Because health advocates cannot trust the tobacco companies to produce a product that reduces the risk of tobacco use, harm reduction has long been controversial in this area. “Harm reduction is a framework for public health policy that focuses on reducing harmful consequences of recreational drug use, without necessarily eliminating the use itself.”
Examples of use of harm reduction include designated driver programs for drinkers and needle exchange programs for drug users. While smoking cessation devices, such as prescription drugs and patches, have been accepted by the tobacco control community, recreational alternatives have not.
Although the electronic cigarette does not use tobacco, it does use nicotine, and produces a vapor that looks similar to tobacco smoke. Because this simulates the act of smoking, it makes the e-cig a recreational alternative. And, because the electronic cigarette is not a product produced or marketed by tobacco companies, the issue of harm reduction should be, and is, reexamined here.
Zachary Cahn, with the Department of Political Science at University of California at Berkeley, and Michael Siegel, a researcher with the Department of Community Health Sciences at Boston University School of Public Health, review evidence of the safety of the electronic cigarette, and also review harm reduction, with their focus on the e-cig.
Electronic cigarettes differ from other nicotine devices due to the fact that these battery powered devices vaporize the nicotine, producing the look of smoke from a traditional cigarette. The electronic cigarette itself is also shaped much like a traditional cigarette, it is inhaled and exhaled, and therefore, it mimics the act of smoking a cigarette. Smoking an e-cig is referred to as “vaping”, and the initial evidence certainly indicates it to be less harmful than smoking, since there is no tobacco, no tar, and far less chemicals than found in tobacco cigarettes.
Because the e-cig mimics the act of smoking, it addresses not only the addition to nicotine, but also the addiction of smoking itself. Much of the addiction of smoking is behavioral, i.e., having something in one’s hand or mouth. Smoking isn’t just an addiction, but also a habit. The e-cig addresses both the addiction and the habit.
Electronic Cigarettes Study
In the research of electronic cigarettes, 16 studies were identified that characterized the components in the e-cig liquid and the vapor. These studies found the primary components include propylene glycol, glycerin and nicotine. Other components found included tobacco-specific nitrosamines (TSNAs) and diethylene glycol (DEG), which the FDA has associated with possible health hazards. TSNAs were found in 2 studies, and in levels far lower than tobacco cigarettes.
Only one of 18 cartridges tested was found to have DEG. Other chemicals in e-cigs have very few health risks, and when compared to the estimated 10,000 to 100,000 chemicals in cigarettes, the evidence clearly shows the electronic cigarette to be far safer than the traditional tobacco cigarette. When compared to other nicotine replacement devices, there is little difference in the health risks.
While no studies have been conducted on the effectiveness of e-cigs as a smoking cessation device, two published studies examined their effectiveness to reduce cravings. It was found that e-cigs effectively deliver nicotine, and deliver it quicker than nicotine inhalers. It was also found that e-cigs deliver a much smaller dose of nicotine than a traditional cigarette, and that they reduce cravings. It was observed by Bullen, et al. that “the reduction in desire to smoke in the first 10 minutes of e-cig use appears to be independent of nicotine absorption.” Studies have found that even nicotine-free cartridges reduce cravings, having a placebo effect.
Harm Reduction Arguments and Truths
Some of the main arguments against harm reduction are:
– Argument: A safer alternative will inhibit smoking cessation and may attract non-smokers and youths.
– Truth: “Switching to electronic cigarettes is not an alternative to smoking cessation, but rather a form of smoking cessation akin to long-term use of nicotine replacement therapy”. Also, there is no evidence non-smokers use the product, and regulations prevent the sale of electronic cigarettes to minors.
– Argument: Skepticism about the role of combusted products in harm reduction -the impossibility to assess the risk of “a new product using a machine measured delivery of smoke constituents, because there’s no good way to simulate actual smoking behavior.”
– Truth: Electronic cigarettes aren’t tobacco; no combustion takes place.
– Argument: Nicotine replacement products are unappealing and ineffective.
– Truth: This is due to the design of nicotine replacement products. The e-cig was designed “with the express purpose of replicating the act of smoking, without using tobacco.”
– Argument: Tobacco companies can’t be trusted to produce and market a safer alternative to tobacco smoking. Because they have introduced products in the past as safer, but in reality, they were not, e-cigs may prove to be more dangerous.
– Truth: Electronic cigarettes are not produced or marketed by tobacco companies. Electronic cigarettes compete against tobacco companies, and David Sweanor, an adjunct law professor, states “they are exactly what the tobacco companies have been afraid of all these years.
Because smoking cigarettes is the leading cause of death in the United States, the “primary goal of tobacco control is to reduce mortality and morbidity associated with tobacco use”. The electronic cigarette is a safer alternative, designed to reduce or replace the smoking of traditional cigarettes. Because there are so few chemicals in the electronic cigarette compared to the traditional tobacco cigarette, the evidence shows them to be a much safer alternative.
Unfortunately, many agencies such as the American Heart Association, Action for Smoking and Health, American Cancer Society, American Lung Association and many other agencies support the efforts taken by the FDA to ban electronic cigarettes in the United States. Banning the use of electronic cigarettes will only harm the users, “unless the evidence suggests that the harms outweigh the benefits”.
Benefits of the use of e-cigarettes have already been observed. The electronic cigarette has been proven to reduce the urge to smoke. Simply stating they are unsafe is not reasonable grounds to take them off the market. Unless proof can be shown that electronic cigarettes do not reduce harm to the user, banning the product will do more harm than good. It will harm the thousands who have already switched to the safer alternative to smoking. If banned, these users will likely take up smoking once again.
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