Throughout the month of February, we’ve been sharing information about how to prevent heart disease, including reducing your personal risk factors. In last week’s article, we discussed how quitting smoking is one of the most effective ways to reduce your risk factors for heart disease. But what about the other effects of tobacco use – like vaping?
We asked Dr. J.S. de Villiers, a Saskatoon-based Cardiologist, a few questions about vaping and the impact it’s having on the health of Canadians. Check out what Dr. de Villiers had to say below.
History can always teach us something. Without looking back at what we have learned about cigarette smoking, we may overlook the risk of a completely new epidemic: Vaping.
A little history
Smoking has been around for a very long time and, through glorified advertising, became popular in the early 20th century. By the mid-nineties, the harmful effects of cigarette smoking was well established. Smoking harms nearly every organ in the body. Smokers develop more frequent heart attacks, stroke and lung cancer. Society became educated on the outcomes of smoking, started changing and smoking was no longer considered “cool”.
The E-cigarette, or vaporizer, was marketed in 2004 as an aid for long-term smokers to switch to a less harmful form of nicotine administration. “Vaping” as it commonly is known today, has now created an industry of its own. In Canada, there has been a rapid rise in vaping and this increase is partially driven by a public perception that vaping is harmless, or at least less harmful than cigarette smoking. E-cigarettes containing nicotine are legal in Canada since the passage of a bill in 2018, and this bill provides some form of regulation of marketing and safety standards.
What is vaping?
Electronic cigarettes (e-cigarettes) are battery-operated devices that heat a liquid (“e-liquid” or “vape-juice”) usually containing nicotine, producing an aerosol that the user inhales. Today, the vast majority of these devices don’t look like a cigarette at all, which has resulted in its adoption in youth population. Over 400 different types of devices are available, and can look like a pen, USB flash drive or even a smart watch, to name a few.
The e-liquid typically consists of a 1) solvent (propylene glycol or vegetable glycerin) and 2) flavourings such as tobacco, mint, fruit, or bubblegum. The e-liquid often also contains another ingredient, most commonly nicotine, although other ingredients such as cannabis are an increasingly popular. A study in Ontario found that very often e-liquids labeled as nicotine-free, did in fact contain nicotine.
Almost 1/2 of e-liquids labelling a certain concentration of nicotine, had concentrations higher than labelled.
Health Canada has identified the availability of flavours as one of the factors that has contributed to the increase in nicotine/cannabis vaping among many age groups. There are also increasing reports of e-liquids containing other recreational drugs such as synthetic cannabinoid receptor agonists, crack cocaine, LSD, and methamphetamine.
Can e-cigarettes help to quit smoking?
E-cigarettes are less harmful than conventional cigarettes. Although early evidence was mixed, recent data does suggest that e-cigarettes may be effective for smoking cessation; however, the evidence is growing and constantly shifting. It is still far better to quit smoking completely than to use e-cigarettes.
More importantly, the long-term effectiveness and safety of e-cigarettes compared with available pharmacotherapies, is uncertain and we need additional high-quality research. Some vaping devices deliver a much higher concentration of nicotine, posing a higher risk of nicotine overdose and or addiction. The American Thoracic Society recommends using proven pharmacotherapy (treatment with medication) rather than e-cigarettes for smoking cessation.
The US Preventive Services Task Force concluded that the evidence is insufficient to fully evaluate the benefits and harms of e-cigarettes for smoking cessation. The biggest concern is that vaping is associated with various respiratory illnesses related to the compounds in the e-liquid, other than the nicotine, when vaporized.
Vaping and its public health concerns:
Although e-cigarettes do not expose the user to the tar, oxidant gases and carbon monoxide of conventional smoking, the e-cigarette contains a number of toxic chemical substances. The first reported cases of serious lung injury, EVALI (E-cigarette or Vaping, product use Associated Lung Injury), was in 2019, including death as a result of this disease. The majority of these cases reported inhalation of tetrahydrocannabinol (THC), but inhaling nicotine has also been documented. Some of these cases had refill cartridges containing Vitamin E acetate, which has been implicated in the disease process.
Vaping as the gateway to tobacco, marijuana and other recreational drug use:
There is ample evidence that vaping has become the new wave of nicotine dependance. Given the marked increase in vaping cannabis products, there is also serious concern about the risk of worsening mental health disorders in youth. Brain development is incomplete until the mid-20s and frequent/prolonged use of cannabis products, especially those with high concentration of THC, can spur the development of dependence and may bring on or worsen disorders such as anxiety, depression and psychosis over time.
Chemical composition of the liquid products:
The active components of e-liquids are not regulated. Little is known about the overall safety or the carcinogenic effects of propylene glycol or vegetable glycerin when heated and aerosolized. At high temperatures, these compounds decompose to form carcinogens. Persons vaping may believe that they are inhaling marijuana or nicotine, but there is often disregard for these other vaporized compounds inhaled at the same time.
The flavorings in e-liquid, are considered “safe” by the general public, because of the notion that it is safe to eat; however the potential harmful health affects when vaporizing a perfectly safe oral product is completely unknown and only time will prove what long-term effects we may encounter in the years to come.
The cultural phenomena of vaping that was billed as a healthier alternative to smoking is simply not true and the harmful effects of vaping is poorly understood by many. Stricter federal, provincial and municipal regulations are required in order to prevent future health related consequences. Additional research and public education is required, otherwise history may repeat itself.