Safe To Vape?

The Center for Disease Control and Prevention (CDC) in the United States caused a stir in September when it revealed that it was investigating more than 450 cases of severe lung disease and seven deaths linked to the use of e-cigarettes. Its pronouncement caused swift reactions – the White House said it was planning to ban e-cigarette products, and many states pushed through similar legislation within days.

By late October, the number of cases had risen to more than 1 500. The number of deaths to 34.

The Indian government quickly prohibited their sale and a fledgling industry which – on the face of it – seemed to have positive health benefits has been brought to its knees. Is the backlash justified?

People have been trying to build electronic alternatives to cigarettes for almost a century, but it’s only in the past decade or so that manufacturing techniques have created an e-cigarette, or “vape”, which has proved popular with consumers. Analysts at Euromonitor International counted an increase from around seven million users in 2011 to 41 million in 2018. “Recent research shows that there are more than 300 000 users in South Africa, most of them under the age of 25,” says Savera Kalideen, executive director of the National Council Against Smoking (NCAS).

The optimistic theory behind vape use is that it can help people wean off cancer-causing cigarettes, because they mimic the physical action of smoking and can deliver a nicotine hit, but don’t produce the same toxic chemical mix of burning tobacco leaves.

It’s the age of users which is a big concern, says Professor Michael C Herbst, a health specialist at the Cancer Institute of South Africa (CANSA).

“While studies demonstrating both risks and benefits of e-cigarettes do exist – with limited evidence for their efficacy as a smoking cessation aid – other studies, particularly in the US, confirm that the majority of e-cigarette users are young adults, and that e-cigarettes play a role as a gateway to cigarette smoking, especially among adolescents and this age group,” Herbst says. “Although they may not be as harmful as combustible tobacco – few things are – they nevertheless do remain a health risk.”

What’s in a vape?

The cases being investigated by the CDC are certainly serious. “Symptoms experienced included breathing difficulties, shortness of breath, chest pain, vomiting, diarrhoea and fatigue as well as pneumonia and respiratory failure,” says NCAS’ Kalideen. “And we agree.”

Many have blamed vaping liquids that have been mixed with cannabis oils to create a modern take on the classic “joint”, but there are deeper issues with the content of e-cigarette fluids.

“The US Food and Drug Administration collected 120 samples to try to identify the cause, with chemical samples collected including nicotine (even when marketed as containing no nicotine), cannabinoids, additives and pesticides,” says Kalideen. “The New York State Department of Health suspected a possible link between vitamin E acetate found in cannabis products, while a study published in JAMA Internal Medicine found that mint and menthol liquids in e-cigarettes have cancer-causing compounds.

“Although it’s all very confusing, what we do know is that e-cigarette liquids contain varying amounts of toxic chemicals that are linked not only to lung diseases, but to cancer, DNA damage and respiratory and heart disease too.”

What’s happening in SA?

More than 90 countries have already regulated e-cigarettes to protect public health, although South Africa has not yet followed suit. Indeed, many outlets sell vaping products without providing any information to users about what the liquid contains, just how it tastes.

“Furthermore, because they’ve been marketed as an alternative to cigarettes for anyone trying to quit smoking, they’re generally regarded as being ‘safe’,” says Kalideen.

“It’s important to remember,” adds CANSA’s Herbst, “that the tobacco industry – the same industry that has adopted questionable tactics to conceal evidence of the harmful effects of cigarettes – is driving this phenomenon and marketing these products aggressively, which is why CANSA feels a responsibility to make the public aware of the potential harm of these devices.”

Want to quit?

Both CANSA and the NCAS are advocating for the regulation of e-cigarettes to avert the health risks and are calling on government to pass the Draft Tobacco Bill which will cover this. The NCAS urges anyone who would like to stop smoking to avoid the use of e-cigarettes and to rather check out other ways to do so by chatting to a doctor, pharmacist or clinic or by calling the NCAS QUIT Line (011 720 3145).

CANSA offers online support at www.ekickbutt.org.za.