Electronic or e-cigarettes are becoming increasingly popular, yet they may be a slippery slope to tobacco addiction, argues an editorial in CMAJ (Canadian Medical Association Journal).
"By allowing the user to inhale a vapour in a manner resembling smoking a cigarette, e-cigarettes provide a uniquely appealing means of obtaining nicotine without exposure to the other harmful constituents of tobacco smoke," writes Dr. Matthew Stanbrook, deputy editor, CMAJ.
The sale, advertising or import of e-cigarettes containing nicotine is prohibited in Canada, although nicotine-free e-cigarettes are legal. Despite this ban, e-cigarettes containing nicotine are readily available because they cross the border from the US where they are sold legally. In the US, the use of e-cigarettes by middle- and high-school students doubled from 2011 to 2012, and 10% of these users had never previously used tobacco.
"E-cigarette companies are ... free to tempt US youth (and those watching from abroad) to imitate smoking behaviour with fruit-flavoured products and movie-star endorsements, and to resurrect marketing campaigns originally designed, but no longer permitted, for cigarettes," writes Stanbrook. "Fears therefore arise that a new generation of youth who would not otherwise take up smoking could be enticed by e-cigarettes into nicotine addiction and subsequent tobacco use."
There is debate over the efficacy of e-cigarettes for smoking cessation; recent scientific evidence failed to show a long-term advantage of e-cigarettes over nicotine patches. As well, people who use e-cigarettes often continue to smoke conventional cigarettes.
"[E-cigarettes] have theoretical advantages over existing forms of nicotine replacement therapy because they provide the experience of holding and inhaling from a cigarette-like device and allow users to regulate the nicotine dose by the way they inhale. A troubling alternative possibility, however, is that e-cigarettes will merely supplement tobacco use in contexts where smoking is no longer allowed and may thereby perpetuate smoking among people who would otherwise be motivated to continue trying to quit."
Given the lack of evidence and the potential harms to public health and policy efforts to limit the negative health effects of smoking and nicotine use, Canada's regulations requiring e-cigarettes to meet the same efficacy and safety standards required for other medical treatments in order to be sold legally are laudable.