Are electronic cigarettes dangerous and potentially hazardous to health or an important tool that can help people quit smoking?
It depends on whom you ask.
Many Canadian health organizations once viewed e-cigarettes, which are battery-powered and turn a liquid solution into a vapour, as a threat. But as more evidence emerges of their potential role in helping people wean themselves off cigarettes, those attitudes are rapidly shifting.
Michael Siegel, a physician and professor at the Boston University School of Public Health, says e-cigarettes "could literally save thousands of lives."
Despite this, the federal government doesn't allow e-cigarettes containing nicotine to be sold in Canada. A large number of public-health experts and tobacco-control advocates are pressing for a change. While there are many unknowns about the long-term safety of e-cigarettes and whether they help people quit smoking, it appears they are a safer alternative to traditional cigarettes.
"I think we owe it to the five million Canadians who are addicted to tobacco products. If there's a product out there that may have some merit to bring down those numbers, we have to look at it," said Jennifer Miller, vice-president of health promotion with the Lung Association.
The Lung Association used to warn that e-cigarette users were inhaling toxic chemicals. But new evidence convinced the organization to change its position and it says they may be a valuable smoking cessation aid.
Former U.S. Surgeon General Richard Carmona, who brought the world's attention to the dangers of secondhand smoke and pushed for indoor smoking bans, joined the board of a major e-cigarette company last month. Carmona said that it is essential to have a high-quality alternative to traditional cigarettes.
But Health Canada warns Canadians not to use e-cigarettes because, according to the department, they are too risky. As a result, electronic cigarettes that contain nicotine are not permitted for sale in this country. Health Canada refused to answer any questions relating to e-cigarettes.
E-cigarettes look like traditional cigarettes, but manufacturers tout the fact they contain no tobacco or the other harmful chemicals found in cigarettes. In countries like the U.S., one in five adult smokers have tried e-cigarettes, according to the Centers for Disease Control and Prevention, and sales are expected to top $1-billion (U.S.). Wells Fargo Securities predicts that demand for e-cigarettes could eclipse traditional cigarettes over the next decade and large tobacco companies like Lorillard Inc. have begun selling them. Altria Group Inc. announced last Thursday it will start selling its own e-cigarette later this year.
In Canada, e-cigarettes without nicotine are allowed and are becoming increasingly common in stores. However, many Canadians may be purchasing nicotine e-cigarettes while in the U.S., from Internet dealers or from retailers selling unauthorized products.
Health Canada, the U.S. Food and Drug Administration and the World Health Organization have all issued warnings in the past five years about the potential dangers and many unknowns about e-cigarettes. Among the chief concerns are the fact that nicotine e-cigarettes contain nitrosamines, a known carcinogen, and that they often come in fruit or candy flavours like chocolate, cherry or piña colada that may appeal to youth and could lead them to get hooked on cigarettes.
If the effects of e-cigarettes containing nicotine are so grave, why are health experts pushing for their approval here?
Boston University's Siegel said the dangers are greatly exaggerated. While it's true that e-cigarettes contain trace levels of nitrosamines, so do approved nicotine replacement therapy products, such as patches and gums. The amounts are very low and don't appear to cause any health problems, he said. And unlike those products, e-cigarettes afford smokers who are hooked on the act of holding a cigarette, taking a drag and inhaling, a very similar experience.
"We know hundreds of thousands of people are dying from cigarettes, yet those are perfectly legal," said Siegel, who does not accept financial compensation from any e-cigarette company. "If [Health Canada is] going to ban anything, why not ban tobacco cigarettes?"
The real potential of e-cigarettes is harm reduction, said Theo Moraes, a pediatric respirologist at Toronto's Hospital for Sick Children. Refusing to regulate nicotine-containing e-cigarettes ignores the reality that many Canadians are already purchasing them online or buying them elsewhere, he said.
One thing is clear, according to David Sweanor, a law professor at the University of Ottawa who focuses on tobacco-related issues: Cigarettes are deadly and e-cigarettes with nicotine are a safer alternative that Canadians deserve to access.
"We have to logically look at these things," said Sweanor, who does not accept funds from e-cigarette companies. "The bottom line is that for anyone who truly cares about reducing … death and disease, they have to be pragmatic rather than dogmatic."