Is vaping safe?

close up of man vaping

E-cigarettes are everywhere and they’re rarely out of the news. Lucy Trevallion looks at the pros and cons of vaping.

“More cancer-causing chemicals found in e-cigarettes”, “Vaping IS a gateway to smoking”, “Belfast woman’s electronic cigarette ‘bursts into flames’”. There are plenty of scare stories about e-cigarettes, but are they really a dangerous trend, or a useful way to quit smoking?

Electronic cigarettes, known as e-cigarettes or vapourisers, are battery-powered devices that mimic the action of smoking, offering nicotine (in most cases), but without the toxic effect of tobacco smoke. They’ve been in the UK since 2007, and keep growing in popularity.

We would not advise non-smokers to take up e-cigarettes, but they can be a useful tool for harm reduction and to stop smoking

More people may be using them, but e-cigarettes are not harm-free. A study published in Environmental Science & Technology in July 2016 identified harmful emissions in the vapour, including possible carcinogens and irritants, though at a much lower level than in conventional cigarettes. The BHF would not advise non-smokers to start smoking e-cigarettes. Public Health England (PHE) estimates they are 95 per cent less harmful than regular cigarettes.

Dr Mike Knapton, Associate Medical Director at the BHF, said: “We would not advise non-smokers to take up e-cigarettes, but they can be a useful tool for harm reduction and to stop smoking.”

According to ASH (Action on Smoking and Health), almost half of the UK’s 2.8 million e-cigarette users are former smokers, suggesting they are helping people to stop smoking.

However, a 2014 study in the New England Journal of Medicine found that “electronic cigarettes may function as a ‘gateway drug’ that can prime the brain to be more receptive to harder drugs.”

Martin Dockrell, Tobacco Control Programme Lead at PHE, said: “We know that e-cigarettes are probably not completely safe, but that’s not the issue. The question is, are e-cigarettes safer than the alternative? And, for almost all e-cigarette users the alternative is smoking, and it's really important that they understand how much safer e-cigarettes are, compared to smoking".

Smoking substitute

Each year smoking causes around 46,000 deaths from cancer and 28,000 from respiratory disease in the UK, plus an estimated 20,000 deaths from cardiovascular disease.

“People might be surprised at how much easier it is to quit with an electronic cigarette,” said Martin. “Any smoker with a heart condition has almost certainly tried to quit in the past, and failed. Try again with an electronic cigarette because you might find that’s a lot easier. And further down the line, you might want to quit the e-cigarette as well.”

“We know that e-cigarettes are probably not completely safe, but that’s not the issue.

The Royal College of Physicians has reviewed the available evidence and advises GPs to promote e-cigarettes “as widely as possible as a substitute for smoking”. 

Recent independent studies from PHE show that most of the chemicals causing smoking related disease are absent in e-cigarettes, and chemicals that are present pose little danger.

Martin said: “For the main carcinogen in tobacco smoke, levels in e-cigarette users were close to that of non-smokers.”

But a small study, published in August 2016, suggested that smoking e-cigarettes for 30 minutes can cause arteries to stiffen, in a similar way to tobacco cigarettes, suggesting more research is needed into their long-term safety.

Fluid situation

Experts agree that we need longer-term data on the effects of using e-cigarettes, particularly in regard to cardiovascular disease. But since e-cigarettes have only been on sale in the UK since 2007, long-term studies don’t yet exist.

Linda Bauld, Professor of Health Policy at the University of Stirling, is reviewing the marketing of e-cigarettes for Cancer Research UK, and warns that advertising of e-cigarettes may change in the future. “At first there wasn’t a lot of marketing around e-cigarettes, then in 2014 CAP [Committee of Advertising Practice] drew up new rules on e-cigarette marketing that allowed them to be shown on TV,” she said.

“Then, in May 2016, the European Tobacco Products Directive banned all broadcast media in the EU from advertising e-cigarettes, effective immediately.” Billboards and point-of-sale advertising do not count as broadcasting so are allowed in the UK, although the Scottish government has given itself powers to limit these.

In Wales, a bid by the Labour Party to partially ban e-cigarettes in public places was voted down in May 2016. The Westminster government made clear it doesn’t want to legislate against using e-cigarettes in public places, but it is unclear whether you will be allowed to smoke e-cigarettes on trains, in pubs, or in workplaces. PHE has now offered principles and recommendations helping premises come to their own decisions.

Nicotine and your heart

Nicotine, while highly addictive, is not a significant health hazard for people without heart conditions. It does not cause acute cardiac events or coronary heart disease, and is not carcinogenic. But nicotine is a problem for people with heart disease. It raises the heart rate, contradicting the goal of most treatments. Tell your GP if you have heart disease and are using nicotine replacement.

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