France launches inquiry into electronic cigarettes

[The Straight Story]

France launches inquiry into electronic cigarettes

The French government has ordered an investigation into the possible risks of 'smoking' electronic cigarettes as more and more smokers turn to the devices in a bid to stub out their habit.

After a wave of recent publicity around electronic cigarettes France’s Health Minister Marisol Touraine announced on Tuesday she had demanded an investigation be carried out into the nature and risks of the product.

...

Professor Bertrand Dautzenberg, a Paris based pulmonologist told Europe1 radio, the device could have the opposite effect that is designed for.

“These electronic cigarettes could also lead children to start smoking,” he said, insisting they should be banned from children. “If the harm in the short term is clearly low, we have absolutely no idea that if they will help to rid people of their nicotine addiction," he added.

http://www.thelocal.fr/page/view/france-launches-inquiry-into-electronic-cigarettes#.UTaYTjei2So

[msongs]

1. users of these poison air for others - inhale nicotine -> blow out nicotine. they are not "safe"

beyond removal of pollutants caused by burning. they are still toxic to anybody breathing air near one of these devices

[Abq_Sarah]

3. Toxic?

I haven't seen any studies that back up that assertion.

[politicat]

4. Um... Not so much, at least as far as the small scale studies have shown.

First, the primary harmful elements in tobacco cigarettes are the products of combustion and the additives put in the tobacco and paper in processing. Second hand smoke is dangerous because it is smoke, and chronic exposure to any sort of smoke will harm lungs over time. (See incidents of emphysema, asthma, lung cancer and COPD in populations that use wood or dung cook fires, for example.) All smokes are carcinogens. All smokes cause harm.

Nicotine as a chemical is about as harmful as caffeine, once the seriously damaging delivery system of lighting tobacco on fire is eliminated. The LD50 for nicotine is high enough that casual or even deliberate contact doesn't kill and the therapeutic uses are significant. (Nicotine has massive potential for the treatment of schizophrenia, to cite one example.) There is some evidence that the most addictive part of tobacco is not the nicotine at all, but the monoamine oxidase inhibitors (MAOI) (specifically, the beta-carboline alkaloids produced during combustion.) The key here is that people have almost no problem kicking nicotine gum or patches, and those who use an oral or nasal delivery system (chew or snuff) have significantly easier experiences giving it up. Second, the current evidence shows that nicotine replacement therapy fails more often than it succeeds because it does not manage the primary addiction, which leads back to the evidence that the MAOIs are the real problem. (NB: MAOI addiction is up there with heroin as most difficult to treat.)

The current, very limited studies on the nicotine content of exhaled vapor puts nicotine molecules in the 8-17 parts per billion range. (Got access to a mass spec? This is an easy experiment to run. We did, in my lab. Lacking that, there are commercially available nicotine mouth swabs available that put the level of nicotine in an inhaler user's saliva at about 14 parts per million, which is only slightly higher than a non-smoker's saliva (2-10ppm) and orders of magnitude lower than a smoker's - 150-300 ppm.) This is direct measurement of an e-cigarette user's breath upon exhalation into a sterile container. The current background level of nicotine in the average non-smoking building is about 9-15 parts per billion -- so statistically insignificant. The vapor is not a smoke, but a mist. This is critical because smokes contain particulates which are far more dispersable than a mist. (Mist droplets sink faster and vapors are more likely to glom together with other liquids than to be dispersed.) The limited studies are consistent with similar studies done on the exhalation of the active ingredients in asthma inhalers -- which are highly potent stimulants delivered in an aerosolized form and could pose a risk to non-asthmatics who are in contact with second-hand inhaler mist. Note that we let asthmatics use their inhalers as needed. Albuterol (the most common inhaler medication) has a similar neurochemical profile to other stimulants like epinephrine, ephedrine and amphetamine (though it is a beta2-adrenergic receptor agonist rather than general adrenergic receptor agonist). With inhalers, most of the drug stays in the body, either on the mucous membranes of the mouth, throat and airway, or in the lungs. It appears that the same mechanism is in play with nicotine inhalers. Nicotine is a heavier molecule than albuterol, so it's even more likely to attach itself to the user's mucous membranes than albuterol. In all other respects, asthma inhalers and nicotine inhalers are equivalent -- both use the same flavorings, carrier liquids and extenders, which are generally regarded as safe.

Now, to opinion: the best option is to never begin consuming any smokable product. For people who have already made that mistake and are deprived of a time machine, the second best option is to quit by any means necessary. For some, oral or dermal nicotine replacement therapy is sufficient. Current success rates with NRT alone are about 7% after 90 days. Success increases to about 35% with the addition of a norepinephrine-dopamine reuptake inhibitor (bupropion) or a nicotinic partial receptor antagonist (Chantix). Current, limited studies in the effectiveness of nicotine inhalers (ecig) are on-going, but 90 day success rates are about 65% in the Swiss study that is in progress. As a means of harm reduction to the user, ecigarettes beat the pants off any other method of smoking cessation. The same Swiss study indicates that second-hand exposure is equivalent to background, meaning that ecigarette use is as safe for others as breathing regular air. Sharing a space with a nicotine inhaler user is significantly safer than sharing a space with a smoker, and the point is to STOP people from smoking. As far as we can tell, sharing air with a nicotine inhaler user is no different than sharing air with someone who is breathing.

If we're going to worry about air pollution, let's start with the really dangerous stuff, like ozone and particulates from cars, which are currently in the parts per million range in the US. When our air is as clean as what comes out of a SCBA tank, we can worry about the levels of albuterol and nicotine and garlic and perfume in the air.

[LadyHawkAZ]

5. THANK YOU! +1000

[SheilaT]

6. Among the many things I find disgusting about smoking

is that the inside of a smoker's home or car will be coated with what I've always assumed to be nicotine. Will that still happen with the electronic cigarettes?

[politicat]

7. It's not primarily nicotine, it's smoke.

Have you ever seen an old hearth, say in an historic building? They all have a blackened area above the hearth from the accumulated smoke. Or the blackened chimney of a kerosene lamp? Petrocarbons produce a black soot, bio carbons are more brown because bio carbon has a higher ratio of carbohydrates, which literally caramelize. Tobacco consumption produces a relatively small amount of soot compared to a daily cook fire, so it takes years to build up that brown patina.

Open combustion is always bad. The brown scum from tobacco smoke is primarily what is called "tar", though it has no relation to either petroleum tar or pine pitch. It's a resin produced by incomplete combustion of carbohydrates. You can make an equivalent substance by lighting a sage smudge or incense or autumn leaves. (Some leaves are far more toxic than tobacco -- don't burn oleander leaves, or poison ivy.) I hear that pot smokers actually value their resin (my drugs are O2 and H2O.) It stinks, and it is ugly, but so is the soot from any burnt plant.

I'll check next time I'm in the lab and the mass spec is free, but my educated guess is minimal to background nicotine in the resin. Note that art conservators who restore paintings ( which quite often have a layer of that brown resin) do not use Haz-mat protection. (They wear gloves to protect the art, not themselves.) Burning tobacco destroys the majority of the nicotine in the unburnt tobacco (Iirc, an unburnt cigarette contains 1-2 mg of nicotine in a gram of tobacco, but the delivered dose is about 100 nanograms, meaning 99% or more is destroyed. Nicotine is a fragile molecule, so combustion will break it down to its component carbon, hydrogen, et cetera. This is why eating a cigarette is a much, much greater poisoning risk for pets and children than being exposed to second hand smoke.) Again, nicotine is fragile (we have to replace the refrigerated, carefully controlled lab-grade bottle every three months because it breaks down) so even if some initially survives the combustion, inhalation and deposition on the wall, it's probably gone in a couple days. Nicotine is NOT methamphetamine or the gazillion toxic waste products of meth manufacture -- it doesn't hang around. Think garlic, not mercury.

Will the mist of a nicotine inhaler leave a residue? Well... We have a potential test. The carrier fluid for both nicotine inhalers and fog machines is the same -- polyethylene glycol, which does not leave any sort of goo. So... Not really, or no worse than cleaning products, cooking grease, or cologne.

One other test -- the lab I'm associated with has a study group in place in a residential group home for schizophrenics. Schizophrenia has a strong correlation with heavy smoking (90+% of schizophrenics smoke) but smoking was banned in 2009. At that time, the group home switched everyone to a nicotine inhaler. (Much safer -- fire and schizophrenia do not mix.) The cleaning bills immediately dropped. I'll see if I can get a wall scraping.

[SheilaT]

8. Thanks for the information.

There is a particular brownish-yellow residue from smoking cigarettes that I have seen many, many times in many, many places. It's vastly different from the black residue at a fireplace.

More than once when house or apartment hunting, I've immediately rejected a place because the previous resident/owner was a smoker, and that smell gets completely imbedded in everything.

[politicat]

11. Yes, I know exactly what you're talking about.

It is the product of incomplete combustion.

And yes, it's gross and hard to remediate, but I doubt it is primarily nicotine. (Nicotine in liquid form is a clear, slippery fluid with few carbohydrates, so it doesn't get sticky when exposed to air, nor does it caramelize when heated.) The tar or resin is probably as toxic as any other soot.

As I said, let me track down some wall scrapings. (This may take a while; smoking is getting rare.) I'd like to know exactly what it is, too; it will may have practical applications for cleanup.

[SheilaT]

16. If it's not nicotine, what might it be?

I ONLY see that kind of ickiness where there have been smokers.

[politicat]

17. It's the residue of smoke -- a soot.

The reason it looks different than the wood smoke from a fire place has many reasons, but the nicotine molecule is a minor one. The bigger risk of any soot -- be it from a backyard barbecue or smoker, a poorly made candle, a diesel truck, a coal plant or any sort of recreational smoking -- is the products of burning carbon-based fuel, the polycyclic aromatic hydrocarbons. I'm not saying that tobacco resin is harmless -- it's not -- but it's not the nicotine that's the problem. The nicotine is the least of the worries.

Why are tobacco stains yellow? Because they are deposited slowly, over time and in small layers which oxidize with each deposit. The yellow has very little to do with the nicotine, and much to do with the sulphur and the polycyclic aromatic hydrocarbons produced by combustion. Why are they a different color than other smoke stains? Because other smoke stains are generally produced by a fast burning, hot fire that is much larger than the tiny, relatively cool smoldering ember at the end of a cigarette or in the bowl of a pipe. (I expect that, with pot legalization here, there will be a number of houses with pot-resined walls in time.) The higher temp of a flame-fire means that the products of combustion are more fully carbonized and produce a more black smoke and soot. Why do tobacco stains smell bad? Well... Because all smoke smells bad when it gets old, and because we think they do. Fifty years ago, when smoking was far more common, we didn't notice it. We didn't associate the odor with danger and we didn't disapprove. Attitudes toward odors are at least partially cultural. Odors and flavors have cultural connotations.

You are aware that there are thousands of molecules in tobacco, and in all plant matter? Sucrose, lignin, cellulose, biotin, actin, beta-carotene, tannic acid, glutamate, and the list goes on and on. Tobacco is a plant, albeit heavily processed by the time it makes it into a cigarette. Set fire to a gram of zucchini twenty times every day and a year from now, you'll have some sort of smoke damage in that room, too. Will it be brown and sticky? Probably, because zucchini is moist and has a high concentration of sugars and cellulose. Well it stink? Probably, because all old smoke stinks. Will it be toxic? No more so than any other similar plant, which is to say somewhat. Toxic like mercury? Nope.

The big three factors that make tobacco smoke residue differ from fireplace smoke residue is mass, moisture and additives. Mass is important because large fires burn cleaner per gram of fuel than small ones. A cigarette is by definition a very tiny, controlled fire. A small fire cannot generate the thermal mass to fully combust all of its fuel, meaning that it produces more smoke and ash. The other side of the mass factor is that smoking tobacco is a repeated, small scale act, performed twenty or forty times a day. If you burn thirty grams of fire wood or zucchini once a day, it will produce less smoke because it has more mass than if you burn one gram thirty times a day. The other piece of this is that smoking is the only common, daily indoor application of fire most modern western world humans use. If we still used cook fires, or gas lighting, or coal fires, or lit our rooms with candles or oil lamps, we would not notice smoking residue because it would be enveloped in the general smog of all that combustion.

Moisture is the second factor, because a moist fuel burns more slowly and produces more smoke than does a dry one. That's why fire-wood has to be seasoned (dried), and why we don't use softwoods for fuel stock, and why food-smoking requires the mesquite or hickory to be soaked in water before going in the smoker. That's why we use waxes and oils with very low to no water content for candles. (you can't make a smokeless shea butter or jojoba oil candle because those lipids like water.) With fire wood, we want a hot, smokeless fire with leaping flame. That's exactly opposite of what is desired for inhalation of smoke for recreational purposes. If the tobacco (or pot or khat leaves or whatever) is too dry, it will burn fast like tinder and the molecules that make people want to experience short-term smoke inhalation will be destroyed. Recreational plant smoking aims for a smolder, which produces lots of smoke, and therefore incomplete combustion.

Which leads us to additives. The tobacco companies add 600 substances to smoking tobacco to slow down the burn, preserve moisture and alter how their product tastes. Some of those are benign -- sucrose and the cellulose in the paper, fig juice, vanillin, rose oil, to name a few. Some are benign until they are burnt, such as glycerin (which produces acrylamide, a known and far more potent carcinogen than nicotine could ever dream of being, and is far more present in the food industry than in smoke stains) and nutmeg oil (hallucinogen). And others are always a problem, like ammonium sulphide (preservative) or isobutylene alcohol (a plasticizer). There have been several studies recently that the fragrance and essential oils used in candles and incense are just as detrimental to indoor air quality as smoking, but the difference here is that 1) most people only use a candle or incense occasionally, not twenty times a day and 2) we find the scent of Cinnamon/Apple/Vanilla/Lavender/Cookie pleasant, and so don't have negative associations. The other difference is that the fuel stock of a candle is a wax that we have selected to burn clean. The fuel stock of a cigarette (and pot and mullein and incense) is designed to burn poorly and generate smoke. Those additives in tobacco can get quite nasty in combination, and very few were designed to be burned.

All fires produce smoke, soot and ash, and the hazard of all of those are chemicals called poly-cyclic aromatic hydrocarbons. Any carbon-based fuel (oil, wood, biomass, coal, autumn leaves, garden waste, tobacco) produces them, and they are hazardous because they like to bond to lipids (fats). Add extra carbon to a lipid, and it will oxidize, which is generally a bad idea. Getting into the whys requires a refresher on organic chem, and this has already been a long discussion; just take it as read that polycyclic aromatic hydrocarbons are the nastiest of our organic pollutants.

[SheilaT]

19. Are you a chemist?

That was a wonderful, concise, yet thorough explanation of combustion. Wow.

[politicat]

23. Um...

That's complicated. I'm in neuropsych and have spent the last several years in drug safety, doing statistical analysis on side effects. I do a lot of population study, but I have to understand how chemicals work in the brain, so I keep up with organic chemistry.

The lab I'm associated with has an association with a group home for schizophrenics who were forced to transition to inhalers in 2009*, and several of my associates in the lab also use inhalers. There's a wide scope for research into this, because we don't understand tobacco at all well.

We've been running experiments as time and equipment allow, but they're necessarily small scale, unfunded and our control samples are not great. Nobody at this point is interested in funding larger scale studies. There's a lot of money on the side of tobacco and Big Pharma's NRT products, and a lot if institutional inertia.

*there is a long standing but poorly understood relationship between heavy smoking (and only smoking) and schizophrenia. If we can figure that out, we can possibly unlock more about schizophrenia and find better treatments.

[jberryhill]

25. nicotine is a minor component of cigarette smoke

That's like saying "There's vitamin D all over the floor" when someone spills milk.

[SheilaT]

26. Well, there is a very specific

smell of stale tobacco/nicotine in a place where cigarette smoking takes place.

To a non smoker it's very unpleasant. As I think I've already said, when house-hunting I have more than once IMMEDIATELY decided not to buy a place when it's obvious that smokers live there. This is one of the many things that smokers simply don't get. The smell, the characteristic yellowish-brown deposits that it leaves behind are disgusting and unpleasant. So it's not nicotine. BFD. It's nothing like the residue of burning wood that is relatively contained in and around a fireplace.

[jberryhill]

27. The point being...

...Ecig vapor does not contain those components of cigarette smoke which, yes, causes irritation to asthma sufferers, permeates fabrics, etc. The objections to "OMG exhaled Ecig vapor" are misplaced. The bulk of the vapor itself condenses on the inhale and the gaseous volumes being what they are, the concentration of any residual components - which are not going to either smell or deliver any detectable dose of nicotine - is trace at best. You are going to smell the last thing I ate much more strongly than anything else if you put your nostrils right up to my mouth.

[Comrade Grumpy]

15. You ought to see the "brown cafes" of Amsterdam.

Half a milennium of smoking has painted the walls.

Of course, they can't smoke there now.

[Taverner]

9. The vapors are not the same as smoke

Vapor will fall to the ground faster than smoke, which stays airborne for some time.

[Bonobo]

20. I heard they actually alter the balance of bodily humors and may even...

create a small evil dwarf that will live in your stomach.

[RoccoR5955]

24. I can attest to that

I am about to have one removed myself.

[Warpy]

2. Definitely control them like any other nicotine product

But I've watched smokers use the things and cutting down seems to be part of it. Instead of compulsively smoking a cigarette down to the butt, smokers get just enough nicotine to quiet down the crazies and put it away. They start to taper themselves down this way and a lot of them have managed to switch to nicotine free cartridges eventually.

Anything is better than inhaling smoke full of particulates into your lungs. People are still getting the harmful effect of nicotine on blood vessels with the e cigs, but they're still a great improvement.

France should keep them away from kids and quite possibly regulate the strength of the nicotine in the cartridges, but anything else would be counterproductive from a health standpoint.

[Taverner]

10. I do want to know if these are safe or not

I know they do not spout Carbon Monoxide or carcinogens - which is 90% of the danger in cigarettes

But no one has done a study on just nicotine - the drug

It can be as safe as coffee or as dangerous as Russian Krokodil...depending on who you ask

[politicat]

12. There have been studies on just nicotine - they're in the NIH public database.

Most of them are 20+ years old now, done in preparation for the rollout of OTC NRT therapy. The meta result is essentially they're OTC safe, and are restricted to over 18 buyers because of existing tobacco control laws.

[Taverner]

13. Ahhhh good.

I thought so - it may cause heart problems down the road, but so will Big Macs, Four Loko and Mountain Dew

[politicat]

18. And coffee, red wine, cheese, chocolate, spinach and not flossing.

Hearts seem to be the human prime point of failure. Almost everything can cause heart problems eventually.

As a vasoconstrictor, nicotine is far less harmful than most maintenance allergy meds.

[Taverner]

29. And singing "La Marseillaise" in Algeria as well

[jeff47]

14. Actually, they have done studies on "just nicotine"

That's why we know the LD50 of nicotine.

It's about as toxic as caffeine.

[Sgent]

21. The real problem

is we don't know what's in them. We know what the manufacturers claim, but there is no regulation of the product whatsoever.

I'm not worried about the nicotine particularly -- there have been numerous studies on that. I am worried a little more about the other chemicals.

[politicat]

22. Using an inhaler still seems to be primarily DIY, so we do know what's in the fluid.

The carrier fluid is usually polyethylene glycol, which is generally regarded as safe and is the major carrier fluid in liquid medicines and medical inhalers. The alternate carrier is vegetable glycerin, which is generally safe up to 500 F, at which point it will burn and produce acrylamide, but the inhaler mechanism doesn't get that hot. Since nothing is getting burnt, there's no major concern about the secondary chemical interactions that we have with tobacco additives.

The flavorings and scents are straight out of the food and scent industry. Most have been in use for forty or more years.

Lab-grade nicotine is derived from post-fruiting season tomato and eggplant leaves.

That's it. I've watched it being made from the same lab chemicals that we use daily, and if we can't trust our suppliers to sell us what we purchased, we have a much, much bigger problem.

These are all very cheap, so it doesn't make financial sense for the necessarily small scale manufacturers to use other chemicals. Hell yes, I'd like to see some basic regulation, but I would worry much more if that regulation came under the auspices of the tobacco industry. They've proven they are not to be trusted. I'm more ambivalent about Pharma getting the control -- they have not been great, but have historically behaved better than big tobacco. On the other hand, they have also proven their poor ability to open source their ingredients. I do worry about imports, but that's because we have a feckless FTC that is overwhelmed and underfunded.

[Alan Selk]

28. Yes they have

The closest thing to studies on just nicotine are the numerous studies on Swedish snus. Snus is a moist smokeless tobacco with very low nitrosamines numbers and is likely the cleanest form of tobacco on the market.

The results of over 150 studies dating back decades has shown that snus users have essentially the same life expectancy as non-tobacco users. It is clear that nicotine does not cause hardening of the arteries or cancer. It's the smoke that kills, not tobacco or nicotine.