Are Electronic Cigarettes And Other Electronic Vaporizers Safe To Use?

What is an electronic cigarette?
December 24, 2014
Why switch to e-cigarettes and vaping?
February 27, 2016

Are Electronic Cigarettes And Other Electronic Vaporizers Safe To Use?

The technology behind the electronic vaporizers, most commonly used as an electronic cigarette, involves heating a non-nicotine or nicotine-infused liquid until it evaporates, creating flavored vapor. Main ingredients in e-juice includes food grade vegetable glycerin, flavoring, distilled water, propylene glycol and sometimes nicotine. We know the long term effect of each of these various ingredients in our body, but we have not studied their long term effect together.

Scientific research on benefits and risks of e-cigarettes is accumulating, but is still limited, as expected, since these devices have only been in the market less than 11 years.

Some of this research was recently summarized and submitted to Health Canada by our Chief Medical Adviser, Dr. Gopal Bhatnagar.

Here are some excerpts from research and opinions from recently published material that may help you answer your question about e-cigarettes safety. You can click on the reference link to see more details and original documents/pieces. 

Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks
“Conclusion: Current state of knowledge about chemistry of liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures tocontaminants of the aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces. However, the aerosol generated during vaping as a whole (contaminants plus declared ingredients) creates personal exposures that would justify surveillance of health among exposed persons in conjunction with investigation of means to keep any adverse health effects as low as reasonably achievable. Exposures of bystanders are likely to be orders of magnitude less, and thus pose no apparent concern.”

– Burstyn I. (2014). BMC Public Health. 14(18)

“Summary: Electronic cigarettes are a recent development in tobacco harm reduction. They are marketed as less harmful alternatives to smoking. Awareness and use of these devices has grown exponentially in recent years, with millions of people currently using them. This systematic review appraises existing laboratory and clinical research on the potential risks from electronic cigarette use, compared with the well-established devastating effects of smoking tobacco cigarettes. Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes. Research will help make electronic cigarettes more effective as smoking substitutes and will better define and further reduce residual risks from use to as low as possible, by establishing appropriate quality control and standards.”

Farsalinos K & Polosa R. (2014). Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Sage Journals: Therapeutic Advances in Drug Safety. 5 (2), 67-86

Long-term effects of inhaled nicotine.
“Summary Excerpt: We could not find any increase in mortality, in atherosclerosis or frequency of tumors in these rats compared with controls. Particularly, there was no microscopic or macroscopic lung tumors nor any increase in pulmonary neuroendocrine cells. Throughout the study, however, the body weight of the nicotine exposed rats was reduced as compared with controls. In conclusion, our study does not indicate any harmful effect of nicotine when given in its pure form by inhalation.”

Department of Medicine, University Hospital, Tronheim, Norway. Waldum HL, Nilsen OG, Nilsen T, Rørvik H, Syversen V, Sanvik AK, Haugen OA, Torp SH, Brenna E.



Although many e-cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don’t exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e-cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette. “Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying,” Strauss said.

E-Cigarettes: Separating Fiction From Fact

Dr. Michael Siegel is a professor in the Department of Community Health Sciences at the Boston University School of Public Health.

“Conclusions: For all by-products measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk to human health from e-cigarette emissions based on the compounds analyzed.”

McAuley T, Hopke P, Zhao J & Babaian S. (2012). Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhalation Toxicology. 24 (12). 850-857

“Failure to distinguish between the nicotine and the smoke leads society to miss a huge opportunity to address the seemingly intractable problems associated with cigarette smoking. The quit or die approach is unethical. It is akin to thinking that anyone who drove a car the 1960s, when there were much less stringent safety standards, should totally forgo driving, rather than have easy access to alternate, potentially less risky, products.”

“if it’s done right, we could have a self-funding public-health revolution, with the potential to save the health-care system billions of dollars by reducing the prevalence of diseases caused by inhaling smoke.”

– Selby, Sweanor & Hughes: E-cigarettes could save the government billions

Results: The study showed that e-cigarettes are a source of secondhand exposure to nicotine (if present) but not to combustion toxicants. The air concentrations of nicotine emitted by various brands of e-cigarettes ranged from 0.82 to 6.23 µg/m3. The average concentration of nicotine resulting from smoking tobacco cigarettes was 10 times higher than from e-cigarettes (31.60±6.91 vs. 3.32±2.49 µg/m3, respectively; p=.0081).

Nicotine and Tobacco Research, online December 11, 2013

Another logical concern is that contaminants can be introduced into e-liquid during the manufacturing process. According to this report published in August 2013 by School of Public Health at Drexel University, there was “no evidence that vaping produces inhalable exposures to these contaminants at a level that would prompt measures to reduce exposure by the standards that are used to ensure safety of workplaces” in a study that utilized data from over 9,000 observations.

Lauren Odum, a pharmacist at the University of Missouri at Kansas City, recently published a review of the scientific literature on using e-cigarettes to quit smoking. “We came up with a lot of anecdotal evidence from patients saying that these are very helpful, but it’s mostly surveys and the data is skewed, because people who have a positive experience are more likely to report back,” she says. Odum works at a smoking cessation clinic and says that patients have told her that e-cigarettes helped them quit or cut back on regular cigarettes. “One of the reasons that people like them is that they don’t have to stop the smoking habit,” she says. “They still get the hand-to-mouth motion and they still get the nicotine, which is the addictive component.


E-cigarettes have not been formally tested as a “quit smoking” tool, but there is a lot of dialogue regarding the use of e-cigarettes as a tobacco harm reduction tool. Particularly, this book provides a good overview of tobacco harm reduction.

A recently published New Zealand trial of 657 smokers concluded that a “modest” 7.3% of nicotine e-cigarette users had quit tobacco after six months, compared with 5.8% using a nicotine patch and 4.1% employing an e-cigarette with no nicotine.

Harm Reduction in Nicotine Addiction: Helping People Who Can’t Quit. Royal College of Physicians of London. October 2007.

This RCP report makes the case for harm reduction strategies to protect smokers. The report demonstrates that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved. The report also argues that the regulatory systems that currently govern nicotine products in most countries, actively discourage the development, marketing and promotion of significantly safer nicotine products to smokers.

– Tobacco Advisory Group of the Royal College of Physicians.

Tobacco harm reduction: How rational public policy could transform a pandemic, International Journal of Drug Policy (2007), doi: 10.1016/j.drugpo.2006.11.013

Nicotine, at the dosage levels smokers seek, is a relatively innocuous drug commonly delivered by a highly harmful device, cigarette smoke. An intensifying pandemic of disease caused or exacerbated by smoking demands more effective policy responses than the current one: demanding that nicotine users abstain. A pragmatic response to the smoking problem is blocked by moralistic campaigns masquerading as public health, by divisions within the community of opponents to present policy, and by the public-health professions antipathy to any tobacco-control endeavors other than smoking cessation. Yet, numerous alternative systems for nicotine delivery exist, many of them far safer than smoking. A pragmatic, public-health approach to tobacco control would recognize a continuum of risk and encourage nicotine users to move themselves down the risk spectrum by choosing safer alternatives to smoking?? without demanding abstinence.

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