It’s been 6 months since we last covered electronic cigarettes, and the devices are still a hot topic for debate. Many states have prohibited the sale of e-cigs to minors and their use on school grounds, whereas others have prohibited them in all areas where traditional cigarettes are restricted. Some reports say that the devices are harmful to our health, but others say their use is totally safe and a great alternative to smoking tobacco. The information out there on whether or not it’s safe to smoke e-cigs can be pretty confusing, but one thing is certain: no one really knows yet. However, a recent report published in Addiction argues that replacing tobacco cigarettes with electronic ones could reduce smoking-related deaths, even though long-term effects are unknown.

After reviewing 81 prior studies on the use and safety of electronic cigarettes, researchers concluded that although e-cigs can contain some of the toxicants present in tobacco smoke, the levels are much lower. According to the report, it’s true that the long-term health effects of the devices are unknown, but compared with cigarettes, e-cigs are likely to be much less, if at all, harmful to users and bystanders. “If there are any risks, these will be many times lower than the risks of smoking tobacco,” said senior author Dr. Hayden McRobbie from the Wolfson Institute of Preventive Medicine at Queen Mary University of London. He added, “We need to think carefully about how these products are regulated.” The report states that the nicotine-emitting devices should face less-stringent regulations than tobacco because allowing them to compete with cigarettes in the marketplace might decrease smoking-related morbidity and mortality. “What we found is that there is no evidence that these products should be regulated as strictly as tobacco, or even more strictly than tobacco,” McRobbie said. However, the report admits that the effects of e-cigs on users with asthma and other respiratory diseases are not known.

Here’s what we do know:

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Research has found that because the nicotine in e-liquids is extracted from tobacco, impurities such as cotinine, anabasine, anatabine, myosmine, and beta-nicotyrine can be included in its makeup, but at very low levels. In some cases, the toxicant levels were comparable to levels in nicotine replacement treatment, which are considered safe. Metal particles were also found in the liquid and aerosol from electronic cigarettes, but the levels were 10 to 50 times below the levels allowed in inhalation medicines. Furthermore, the studies found that aerosol from 1 of 21 e-liquids was cytotoxic, but this was 800 times less cytotoxic than tobacco smoke. When it came to second-hand inhalation, pollutant levels exhaled by e-cig users were much lower than cigarettes and are likely to pose a much lower risk than tobacco smoke.


Safety-wise, none of the studies reported any serious adverse effects after using electronic cigarettes. Effects were mild to moderate and included symptoms such as mouth and throat irritation and dry cough. Out of e-cig users on online forums that had sections dedicated to the reporting of adverse effects, 2% reported an increase in blood pressure.

Effects on Regular Smokers

In regular tobacco smokers, using e-cigs after refraining from smoking cigarettes overnight reduced the urge to smoke within 5 to 30 minutes, even in users of non-nicotine e-cigs. Three studies evaluating the effects in tobacco smokers who did not intend to reduce or quit smoking reported at least a 50% reduction in smoking at the end of 1 week in 32% of participants, including 14% who quit smoking altogether. The report concluded that e-cigs are effective at reducing the urge to smoke and facilitate both quitting and reduction of smoking tobacco.

However, some experts warn that encouraging e-cigs without concrete evidence of their health effects is “reckless.” Dr. Norman Edelman, a senior medical consultant for the American Lung Association, says the FDA should finalize proposed e-cigarette regulations by the end of 2014. “So far there hasn’t been very much chronic use of e-cigarettes. So it’s not possible to say there will be no harm,” he said. “Since we are talking about a recreational drug—it’s not essential to life, it doesn’t cure any illness—it would only make sense to regulate it rigorously until we find out whether it’s good or bad.”


  1. E-cigarettes ‘less harmful’ than cigarettes. BBC website. July 30, 2014.
  2. Hajek P, Etter J-F, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit [published online ahead of print July 31, 2014]. Addiction. doi: 10.1111/add.12659.
  3. Reinberg S. Benefits of e-cigarettes may outweigh harms: study. WebMD website. July 30, 2014.