. They use only vegetable glycol and other food grade ingredients. I do not work for them or represent them. You can learn more at their website.

Submitted By: M H F

I think I am somewhat objective. I think the only ones to gain in this debate are the ones making money selling e-cigarettes and e-juice. Of course they want people to think e-cigarettes are safe and the answer to quitting.

What have the health professionals and experts to gain by not endorsing such a product? If it was proven to work by helping people quite why wouldn’t they be the first to support and promote it? millions of dollars could be saved on tobacco related deaths and diseases. That money could be well used for other health areas. They are not getting making big bucks to be anti e-cigarettes.

Why would anyone want to use a product that hasn’t been approved for use by the federal government? Are they just taking the manufacturer and seller’s word for it? They stand to make millions on the sale of these. I think something has to be tested for many years before it is known to be safe.

Submitted By: Angela G

So you are saying that I should continue to smoke real cigarettes, as nothing else has been effective. OK, I’ll just go ahead and die of lung cancer to please you because I should be afraid of vapour. Not. Stop convincing people to smoke cigarettes and stop encouraging big tabacco!

Submitted By: Doctors nova scotia

Hi Angela, we are definitely not suggesting that anyone should use traditional cigarettes. Tobacco use is the number one preventable cause of death in Nova Scotia. One out of every 5 deaths in the province is caused by tobacco use (over 1,700 deaths per year).

Some readers have had told us that they’ve quit smoking through using e-cigarettes; however, there’s still a lot of unknowns and risks associated with the products. Within Canada e-cigarettes cannot be sold as cessation aids because their isn’t enough evidence to support their effectiveness. According to the World Health Organization (WHO), the safety of electronic nicotine delivery systems has yet to be scientifically demonstrated.

Doctors are concerned that e-cigarettes are unproven cessation devices and should be required to undergo the same rigorous testing for safety/efficacy as other nicotine replacement therapy.

Doctors Nova Scotia has been involved in the movement to reduce tobacco use for decades. This is just another way we’re trying to address the issue.