Dr. John Oyston, MB BS, BMedSci, FRCA, FRCP(C), September 21st, 2022

1. There is no tobacco in e-cigarettes

Vaping liquid is made of a mixture of vegetable glycerin and propylene glycol, to which nicotine and artificial flavours (such as tobacco or fruit) are usually added.

Because vape liquid is heated but not burnt, the health risk from long-term use of e-cigarettes is “unlikely to exceed 5% of the harm from smoking tobacco” [1].

2. Vaping does not cause death, “Popcorn Lung” or “E-cigarette- or vaping product-associated lung injury” (EVALI)

Health Canada states “there have been no deaths reported as a result of vaping-related illnesses in Canada” and “there have been no reports of popcorn lung occurring due to vaping.”.

The 2019 USA outbreak of severe acute lung injury labelled as EVALI was caused by Vitamin E added to bootleg cannabis products, not legal nicotine vaping [2].

3.Vaping is more effective at getting smokers to quit than conventional nicotine replacement therapy

In a randomized control trial, the 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (P<0.001) [3].

A Cochrane meta-analysis of 61 studies concluded: “For every 100 people using nicotine e-cigarettes to stop smoking, 9 to 14 might successfully stop, compared with only 6 of 100 people using nicotine-replacement therapy” [4].

4. Switching from smoking to vaping saves lives and improves health

Replacing cigarettes with e-cigarettes would result in 1.6 – 6.6 million fewer premature deaths, with 21-87 million fewer life years lost in the USA alone [5].

In a five-year study of COPD patients, switching was associated with fewer exacerbations, improved lung function, and a longer six-minute walking distance [6].

5. Teen vaping has not led to an increase in teen smoking

While teens who experiment with one form of inhaled nicotine are indeed likely to experiment with the other form, NYTS data shows that smoking rates have declined more rapidly in the USA since vaping became popular. Over half the teens who were vaping in 2019 had quit by 2021, suggesting that vaping is a fad, not an addiction.

References

[1] Nicotine without smoke Tobacco harm reduction A report by the Tobacco Advisory Group of the Royal College of Physicians April 2016. Available from:   https://www.rcplondon.ac.uk/file/3563/download

[2]Peter Hajek, Ph.D., Anna Phillips-Waller, B.Sc., Dunja Przulj, Ph.D., Francesca Pesola, Ph.D., Katie Myers Smith, D.Psych., Natalie Bisal, M.Sc., Jinshuo Li, M.Phil., Steve Parrott, M.Sc., Peter Sasieni, Ph.D., Lynne Dawkins, Ph.D., Louise Ross, Maciej Goniewicz, Ph.D., Pharm.D., et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy February 14, 2019 N Engl J Med 2019; 380:629-637 DOI: 10.1056/NEJMoa1808779  https://www.nejm.org/doi/full/10.1056/nejmoa1808779 )

[3] Mendelsohn CP, Wodak A, Hall W. Nicotine vaping was not the cause of e‐cigarette, or vaping, product use‐associated lung injury in the United States. Drug and Alcohol Review 2022; Available from: https://doi.org/10.1111/dar.13533

[4] Hartmann-Boyce J, McRobbie H, Butler AR, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub6. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub6/full

[5] Levy DT, Borland R, Lindblom EN, et al Potential deaths averted in USA by replacing cigarettes with e-cigarettes Tobacco Control 2018;27:18-25. Available from: .https://tobaccocontrol.bmj.com/content/27/1/1

[6] Polosa, R., Morjaria, J., Prosperini, U., Busà, B., Pennisi, A., Malerba, M., Maglia, M. and Caponnetto, P., 2020. COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up. Therapeutic Advances in Chronic Disease, 11, p.204062232096161. Available from https://journals.sagepub.com/doi/10.1177/2040622320961617