E-cigarette: evaporation of medications

18. October 2013

E-cigarettes are still controversial. For those on the path to a smoke free life they can apparently be at least as helpful as nicotine patches – if and when the EU does not thwart access and block the market from its manufacturers.

Although e-cigarettes do not put out smoke like traditional fags, they are nonetheless no less controversial, as DocCheck reported last June. Since 2006, “smokers” have been able to reach for this as an alternative, even though an e-cigarette produces vapour rather than smoke. Inside the device, a heating wire is subjected to voltage via a battery pack. With the push of a button a fluid chosen by the consumer is vaporised at 60 to 120 degrees Celsius. These fluids are available in different flavours, with or without nicotine.

Many smokers of regular cigarettes are already trying to rid themselves of their vice by using the electric vaporiser. Whether this is a promising approach is something New Zealand scientists investigated in a recent study. They presented their results in the prestigious journal “The Lancet”. Quite without intention the study brought to light several findings – but first …

The study design

First, the researchers recruited 657 adult smokers who were determined to start a smoke-free life. Prerequisite for participation in the study was in addition to have smoked at least ten cigarettes daily over the past 10 years. The aspiring non-smokers were divided into three groups: Group 1 would smoke e-cigarettes without nicotine, Group 2 e-cigarettes with 16-milligram nicotine cartridges. An investigation showed that 300 puffs on e-cigarettes loaded as such contain as much nicotine as about five ordinary cigarettes. Group 3 received nicotine patches to be changed daily with 21 mg nicotine in each. After 12 weeks, the subjects were supposed to start a nicotine-free everyday life without a supportive device. During the study period, all participants were also able to avail themselves of a supportive telephone service as required and after 6 months the researchers tested how many subjects had actually stopped smoking.

Hardly a perseverer – no significant data

The most poignant realisation which all participants had to draw out of the study: Quitting smoking is obviously more difficult than assumed. More than a fifth of the study participants already gave in before the end of the study. Six months after the start of the study from among the “placebo vapour puffers” (group 1) just 4.1% had persisted in abstaining, among the nicotine patch users the figure was 5.8%. The e-cigarette vapour-puffers were indeed the most successful, with a still somewhat limp figure of 7.3% perseverers, but overall because so few participants had remained steadfast, the scientists obtained no statistically significant data. Which method is superior to the others for now cannot be clearly established.

E-cigarette puffer somewhat stauncher

Some trends from the study results, however, were distinctly able to be deduced. The majority of study participants could not resist the desire for a “real” cigarette for long, and within the first 50 days again reached for the tobacco-containing fag. The participants of the e-cigarette group however were overall more steadfast in resisting, because they on average held out twice as long as their counterparts with their adhesive plasters. The relapsers also differed in their cigarette consumption: former participants of the e-cigarette group smoked after relapse at least two cigarettes per day on average fewer than relapsed participants from the plaster group. At this point, however, the study authors noted that many of the aspiring non-smokers had already had earlier, unsuccessful attempts to stop smoking using nicotine patches, which could adversely affect their use of the patch.

After all …

Although probably everyone had hoped for altogether more perseverance, there was nevertheless still a positive trend among the aspiring non-smokers to record: Compared with their cigarette consumption prior to the study, 57 percent of those returning to the habit were smoking at most half of what was previously their usual number of cigarettes.

Short-term application problems

Another (secondary) finding of the study is that short-term use of an e-cigarette brings apparently no serious health risks. Scientists at the German Cancer Research Centre in Heidelberg (DKFZ) nonetheless are strongly committed to have e-cigarettes subject to the same regulations as pharmaceuticals. This would mean that e-cigarettes containing nicotine would only be available in pharmacies in Germany. “The possible health effects of long-term e-cigarette use is at present something which has been revealed by no studies, since the products have only been on the market a few years”, the researchers state in an opinion piece dated April 2013 as justification of these efforts. E-cigarettes, or rather the ingredients that would be vaporised in them, should not be treated in a manner free of concerns. The so-called fluids could – when consumed over a longer period – have a harmful effect. “Fine and ultra-fine aspirable liquid particles, nicotine and carcinogenic substances” that are released into the air are seen by the DKFZ researchers as also placing “passive steam aspirers” at risk.

The legal situation

In Germany, on 17 September 2013 the Higher Administrative Court in Münster dismissed the legal views of the city of Wuppertal, North Rhine-Westphalia, the Federal Republic of Germany, and gave a finding stating that nicotine-containing fluids designated for smoke-free e-cigarettes are not medications. The European Parliament, however, has now launched a legislative initiative, according to which electric cigarettes are to be subjected to medication law. Thus the products would need the respective authorisation, which would be issued only after years of testing. That would be a sharp setback for the booming industry – and possibly also for those who want to stop smoking by using the e-cigarette.

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