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I am an Internal Medicine physician and a mom of two kids. I have long had an interest in public health education. All too often I see medical misinformation in the media. I want to get relevant, useful, non-judgmental, unbiased and accurate medical information out to teens, and to encourage teens to be part of the discussion! Nothing replaces a conversation with your doctor, your parent, or another supportive adult in your life, but Real Talk with Dr. Offutt can be a place to get involved in your own health!

Tuesday, December 3, 2013

Vaping and Technofoggers

It has been a while since we last chatted about anything new – that busy holiday season is upon us!  Hope you all thought the last topic – smoking – was useful.  It seems like a logical next topic is e-cigarettes.  Or “novel tobacco products”.  Or Vaporettes.  Technofoggers.  E-cigs.

So, as with everything, there is good news and there is bad news.  The good news is that amongst teens such as yourselves, cigarette smoking actually seems to be down.  Which is GREAT!  Great for all the reasons we discussed here: Smoking is bad. You shouldn't do it. Blah blah blah.  But of course I must follow that with the bad news:  Use of e-cigs, or vaping, DOUBLED among middle school and high school students in ONE YEAR!  (2011 to 2012).  Yikes!  That means that 10% of high school students have tried vaping.

Since knowledge is power, and I always want you all to have the straight talk that you need to make decisions that are right for you, here we go talking about e-cigs.  Tough part here, is not all that much is known about e-cigs – so don’t assume that less information means that vaping and e-cigs are better for you than the older way to get nicotine in.  Here is some info for you to chew on.

What are e-cigs exactly?
E-cigs are battery operated devises that heat up liquid to make a vapor that you inhale just like a cigarette.  The vapor has nicotine (that addictive thing in tobacco), flavors (like berry, fruit, chocolate, mint, etc) and Mysterious Chemicals.  The reason I write Mysterious Chemicals is that there are more than 250 different types of technofoggers.  All made throughout the world.  Without any regulation or quality control to make sure certain things stay out of them.  Like chemicals that cause cancer.  Or that a certain amount of nicotine is in them.  So you never know how much you’re getting.  They can look like a whole bunch of things – cigarettes, sparkly pens, cool tubes.  I even heard they can look like thumb drives.  Here are a couple of pix for you:

 






 
How do teens get a hold of e-cigs?
Now, this is not a How-To guide for you.  Sorry.  But I am gonna tell you in case you are wondering where that classmate of yours got it….. or you think they must be safe if they are so easy to come by….  It turns out that 20 states have actually banned sales of e-cigs to minors (teens younger than 18).  But that does leave more than half of the 50 states without laws on the books.  And of course, there is that fabulous World Wide Web.  Internet sales are HUGE and can distribute product from anywhere in the world.

But I heard they help you quit smoking – whaddaya say to THAT?!
Sadly, the studies just aren’t there to say that they do help quit smoking.  In order to be approved to be sold as a tool or drug, really, to help you quit smoking, there are specific requirements about the number of studies and types of studies that need to be done, before they can be sold to do that.  And the studies that are out there aren’t in teens.  And, as we have discussed before, teen brains are different than adult brains – they are still being built.

But they have to be safer, right?
Well, again good news and bad news.  Good news is – they don’t have tar or carbon monoxide (yep smoking tobacco makes you breathe in CARBON MONOXIDE!).  Bad news is they have all sorts of other Mysterious Chemicals in there.  Some are known to be cancer causing.   But you don’t know what you’re getting – remember, more than 250 brands, none regulated to make sure you know what is in whatever you are getting.  And international laws are different from country to country.   And since they are so new, we have no idea what happens when people smoke them for months, years, decades.  Big mystery at this point.  So, you might grow up, have kids of your own, and THEN have health issues from vaping that we couldn’t even imagine now.  SO it is kind of like the lottery.  A bad lottery.  More like Russian Roulette. 

Any more bad news?
Why yes.  Actually the worst news is that the way you inhale nicotine through the vapor is incredibly addictive.  It is like freebasing nicotine.  And is very similar to the way it is absorbed through your lungs with an actually tobacco cigarette.  The problem is here, back to the wide variety of e-cigs out there, you don’t have a measured amount of nicotine in these things.  So you could easily be having a pretty good amount.  That Deeply Satisfying feeling you get is nicotine acting on your brain to make you want more, More, MORE.  There we go – you are addicted!    Remember that because teen brains are different than adults, teens get addicted with much smaller amounts of nicotine than adults.  Many teens show signs of addiction even at low levels of smoking.  Low like 3 cigarettes a week.  Low like smoking for less than a month.    

And again, a refresher about nicotine and teen brain development:  Your brain is still developing, and those nerves are still growing and connecting.  So if you expose your brain stuff to nicotine, you may actually grow a “reward pathway” in your brain that makes you go back for this stuff.  Meaning those nerves fire off to make you feel gooooooooood when you smoke.  And those pathways will stick for the rest of your life making it hard to overpower when you decide, enough is enough and you want to quit.  You know what, it takes only a DAY for the brain to rewire itself from a SINGLE dose of nicotine.

Hey, I know the ads are cool.  Glamorous.  Sexy.  And mmmmm, those flavors.  And your favorite celebrity SWEARS by them. Look, don’t be a sucker.  The e-cig companies are advertising like the cigarette companies did way back in the 1940s and 50s.  Yes, that is SOOOOOO last millennium.  And boy did they work then – really got people smoking!  The thing is, now those types of cigarette ads are illegal.  SO just cuz you see more ads for e-cigs, does NOT mean they are safer than cigarettes. 

Here’s something to think about – there is a big worry that teens that start out using vaporettes will get hooked on the nicotine, and might switch over to tobacco smoking later in life.  There is a HUGE relationship between smoking a cigarette in the last month and smoking in the future.  And remember, all those adults that are trying to quit smoking, well almost all of ‘em who smoke every day, had their first cigarette by 18. 

So, you disagree?  Feel free to drop in a comment below (you can even stay anonymous, but I check em before I post em cuz I don’t want spam here).  Join the discussion!

You are smarter than technofoggers.   Don’t get all distracted by all the smoke and mirrors about vaping.

5 comments:

Anonymous said...

Tip #1

Dont write about e-cigs, then publish a pic that shows a cartomiser plugged into a charger, it sort of shows you don't know how they work.

Tip #2

'mysterious chemicals' what is this alchemy class?

Laura Offutt MD said...

These are great points that you have made that highlight a few important things I should reiterate.

Your first point regarding the cartomiser reinforces the fact that there are more than 250 different manufacturers of e-cigs. This means that there is more than one way that power is supplied to the device to heat up the liquid to generate vapor. Examples in addition to cartomisers are atomizers, tanks, batteries, disposable carterisges with disposable batteries, etc. The picture that you are referring to is actually courtesy of the FDA website. It does in fact represent one form of e-cig.

And with regards to Mysterious Chemicals - no, not an alchemy class. But a bit of humor to get the point across that since e-cigs are not regulated in the way that they are manufactured, there are countless other chemicals that are found in the many different versions of e-liquid. Some of these are known to be cause cancer. Some are not. The list of chemicals is not completely known, but if you think it would be helpful to list some of them that havebeen identified, we can have a bit of alchemy discussion.

Thanks for joining the disucssion!

bbav said...

Actually most e-liquids contain the same basic ingredients most of which are found in stuff you consume a lot of.
Propylene Glycol found in makeup, mousse, shampoo,baby wipes and Asthma inhalers

Vegetable glycerin found in Baked goods used to increase moisture
used as a thick gel for creams, gel capsule pills, rubs and jellies
Eye & ear drops, toothpastes, pastes, and many dental care products.

Food safe flavourings,Most companies use the same flavourings as cupcake companies etc.

And of course a measured amount of nicotine..If you are worried about nicotine stop eating tomatoes,potatoes and aubergines aswell as a lot of other vegetables as they also contain nicotine.

Should kids be using them..NO
Should non smokers be using them..NO
Do they help people stop smoking..Yes,studies may not have been done but that is because most of the companies that sold them,until recently were all small start-ups that couldn't afford to finance the studies needed (no big pharma money) But you only have to ask on twitter or any of the many ecig forums to find lots of anecdotal evidence that they have helped lots of people stop smoking.
Including myself..I smoked from the age of 13 until 2 weeks after my 36th birthday when I started using a proper personal vapouriser.not a cig look alike as they don't work for me and I don't trust them as they are mostly made by big tobacco now.
I haven't wanted a real cig since.
Every other attempt to stop smoking failed miserably,ecigs worked.

Laura Offutt MD said...

Thank you for #JoiningTheDiscussion. You doubted I would post your comments, but I welcome them as a discussion is the best way for meeting of the minds. You may not have realized that my audience is teens, and that is the filter through which this post was written.

You make a very important point that NO, kids should not use e-cigs and I could not agree with you more. I also agree wholeheartedly that e-cigs should not be used by non-smokers. And I think that the worst news is that the way you inhale nicotine through the vapor is incredibly addictive. It is like freebasing nicotine. The problem is here, back to the wide variety of e-cigs out there (recall – international unevenly regulated market), you don’t have a measured amount of nicotine in these things. So you could easily be having a pretty good amount. That Deeply Satisfying feeling you get is nicotine acting on your brain to make you want more, More, MORE. There we go – you are addicted! The point I emphasize with my followers is that because teen brains are different than adults’ brains, teens get addicted with much smaller amounts of nicotine than adults. Many teens show signs of addiction even at low levels of smoking.

With regards to the chemicals in the e-cigs, in regulated economies and industries, there is documentation regarding what the chemicals are that are included in e-cig liquids. The problem herein is that most e-cig sales are via the internet, and supply can come from any country around the world. Hence a user may NOT know what other chemicals are included in the liquid.

As for your point about e-cigs being a tool for smoking cessation, yes, certainly more options are better. But that is a discussion for another age group. I have many colleagues that are experts in tobacco cessation as well as in the potential use of e-cigs for this purpose, and I will summarize their views to say that the jury is still out. One of the biggest problems using e-cigs for smoking cessation is that the behavior of inhaling is not changed, making the overall addiction of nicotine PLUS behavior difficult to alter.

Thanks again for your thoughtful comments. It sounds like you hope that there is a need for additional research in helping tobacco users to quit, and again, I am with you there 100%.

Steffen said...

My son turned 18 last year and he immediately went out and purchased vaping supplies. I say vaping supplies because he and his peers are not purchasing the e-cigs but the multiple different mods out there. My wife and I as ex-smokers (quit without any help) purchased a couple of the ego brand Clearomizers and tried it out. I then purchased a mod with a couple rebuildable drip coils (one single and one dual). After trying several different brands of juice, even the crazy Five Pawns my wife and I decided it wasn't for us.

My wife quit because it actually made her want to smoke MORE. I quit because it really wasn't as satisfying as smoking for me and I was unsure about what exactly it was I was smoking. I'm going to go down a road where honestly I'm not an expert however, I do know that there are safe uses of certain compounds in certain states (not united but being) and then that same compound is unsafe in other uses. Such as: vegetable glycerin may be safe to use in cosmetics or cooking but once my son drips is on a coil that then reaches who knows what temperature... that vegetable glycerin and anything else mixed in it changes it's molecular structure. Not to mention the carcinogens from the metal coil which in the case of the mods gets RED hot.

As for the nicotine. When I smoked a cigarette (I only smoked organic) or a clove I took slow relaxed drags and often would have to re-light my clove or cigarette multiple times (natural tobacco and cloves don't stay lit very well). When I tried vaping I also took slow relaxed drags... My Son? Cheeks collapsed chest collapsed eyes bulging out of his head like he's sucking a golf ball through a garden hose! All the boys at the vape shop are the same. For them, it's all about the cloud... the "hit" of nicotine... the quantity of vapor they can produce at one time; then they do it again, and again, and again...

We talk to my son about it regularly and so far his only search for knowledge is from his peers. To me that is a very dangerous way to validate something as safe or not. I honestly don't know if it is or isn't... but I'm willing to ask the questions and willing to have an open mind. The truth is, I've been to several vaping supply stores where I live, and on-line. I've been with my son and his friends, with my wife, and by myself... nowhere have I seen or heard of anyone doing controlled tests on the ingredients of e-juice after it's been burned on a wad of cotton (organic, surgical, or not). Pepsi might be safe to drink but I don't think I want to put it in a container, heat it to 3000 degrees and smoke it. (I got 3000 degrees from a youtube video of a guy with a thermometer on his dual coil mod)