An all-out war is raging against electronic cigarettes, the newest and most promising delivery device to help people stop smoking or to maintain nicotine dependence. Opponents of e-cigarettes (ECs) have created a hysteria that is eerily reminiscent of “reefer madness.” Pure nicotine, delivered via vaping, has taken the “demon drug” position formerly held by marijuana, among others—with all the scaremongering, misinformation, fear-based lies, and junk science that implies.
A public health official in California has deemed e-cigarettes “a community health threat.” Janie Heath, dean of the Kentucky College of Nursing, exclaimed, “Let’s be clear: There is nothing safe about e-cigarettes. They deliver nicotine, a highly addictive drug that carries many documented risks.” And an avalanche of methodologically flawed and widely publicized studies have asserted that e-cigarettes are full of cancer-causing chemicals, cause “popcorn lung,” don’t help smokers quit, and—wait for it!—can cause car crashes.
Public health organizations and federal drug agencies including the National Institute on Drug Abuse (NIDA) argue—despite no adequate evidence—that vaping is a “gateway” to tobacco for youth and that “e-cigarettes are no better than smoking regular cigarettes.” Numerous articles and well-respected, anti-smoking groups refer to e-cigarettes as “tobacco products,” which they clearly are not. The American Lung Association’s website contains a statement that declares: “Electronic cigarettes, or e-cigarettes, are a popular new tobacco product that have still largely unknown public and individual health effects.” The word “scourge” is usually reserved for heroin panics, but it’s being used to describe electronic cigarettes. Michael Seilback, a vice president of the American Lung Association, said in a press release: “The scourge of e-cigarettes in New York has warranted action and Governor Cuomo’s proposal comprehensively tackles the proliferation of e-cigarettes in New York.”
But you know what the real scourge is?
The real scourge is that 480,000 people die in the United States from smoking-related illnesses every year. And electronic cigarettes—which are the best hope for hundreds of thousands of inveterate smokers to quit and stay alive, and which cause a tiny fraction of the harms of real cigarettes—are subject to a vicious and unrelenting campaign of lies and deception to convince smokers not to use them.
Are the enemies of vaping so implacably and irrationally opposed to it that they prefer smokers die rather than switch to e-cigarettes?
Common sense alone dictates that because e-cigarettes don’t contain tobacco, they are safer. It is the tar and at least 69 other chemicals in combusted tobacco that cause cancer—not nicotine. But there is plenty of scientific evidence to demonstrate that ECs are safer than cigarettes by orders of magnitude.
An expert, independent review conducted by Public Health England estimated that e-cigarettes are around 95% less harmful than smoking. Professor Kevin Fenton, director of health and wellbeing at Public Health England said: “E-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm.”
In an exhaustive review of the safety and risks of vaping, Riccardo Polosa and Konstantinos E. Farsalinos, two leading European tobacco harm reduction researchers, concluded: “…toxicological studies have shown significantly lower adverse effects of EC vapor compared with cigarette smoke.” And a Cochran review found there was no evidence that short-term use of e-cigarettes is associated with adverse health risks. Studies have found that the most common side effects of vaping are a dry cough and mouth and throat irritation, which usually resolve after a few weeks.
A growing number of e-cigarette batteries have exploded, mainly when charging. One teenager from Colorado suffered third-degree burns after an e-cigarette in his pocket exploded. This is an urgent reason to regulate the batteries in e-cigarettes, not to ban them.
Electronic cigarettes help smokers quit. That’s why millions of people are using them. The Consumer Advocates for Smoke-free Alternatives Association (CASAA) conducted a survey in 2015 of 19,823 its members; 87% reported they quit smoking entirely after starting to vape. In response to an article in Consumer Reports that rejected recommending the use of ECs, more than 1,300 readers responded saying that electronic cigarettes helped them kick the habit. And according to a new study published in the journal Addiction, using ECs led to an estimated 22,000 more people quitting tobacco every year. The researchers found: “E-cigarettes appear to be helping a significant number of smokers to stop who would not have done otherwise—not as many as some e-cigarette enthusiasts claim, but a substantial number nonetheless.”
E-cigarette haters reject the idea that vaping is harm reduction. This is one of the most dishonest ideas currently being debated (even in this political climate). Their hatred stems from a stubborn and irrational belief in abstinence-only paths, and that maintaining the use of “addictive” substances is wrong and “enabling.” It’s similar to how methadone maintenance is often reviled, with methadone users viewed as “addicts” and pressured to taper off the medication quickly. (But daily caffeine users, not so much!)
In one recent article, “Is Vaping an Effective Form of Harm Reduction?”, Dr. Linda Richter answers with an unequivocal “no.” She states that vaping isn’t harm reduction because: “Research is finding that a significant proportion of electronic cigarette users are dual users, continuing to smoke cigarettes while using other nicotine products.”
But dual use is harm reduction! It means that you’re smoking tobacco less often than you were previously, which reduces your risks. A recent study found that among smokers with hypertension, there was a major reduction in blood pressure at the end of one year among those who switched to e-cigarettes completely, or who remained dual users but decreased their cigarette consumption by at least 50%.
The reality is that smokers who use other nicotine replacement therapies (NRT) like the patch, gum or the Nicotrol inhaler also often continue to smoke cigarettes. Many smokers cannot completely give up cigarettes on their first try with NRT and relapse is the norm. E-cigarettes offer nicotine replacement therapy in much the same way that the Nicotrol inhaler does. Pfizer, the manufacturer of Nicotrol, promotes the inhaler as: “Designed to wean your body off cigarettes, supply you with nicotine in controlled amounts, while sparing you from other chemicals found in tobacco products.” Ditto e-cigarettes.
And here is the other issue for the e-cigarette haters: inhalation. They don’t want drugs, or at least some drugs, to be inhaled. This is another knock-on effect of the War on Drugs: The ways drugs are delivered to the brain have become politicized and stigmatized. Smoking crack cocaine carries a heavier dose of stigma than snorting powder cocaine, for example. And in another display of idiocy in the vaping vs. smoking wars, New York state Governor Mario Cuomo insisted that patients enrolled in the medical marijuana program could not smoke the drug—only other forms of drug delivery are allowed including…vaping. The nicotine patch, nicotine gum and Chantix are “okay” because they don’t simulate smoking. Vaping clearly does, and there’s the rub.
But demonizing nicotine inhalation is nonsensical. It’s a fast, safe way to supply nicotine to the brain.
The war on vaping is also a war on nicotine, and by extension, a war on nicotine users. Because nicotine has been associated with the tobacco plant and nefarious “Big Tobacco” corporations and delivered by the toxic, combusted cigarette, it’s viewed as a dirty, unsafe drug. Nicotine is often compared to heroin in terms of addiction potential—a comparison designed to instill fear. The ramped-up attacks on nicotine and the insistence on total abstinence suspend empathy and compassion for smokers, promoting stigma and discrimination instead.
Public health campaigns to persuade smokers to quit use messages that shame, scare and insult smokers’ intelligence. See, Top Forty: Scariest Anti-Smoking Commercials, for a heavy dose of humiliation. And in a series of graphic anti-smoking ads titled, “Tips From Former Smokers,” the Centers for Disease Control (CDC) essentially blames smokers for getting sick and for their own deaths.
The video of Terrie Hall—she was filmed by the CDC in the hospital two days before her death from a facially disfiguring, smoking-related cancer—is appalling reality TV and classic blame-the-victim.
But why would a person smoke two packs of cigarettes every single day for two decades, for example, despite the well-known risks, if they weren’t getting something helpful from every drag? Human beings simply don’t engage in daily, compulsive behaviors for years that don’t confer powerful rewards—and the reward from smoking is nicotine.
The drug has well-documented, beneficial effects on attention, concentration and mood. “In some ways I think of nicotine as the perfect psychotropic drug,” says Paul Newhouse, a scientist at Vanderbilt University. “The nicotinic receptors in the brain act as modulators rather than classic transmitters, scanning the system and stimulating what needs to be stimulated and relaxing what needs to be relaxed…That’s why you have a smoker who uses a cigarette to wake up and to go to sleep.”
And yet, in article after article on vaping, nicotine is deemed dangerous. Richter claims that e-cigarettes “are delivery devices for the highly addictive drug nicotine, use of which can result in serious health consequences including the disease of addiction.”
In fact, scientists and researchers have long understood that nicotine, disconnected from smoke inhalation, is relatively benign. In Nicotine Safety and Toxicity, an authoritative book published in 1998, the effects of nicotine on the brain and body were examined and the authors concluded that the drug has little if any negative impact on cardiovascular health and is not carcinogenic.
Nicotine is addictive—although it’s important to note that millions of smokers have gotten unaddicted.
But it’s not necessary to quit nicotine. It’s possible and even desirable for some people to use it as a maintenance medication, much like methadone. In particular, people with a serious mental illness—a population with exceptionally high rates of smoking—could benefit from nicotine maintenance via vaping. It’s a matter of life and death. Tobacco-related illnesses are the main reason why people with mental illnesses die an estimated 25 years sooner, on average, than those in the general population.
As with medical marijuana, the health benefits of nicotine can no longer be denied or dismissed. The war on nicotine cannot be won, and those who fight it should be ashamed. Nicotine is here to stay. And the invention of electronic cigarettes has revolutionized the field of tobacco harm reduction and saved lives.
Helen Redmond has written for Al Jazeera, AlterNet, Harpers and the Socialist Worker. She is a Licensed Clinical Social Worker and adjunct faculty member at the Silver School of Social Work at New York University. She is a documentary filmmaker and is currently working on a documentary about methadone. She is also an organizer and speaker for the first harm reduction for tobacco conference to be held in the US, taking place in Brooklyn on Thursday, April 21 2016: You can register for the event on the conference website.