Information correct as of 13 March 2020.
E-cigarettes have featured regularly in the news in recent times. Reports of illnesses and even deaths among
e-cigarette users in the United States have sparked huge debate about how safe the devices really are.
So what are public health officials saying about e-cigarettes? Is it safe to keep on vaping? Here we take a look at what’s happening in the US and the latest guidance for UK
What’s happening in the US?
According to recent reports, since spring 2019 at least 68 deaths in the US have been linked to the use of e-cigarettes, and at least 2,739 people have developed serious respiratory illnesses 1.
Those affected have reported symptoms such as a cough, shortness of breath, fatigue and in some cases vomiting and diarrhoea.
In some people, the condition has caused severe lung damage which has developed to become life-threatening.
Public health officials in the US are investigating these illnesses and think they are related to different substances found in the e-liquids that were used in these cases 1.
What’s in an e-cigarette?
To understand the issue, let’s take a look at e-cigarettes and how they work.
E-cigarettes are battery-powered devices. They work by heating a solution called an e-liquid, causing it to vaporise. This vapour is then breathed in by the user.
E-liquids sold legally in the UK contain nicotine, a chemical which is highly addictive but does not cause cancer 2.
E-cigarettes are battery-powered devices. They work by heating a solution called an e-liquid, causing it to vaporise
E-cigarettes do not contain tobacco, which creates harmful chemicals when burned such as tar, carbon monoxide, hydrogen cyanide, lead and arsenic 2.
In order to create an e-liquid, nicotine is usually mixed with water and a base chemical such as propylene glycol, an ingredient that’s widely used across the food, pharmaceutical and cosmetic industries. Flavours are also usually added 2.
In the UK, e-cigarette products are tightly regulated for quality and safety 3. The regulations restrict the amount of e-liquid each e-cigarette can hold and the strength of the nicotine. Certain ingredients, including colourings, caffeine and taurine, are also banned.
In the UK, all e-cigarettes and e-liquids must be notified to the Medicines and Healthcare Regulatory Authority (MHRA) before they can be sold 3.
Covid-19 and vaping
E-cigarettes (vapes) can be an effective aid to stopping smoking and staying smokefree. The evidence on the health risks of e-cigarettes is still developing. However, it is clear that vaping is far less harmful to the respiratory system than smoking. There is very little evidence on vaping and coronavirus (COVID-19) and it is unknown whether vaping makes you more susceptible to severe disease if you become infected. If it does, the risk is likely to be much less than if you smoke.
Vaping remains much less harmful than smoking for most people and it is very important that you avoid returning to smoking.
Vaping involves repetitive hand-to-face movements, which provide greater risk of a route of entry into the body for viruses. To reduce the risk of contact with coronavirus (COVID-19), you should:
- Wash your hands more frequently than usual, for 20 seconds, with soap and water (or use hand sanitiser if soap is not available)
- Clean your e-cigarette regularly
- Public Health England strongly advises against sharing any vaping devices.
Public Health England’s 2018 independent e-cigarette evidence review found that, to date, there have been no identified health risks of passive vaping to bystanders. There is currently no evidence that coronavirus (COVID-19) can be caught from passive exposure to e-cigarette vapour, but in the absence of evidence we recommend that vapers avoid exhaling clouds of vapour in the presence of others.
The UK has adopted a harm reduction approach when it comes to e-cigarettes.
While recognising that quitting smoking is always the best option for smokers, guidance published by the National Institute for Health and Care Excellence (NICE) supports the use of e-cigarettes to help smokers who are struggling to quit 4.
This is backed by an evidence review carried out by Public Health England (PHE), which found that although not completely risk-free, e-cigarettes are at least 95% less harmful than smoking 5.
Yorkshire Cancer Research supports this evidence based position, and encourages the use of e-cigarettes as a tool to quit smoking.
E-cigarettes are at least 95% less harmful than smoking
The black market
Although e-cigarettes are tightly regulated in the UK, across the globe a black market vaping industry exists, supplying harmful and potentially deadly products to e-cigarette users 6.
Some e-liquids bought off the street in the US have been found to contain counterfeit substances, including ‘cutting agents’ used to dilute the product. American health officials say they may also contain contaminants like pesticides, poisons and toxins, and they are testing samples for traces of these substances 7.
There are also worries that dangerous wiring found in homemade products could be heating e-liquids beyond a safe level 8. Overheating can cause high concentrations of compounds like formaldehyde which could be harmful to users, or result in e-cigarettes catching fire.
Many of the patients affected by the illnesses in the US have admitted buying their e-liquids off the street 1. About 80% have reported using products containing tetrahydrocannabinol (THC), a substance found in cannabis that produces the ‘high’ sensation associated with smoking the drug 1. 33% reported exclusive use of THC-containing products 1. THC is legal in some states in the US, but it’s illegal in the UK 9. Recent laboratory tests by The Centers for Disease Control and Prevention in the US have found vitamin E acetate - a substance used in some THC-containing e-liquids - in samples from people affected. This is the first time that scientists have found a chemical of concern in patients with these lung injuries 1. Vitamin E acetate, along with other vitamin additives, are banned as ingredients in UK-regulated e-cigarettes.
While more research is needed to determine the exact cause of the outbreak, the problem is currently confined to the US. There have been no confirmed deaths linked to vaping in the UK. 6.
A fraction of the risk
To put the issue into context, in the US cigarette smoking is responsible for more than 480,000 deaths a year - that’s around 1,300 every day 10.
Public Health England has reassured people in the UK that using e-cigarettes is still much safer than smoking tobacco and people shouldn’t switch back to smoking.
They say that vaping carries a “fraction of the risk of smoking”, but recommend that people use UK-regulated e-liquids and don’t risk vaping homemade or products sold online or on the black market 6.
In its latest statement, Public Health England warns: The illicit drugs market is global and it is possible that similar products to those in the US are available in the UK, which is why we are warning of this new and serious threat and continue to monitor carefully the situation in the UK 6.
PHE has also issued advice for people who vape THC, saying: If you are vaping THC (or an unknown liquid which could contain THC) it can be hazardous. These are the products most implicated in the US outbreak. If you feel unwell or have any difficulty breathing after vaping THC, go to A&E and tell them precisely what the product was you were using 6.
In the UK you can check on the MHRA website whether the product you’re using can be legally sold 3. You can also report a side effect or safety concern for e-cigarettes through the Yellow Card Scheme.
All official bodies are advising that it is always preferable to vape than smoke, and this has not changed 11.
Public Health England says: If you’re not a smoker, don’t start and don’t vape. If you’re a smoker, quit now and consider using an e-cigarette to help you. Remember that using a quit aid along with support from your local stop smoking service gives you the best chance of quitting successfully 12.
All official bodies are advising that it is always preferable to vape than smoke
Quitting for good
Smoking causes at least 15 different types of cancer, including seven in 10 lung cancers 13. This means around 4,650 people are diagnosed with a smoking-related cancer every year in Yorkshire alone14.
Around 300,000 people have already made the switch from smoking to e-cigarettes in our region 15, 16.
The devices are widely cited as an effective stop smoking tool. A recent study by researchers at University College London found that they could be helping between 50,000 and 70,000 people quit smoking every year in England 17.
Data published by NHS Digital shows that using a nicotine-containing e-cigarette makes it much more likely someone will quit successfully than relying on willpower alone 18.
If you’re struggling to quit smoking for good, you can access free support and advice by visiting www.nhs.uk/smokefree.
E-cigarettes are widely cited as an effective stop smoking tool
Information correct as of 14th February 2020.
- Center for Disease Control and Prevention, Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping, November 11th 2019, https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
- E-cigarettes: A briefing for stop smoking services, https://www.ncsct.co.uk/usr/pub/Electronic_cigarettes._A_briefing_for_stop_smoking_services.pdf
- E-cigarettes: regulations for consumer products, https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products
- Stop smoking interventions and services, https://www.nice.org.uk/guidance/ng92/chapter/Recommendations#advice-on-ecigarettes
- E-cigarettes and heated tobacco products: evidence review, https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review#history
- Smoking & Tobacco Use, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#targetText=Cigarette%20smoking%20is%20responsible%20for,or%201%2C300%20deaths%20every%20day.&targetText=On%20average%2C%20smokers%20die%2010%20years%20earlier%20than%20nonsmokers
- Deaths spark row over watchdog’s ‘reckless’ attitude to vaping, https://www.thetimes.co.uk/article/deaths-spark-row-over-watchdogs-reckless-attitude-to-vaping-tv7d68mjw
- E-cigarette evidence update - patterns and use in adults and young people, https://publichealthmatters.blog.gov.uk/2019/02/27/e-cigarette-evidence-update-patterns-and-use-in-adults-and-young-people/
- The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015 - https://www.nature.com/articles/s41416-018-0029-6
- Cancer incidence - https://www.cancerdata.nhs.uk/incidence
- Use of e-cigarettes (vaporisers) among adults in Great Britain, https://ash.org.uk/wp-content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf
- E-cigarettes may help more than 50,000 smokers to stop smoking in England each year, https://www.eurekalert.org/pub_releases/2019-10/sfts-emh101019.php
- Statistics on NHS Stop Smoking Services in England April 2018 to March 2019, https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-nhs-stop-smoking-services-in-england/april-2018-to-march-2019