Electronic Cigarettes and the Medical Society Michele Coleman MPH, MPA 2014 WI Medical Society Health Policy Intern
LRB 1844 Exempting electronic smoking devices from the types of smoking devices that may not be used in certain locations Current state law forbids smoking in most enclosed public areas. Because the definition of smoking includes cigarettes, cigars, pipes, and any other lighted smoking instrument, it is unclear whether or not smokeless products like electronic smoking devices are exempt. This bill exempts inhaling or exhaling vapor or a vaporized solution from electronic devices that do not contain tobacco from the definition of smoking. This will allow smokers to be free to use this successful cessation tool inside or outside.
E-Cigarette Background Battery powered device that stimulates tobacco smoking, generally uses a heating element to vaporize a liquid solution, may or may not contain nicotine or flavorings. The WHO: "consumers should be strongly advised not to use" electronic cigarettes until a reputable national regulatory body has found them safe and effective. The AAPHP: those who are unwilling to quit tobacco smoking should consider other nicotine containing products such as electronic cigarettes for long term use instead of smoking. The CDC believes that there is enough evidence to say that electronic cigarettes are less harmful than smoking.
Safety of Manufacturing Lack of regulatory oversight of the manufacturing process, marketing, and quality control; and the purity of ingredients used Laboratory analysis of electronic cigarettes conducted by FDA several contained detectable levels of nitrosamines, tobacco-specific compounds known to cause cancer. One Smoking Everywhere cartridge was found to contain diethlyene glycol The electronic cigarette cartridges that were labeled as containing no nicotine had low levels of nicotine present in all cartridges tested, except one. The FDA currently only regulates e-cigarettes marketed for therapeutic purposes.
Impact on Youth The CDC, the FDA, the International Union Against Tuberculosis and Lung Disease, the American Academy of Pediatrics are concerned that e-cigs might increase addiction to and use of nicotine and tobacco products in children. 2012 National Youth Tobacco Survey: included 24,658 US students, found electronic cigarette use among middle and high school students almost doubled from 2011 to 2012. In 2012, 1.78 million middle school and high school students had tried e-cigarettes 10% of students who have used e-cigs have never smoked Role models to children, risks of normalizing to children
Secondhand Exposure There is no adequate data on e-cigarette emissions. While the FDA found the liquid and vapor to contain traces of toxins, the level of these toxins is ~ 1/1000 of cigarette smoke. Nicotine emitted via second-hand vapor varied by brands of e-cigarettes - ranged from 0.82 to 6.23 µg/m 3.
Smoking Cessation Tool No studies have measured directly the effectiveness of electronic cigarettes in helping smokers cease smoking Bullen, C., McRobbie, H., Thornley, S., Glover, M., Lin, R., & Laugesen, M. (2010). Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tobacco Control, 19(2), 98-103. Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V., Williman, J., & Walker, N. (2013). Electronic cigarettes for smoking cessation: a randomised controlled trial. The Lancet, 382(9905), 1629-1637. Caponnetto, P., Campagna, D., Cibella, F., Morjaria, J. B., Caruso, M., Russo, C., & Polosa, R. (2013). Efficiency and safety of an electronic cigarette (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PloS one, 8(6), e66317.
Regulation in Other States Prohibits sales to minors: Maryland, Kentucky, Minnesota, New Jersey, New Hampshire, Tennessee, Utah, Wisconsin, and Colorado. New Jersey voted in 2009 to treat the electronic cigarette in the same category as tobacco products by including them under the New Jersey Smoke-Free Air Act, which prohibits smoking in indoor work and public places. New York State banned the use of e-cigarettes within 100 feet of a public or private school entrance in September 2012, and banned e- cigarette sales to minors starting on 1 January 2013. Electronic cigarettes are to be licensed and regulated as an aid to quit smoking in 2016 by the NHS and the UK
AMA s Stance E-cigarettes might present an effective alternative to leaf tobacco use for some smokers, but clinical testing, larger population studies, and full analyses of their ingredients and manufacturing processes need to be conducted before their safety, viability, and impacts can be determined as either clinical tools or as widely available, effective alternatives to tobacco use. Whether e-cigarettes can safely help people quit smoking also is unknown, but with their fruit and candy flavors, they have a clear potential to entice new smokers.
AMA urges that: 1) E-cigarettes be classified as (nicotine) drug delivery devices and should be subject to FDA regulation with appropriate standards for identity, strength, purity, packaging, and labeling with instructions and contraindications for use, including age of the user. 2) State legislatures prohibit the sales of e-cigarettes and all other nicotine devices that are not FDA-approved. 3) As currently marketed, e-cigarettes be included in smoke free laws but separately defined from tobacco products.
Society s Current Policy SMK-001: Promote Smoke-Free Workplaces: Based on evidence on the harmful effects of second-hand smoke, the Wisconsin Medical Society supports legislation promoting a smoke-free workplace. (HOD, 0410) SMK-002: Smoking and Tobacco: The Wisconsin Medical Society, recognizing the clear, scientific documentation of the threat that the use of tobacco and smoking poses to the health of Wisconsin residents, tobacco users and non-users alike, supports: SMK-003: Smoke Free Wisconsin: The Wisconsin Medical Society continues to support legislation for a smoke free Wisconsin, that includes all public and work places including provisions for support of smoking cessation programs, a legislative priority for the Society until such legislation is passed. (HOD, 0412)
Other considerations Electronic cigarette sales increased from 50,000 in 2008 to 3.5 million in 2012. As of 2011, in the United States, one in five adults who smoke have tried electronic cigarettes Tobacco companies are buying e-cigarette manufacturers Johnson Creek Enterprises in Hartland, WI is the largest producer in the nation of the vaporizing liquid