The debate on e-cigarettes lights up (Guest Post: Breanca Thomas)

Breanca Thomas is a PhD student in Health Promotion Sciences in the College of Public Health at the University of Oklahoma Health Sciences Center and a 2013-14 OK Policy Research Fellow. She intends to pursue a research career focusing on effective methods of reducing health disparities among at-risk groups.

Oklahoma leaders have been weighing e-cigarettes’ possible commercial and health benefits with their potentially harmful health effects. The caveat? Neither risks nor benefits of these products have clear evidence.

Electronic cigarettes, or e-cigarettes, have gained popularity nationally and especially in Oklahoma. E-cigarettes are devices that simulate smoking a traditional tobacco cigarette. The device contains liquid nicotine that is heated to produce a vapor similar to cigarette smoke.

E-cigarettes have been prescribed by some medical professionals as a tool to stop smoking, like nicotine patches or gum. However, these devices are not widely regulated by the Food and Drug Administration (FDA), because regulations are triggered only when manufacturers specifically market e-cigarettes as a way to stop smoking.

The thriving e-cigarette business in Oklahoma recently gained national attention in a long feature in the New York Times, which estimated that Oklahoma is home to about 300 of the nation’s 5,000 vape shops, or 6 percent of stores that sell e-cigarettes and related products.

What Oklahoma has done to regulate e-cigarettes

In the past six months, Oklahoma has enacted two measures regulating e-cigarettes. The first is an executive order by Governor Mary Fallin that bans vaping devices and e-cigarette use on state property. State property includes state-owned and leased buildings and state vehicles, but it excludes Veterans Affairs residential facilities. The ban, which went into effect on the first day of 2014 , is viewed by supporters as a preventive health measure for Oklahomans.

The second measure is a law passed this session, SB 1602, that prohibits the sale of e-cigarettes to minors, with business owners subject to $100 to $300 fines for violations. The bill, which passed both chambers unanimously and was signed by Gov. Fallin, makes Oklahoma one of 28 states to prohibit sales to minors. Nearly one-fifth of Oklahoma high schoolers report having used an e-cigarette, according to a 2013 survey.

Though both measures may be a step in the right direction, they may also miss opportunities. Neither law defined e-cigarettes as tobacco products. Instead, e-cigarettes and related materials are referred to in SB1602 as “vapor products”. This distinction remains even while tobacco companies have developed their own lines of e-cigarettes and e-cigarette sales are in the $1 billion range.  

Though e-cigarettes do not contain smokeable tobacco leaves, the liquid nicotine in e-cigarettes is produced from tobacco and is not without potential harm to others. Additionally, not classifying e-cigarettes as tobacco products keeps e-cigarettes from being subject to the same taxation laws as tobacco and may reduce needed state revenue. Oklahoma may have missed an opportunity to both take a strong stance against the harmful effects of tobacco and boost tax revenues that could be directed to promoting public health.

What we know about the health risks of e-cigarettes

Information on the effects of e-cigarettes is negligible. Research and clinical trials are ongoing, but understanding the effects of e-cigarettes will take years. Neither supporters nor opponents of e-cigarettes know their risks or benefits or the concentration of chemicals being inhaled. Chemicals in some batches of liquid nicotine are known to be toxic to humans, and samples have been found to contain carcinogens, including a chemical used in antifreeze.

Earlier this year, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room, the New York Times reported.  Of 25 cases of e-cigarette and nicotine poisoning reported  in Oklahoma in the first two months of 2014, 23 involved children under age 4. Not restricting e-cigarette use at VA facilities may also continue to harm a group that tends to be at-risk.

Consumers and health professionals can complete forms related to adverse events with e-cigarettes through the FDA, though whether the events are directly caused by e-cigarettes is unknown. Reported problems using prescribed e-cigarettes include fire hazards created by charging the e-cigarette, induced allergies and asthma, heart palpitations, and death. Many of these adverse event forms also include pleas to the FDA to remove e-cigarettes from the market.

Though e-cigarettes may be able to reduce the number of Oklahomans who smoke traditional tobacco products, neither clear outcomes nor regulations exist for these devices. Oklahomans must decide whether the risk of e-cigarettes outweighs its unquantified promise.