Minnesota 2020 Journal: E-cigarettes are Bad for Minnesota
Electronic cigarettes have more in common with crack pipes than they do with conventional tobacco cigarettes. The traditional slender, white paper cigarette is a highly regulated product because ingesting tobacco smoke is incredibly harmful, particularly over time. E-cigarettes, like crack pipes, are unregulated drug delivery devices. They deliver flavored, heat vaporized nicotine, inhaled by the user, presumably seeking the same mild euphoria that nicotine yields in tobacco products.
The e-cigarette industry clearly wants it both ways. They’re quick to evoke the cigarette smoking experience, targeting smokers seeking an extra-legal smoke-free laws work-around. Simultaneously, e-cigarette manufacturers and marketers embrace plausible deniability, claiming that, since there’s no smoke, public regulation is unnecessary. It’s sort of a no-smoke-ergo-no-fire argument. They also couldn’t be further from the truth.
But, I’m getting ahead of myself. Let’s start with the basics. Electronic cigarettes are a battery powered drug delivery device that heats a small amount of liquid synthetic nicotine, released from a cartridge, vaporizing it for ingestion through the lungs. Nicotine cartridges and batteries must be regularly replaced. The devices were first produced in China about 10 years ago. Today, they’re manufactured in the US under license.
Most e-cigarettes resemble cigarettes although there’s no design reason that they couldn’t be manufactured to look like an emphysema inhaler or a toddler’s sippy cup. I suppose that the sippy cup design might too strongly suggest a water bong thus undermining the industry’s subtly flexible insistence that e-cigarettes are cigarettes when the industry wishes them to be and aren’t when it doesn’t. And, of course, the emphysema inhaler, also called a bronchodilator, is an FDA-approved drug delivery device which undermines industry insistence that their device doesn’t require oversight.
In nearly all e-cigarette models, the user draws air through the device, triggering a battery powered heater to vaporize a small amount of nicotine and, simultaneously, propylene glycol. PEG is used as stage smoke and has a low oral toxicity. It’s used, as in stage productions, to suggest smoking without smoke. When you see e-cigarette users exhaling smoke, they’re actually exhaling propylene glycol in a gleeful bait and switch. The e-cigarette user inhales the hot vaporized nicotine and PEG in an air blast that strongly suggests smoking’s sensation. The expelled PEG vapor completes the smoking illusion.
E-cigarette TV ads emphasize this point, suggesting a legal path for skirting clean indoor air laws. Typically, an e-smoker brightly claims, “I’m not smoking because there’s no smoke!” This is true in so far as tobacco smoke is by-product of tobacco combustion. I’ve yet to watch an ad featuring an actor stating, “I’m not smoking, I’m ingesting hot vaporized nicotine and propylene glycol!” I think of this as the too-clever by half approach.
The e-cigarette industry insinuates or, in some cases, out-right claims several benefits. First, anything that involves using less tobacco must be better than smoking. Second, e-cigarettes are an addiction maintenance strategy for nicotine-hooked smokers. Third, e-cigarettes are a smoking reduction and cessation strategy. The problem in all cases, and the driver behind regulator interest, is that these three claims are health claims, offered with no supporting data, controlled studies or application process. FDA takes a very dim view of claimed, unsubstantiated health benefits.
At present, e-cigarettes are legal in Minnesota although it’s probably safer to say that e-cigarettes aren’t illegal. The mounting regulatory questions surrounding their use and its consequences haven’t been addressed by policymakers. That’s rapidly changing on every level from federal to municipal. State Representative Phyllis Kahn (D-Minneapolis) announced plans to sponsor legislation that regulates e-cigarette use under the Minnesota Clean Indoor Air Act of 1975. A number of Minnesota cities are exploring similar municipal bans.
Kahn’s proposal will prohibit e-cigarette use in indoor spaces, grouping the devices with conventionally smoked tobacco products. That’s different from the FDA’s interest in e-cigarettes as unlicensed drug delivery devices. While FDA hasn’t taken steps to extend regulatory control over device manufacture and sales, it has, in effect, prevented devices manufactured outside of the US from being imported under unlicensed drug delivery device restrictions. In a remarkable case of reverse off-shoring, e-cigarettes sold in the US are now manufactured in the US to avoid the import ban.
Minnesota doesn’t need e-cigarettes and it certainly doesn’t need the myriad of lame excuses for their unregulated use. Any claim that involves inhaling flavored, hot vaporized nicotine ought, on its surface, raise a huge red flag of concern. If e-cigarettes are a smoking cessation therapy, there’s a clear FDA regulatory review and application path. Otherwise, let’s stop pretending that e-cigarettes are anything other than a clever sidestepping of public health laws as unregulated drug delivery devices. You’ll notice that no one’s out there defending crack pipes.