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VOL. 129 | NO. 39 | Wednesday, February 26, 2014

Vapor Haze of the Future

Popularity of e-cigarettes grows though risks unclear

By Don Wade

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Create A Cig, located in a strip mall on Poplar Avenue across from East High School, is not just an electronic cigarette retail store.

Several stores in the Memphis area sell e-cigarettes, battery-operated cartridges filled with a nicotine liquid that create a vapor when heated.


Walk inside and you feel like you are in a coffee house (notice the Jenga and Yahtzee games), in an ice cream parlor (not just 31 flavors, but a base of 250), and in a head shop – it smells rather like incense burning, and the Rolling Stones’ “Miss You” from 1978 is playing through the speakers.

So time and place can be a little confusing here in the vaporous haze. But make no mistake, it is vapor and not smoke that you see, smell and taste – if you’re so inclined.

Except for the discarded and autographed cigarette packs that adorn a corner wall – billed as a shrine to smokers who have quit – this is a tobacco-free zone. It is also free of government regulation and, from a health perspective, home to many more questions than answers.

But from 30,000 feet, above the vapor and mystery of e-cigarettes – and above the smoke of their traditional, record-killing cousins – there are a few numbers worth noting.

Each year, more than 480,000 Americans die from cigarette smoking, according to “The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General.”

That same report says that more than 16 million Americans suffer from a disease caused by smoking.

Among American smokers, 68.9 percent want to quit and 42.7 percent have made an attempt to quit in the last year.

Sales of e-cigarettes, which are marketed as a way to quit smoking, were projected to reach $1.7 billion for 2013.

There are several retail shops in the Memphis area that cater to “vapor heads,” as e-cigarette users are sometimes known. Create A Cig owner Aaron Lavene opened the shop on Poplar in November and has another store in Collierville that is about to open. Create A Cig started in Austin, Texas.

Lavene is just 23 years old and while on a recent weekday afternoon people of varying ages entered his store and bought e-cigarette kits that range in price from $30 to $350, his clientele did seem to skew younger.

Justin Morris, a University of Memphis student, was sitting at the counter vaping away that afternoon and explaining that he made the transfer from tobacco cigarettes to e-cigarettes in two days.

“It’s complete replacement,” he said, almost sounding like a spokesman. “You don’t even go through withdrawal.”

E-cigarettes are battery-operated cartridges filled with a nicotine liquid that creates a vapor when heated. The user can adjust the device’s atomizer based on how strongly the person inhales.

“Some people want more of a throat hit,” Lavene said.

There is some research indicating that e-cigarettes deliver users their nicotine faster than smoking cessation therapies such as gum or lozenges.

“In 20 years, I would predict that we will know they’re safer than cigarettes, but they’re not safe.”

–Bob Klesges
Professor, University of Tennessee Health Science Center’s Department of Preventive Medicine

Bob Klesges, a professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center, is a seven-time contributor to the Surgeon General’s report. He recalls how when cocaine became popular in the 1970s an overdose of the drug was uncommon. But when people started smoking it – crack, in other words – addiction ramped up.

“It’s getting into the lungs and goes from the lungs to the brain in seven seconds,” Klesges said. “Same thing with nicotine, same mechanism.”

The safety of e-cigarettes has spawned much debate, with people such as Klesges and Lavene standing at opposite ends of the argument. But when Lavene is told that even Klesges admits it is impossible to currently prove how harmful e-cigarettes are or are not, or how effective they are or are not in helping people to quit smoking, Lavene said: “I agree, I agree.”

Klesges and Lavene also agree that there needs to be a law that prevents sales to minors.

“I don’t need angry parents knocking down my door,” Lavene said.

Most people inside the e-cigarette industry believe regulations on sales to minors and on advertising and Internet sales are coming. The industry is now well-populated by the tobacco companies. Lorillard Inc. owns the blue e-cigarette brand and Philip Morris is also in the e-cig game now.

Sally Satel, a resident scholar at the American Enterprise Institute and a psychiatrist specializing in addiction, wrote an opinion piece for The Washington Post that went so far as to say e-cigarettes could reduce the U.S. smoking rate of 18 percent and thus, “We should not only tolerate them but encourage their use.”

Some of the ingredients in e-cigs, such as propylene glycol and glycerin, can be found in such items as toothpaste, hand sanitizer and asthma inhalers. Satel describes them as “harmless.” She also notes that there are traces of nitrosamines, which are known carcinogens, but at levels comparable to the nicotine patch.

E-cigarettes do not contain tar and there is an old line that says people smoke for the nicotine but die from the tar. Even so, Klesges remains troubled by both what isn’t known about electronic cigarettes and the aggressive way tobacco companies have become involved. Flavorings, he says, could be a way to entice younger users.

“Some people want straight tobacco (flavor),” said Lavene, who personally prefers hypnoice. “And some people want strawberry shortcake.”

Klesges says he couldn’t even submit a grant proposal to see if electronic cigarettes help people to quit smoking.

“You know why?” he asked. “Because I have to demonstrate the thing is safe for human consumption. And because we don’t have that data, we can’t even research it. In 20 years, I would predict that we will know they’re safer than cigarettes, but they’re not safe. If I’m gonna give you skim milk and someone else e-cigarettes, I know who I’m betting is going to the hospital first.”

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