E-cigarettes first appeared on the radar of AOA Trustee Thomas L. Ely, DO, when he began seeing youth-targeted advertisements for them in magazines. Then, he had a conversation with a member of Tennessee’s Health Department about the devices’ potential to harm patients. Later, Dr. Ely shared his concerns with the AOA’s Bureau of State Government Affairs, which he chairs, and the group began looking into e-cigarettes.
E-cigarettes are plastic devices, usually shaped like a cigarette or a pen, that use battery power to vaporize liquid nicotine for the user to inhale or “vape.” Consumers often try e-cigarettes when attempting to cut back or quit smoking. The bureau learned that e-cigarettes were almost entirely unregulated.
“Even though there are restrictions with respect to tobacco use by states, those restrictions did not pertain to e-cigarettes,” says Dr. Ely, who is a family physician in Clarksville, Tennessee. “So someone going into a restaurant that doesn’t allow smoking could sit next to you and use an e-cigarette because that was not covered under any of the existing laws. It seemed unusual that you could do that.”
The bureau’s research led to the development of a policy paper and resolution calling for the regulation of e-cigarettes and nicotine vaping, which the AOA House of Delegates passed today.
A number of states, including New Jersey, Minnesota and Utah, have already passed laws on e-cigarettes, but many have not. In April, the Food and Drug Administration issued a proposed rule to regulate e-cigarettes, which is as far as federal regulation has reached.
Regulations should require ingredient lists and warnings about the addictiveness of nicotine to be prominently displayed on e-cigarette packaging, says Dr. Ely, who a Tennessee delegate to the AOA House. Regulations should also ban the sale and advertisement of e-cigarettes to minors and band e-cigarettes in spaces where conventional cigarette smoking is already prohibited.
The paper calls for research investigating the health impacts of e-cigarettes. Effects are currently not known, but patients who buy cheap units may also be inhaling aluminum or copper vapor alongside their nicotine mist, says Steven Bander, DO, a Texas delegate who is also a member of the BSGA. In addition, poison control centers have seen a surge in calls regarding sickness from overexposure to liquid nicotine, according to news reports.
Also unknown, Dr. Ely notes, is how useful e-cigarettes are as a smoking cessation aid. He says he doubts the devices actually help people quit smoking.
“One of the things that is the most difficult for patients to give up in smoking cessation is the handling of a cigarette,” he says. “Every time you pull out a cigarette, you’re touching it with your hands. Every time you put it in your mouth, your lips are touching it. You don’t even think about it, but when you’re not doing it, all of a sudden something doesn’t feel right.”
A device that allows users to maintain these familiar habits may perpetuate smoking instead of helping people quit, he notes.
Dr. Bander agrees.
“It’s interesting because my patients who use e-cigarettes don’t stop smoking,” says Dr. Bander, who is a family physician in Wylie, Texas. “They just cut back. They smoke a half a pack of cigarettes a day along with the e-cigarettes, and that almost defeats the purpose.”
E-cigarette sales in the U.S. this year are projected to reach up to $1.5 billion, according to Bloomberg Industries. In 2012, sales were around $400 million, reported The Economist. From 2011 to 2012, the percentage of middle- and high-school students using e-cigarettes doubled to nearly 3% and 10%, respectively, according to the National Journal.