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E-Cigarettes: Expert Q&A With the CDC

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Q: The CDC says e-cigarettes have far fewer toxins than conventional cigarettes, so why issue warnings?

A: There are 250 brands of these e-cigarettes and they’re completely unregulated, so what is in one may be different than another. Some have small levels of cancer-causing chemicals, some don’t.

The more important thing is that people will be exposed to nicotine. ... Nicotine is addictive. ... It’s not a benign chemical.

Q. Is nicotine by itself a harmful substance?

A: Nicotine is not the main ingredient in cigarette smoke that is harmful.

Nicotine’s main “harm” is that it is a psychoactive chemical that is the primary driver of a smoker’s desire to continue smoking cigarettes. Smokers become addicted to it, and continue to crave smoking and suffer withdrawal symptoms when they stop.

Nicotine does have some direct harms that we know about. In general, these are less-well understood than the effects of tobacco smoke, because until recently most people got their nicotine from cigarettes. However, we know that nicotine contributes significantly to the harms to the developing fetus, probably through direct effects on the placenta as well as from passing across the placenta into the fetus. Some of this is likely related to how nicotine acts to constrict blood vessels.

Another significant concern is the effect of nicotine on the developing adolescent brain, which will develop differently under the influence of nicotine than without it.

Q: What might FDA regulations look like?                         

A: I can’t comment because they’re a sister agency, but it’s in nobody’s interest to continue in the Wild West state we’re in, where they can be sold to anybody, including adolescents, in half the states. There are no required manufacturing standards and they can market them as if they were peanut butter or something. It doesn’t mean (e-cigarettes) will be treated just like cigarettes, because they’re not, but they’re a product that contains a psychoactive addictive ingredient.

Q: We know how many teens have tried e-cigarettes but not how many use them regularly. When will that data be collected?

A: We’ll ask that in the 2013 survey. [The number of teens using e-cigarettes] will be smaller, but it’s still not going to be inconsequential. It’ll be tens or hundreds of thousands of kids who’ve used them more than once in the last 30 days.

We’ve found from 20 years-plus experience that if a child or adolescent has used a cigarette in the last 30 days, that is very predictive of future cigarette use. We fear the same will hold true with e-cigarettes. Most of what we know of substance abuse patterns makes us worry this will turn out to be the case.

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