Some people are turning to electronic cigarettes to stop smoking tobacco. While e-cigarettes cut out the tar and carbon monoxide that come with traditional smoking, some medical professional aren't convinced they're a safe substitute.
"Vaping" cuts out the tobacco smoke associated with lung cancer, but the nicotine and chemicals in an e-cigarette carry their own risks, says Josselin Carter, a physician assistant with the Our Lady of the Lake Smoking Cessation Program in Baton Rouge.
"You are trading off the tar, carbon monoxide and you are switching it for propylene glycol and some questionable flavoring and other metals as well as the nicotine," Carter says. "Overall, you don’t know the effects of the other chemicals because there is no long-term effect history."
E-cigarettes use a heating element to warm and vaporize a liquid that contains flavorings and nicotine. They give smokers the physical sensation of smoking without the harmful smoke.
Public Health England, an agency of the United Kingdom’s Department of Health, has found that e-cigarettes are “significantly less harmful than cigarettes and have the potential to help smokers quit smoking.”
However, the U.S. Department of Health and Human Services is not yet on board.
“For now, we do not know if using e-cigs is a safe and helpful way to quit smoking, so using e-cigs is not recommended,” the agency states on its SmokeFree.gov website,
The presence of nicotine in e-cigarettes concerns Carter. Nicotine, a substance found in tobacco, elevates a smoker's mood and suppresses the appetite.
Nicotine is known to damage blood vessels and lead to heart disease, Carter says. A 2013 study found that nicotine chewed through cells found in the heart and led to atherosclerosis — plaque that builds up in arteries.
"The patients that are at risk for heart attacks or strokes or cardiovascular disease, that is still a huge factor when nicotine is being consumed," Carter says.
The amount of nicotine consumed in an e-cigarette is difficult to understand, Carter says.
"How much you actually use it, how heated the element is, how long you inhale for — those are the variables in vaping," she says.
Proponents of e-cigarettes agree with the findings of Public Health England. Dr. Joel Nitzkin, a New Orleans physician and a fellow at the R Street think tank, says that while nicotine is not harmless, the other ingredients in e-cigarettes are known to be safe.
“We know exactly what is in e-cigarettes and related nicotine vapor devices,” he says.
The propylene glycol used in e-cigarettes has long been used as theatrical fog, Nitzkin says, and in the past has been used as a propellant in asthma inhalers. Other ingredient, glycerine and additional flavorings, are considered safe for ingestion, he says, “although they may pose some risk of lung irritation.”
Carter says that some e-cigarette users don’t realize the amount of nicotine they are One patient, Carter says, smoked a pack of cigarettes a day, then switched to e-cigarettes. When the e-cigarette broke, she returned to traditional smoking and subsequently needed a pack and a half a day to feed her habit.
"She may have been getting more nicotine from her e-cigarette than she was accustomed to," Carter says.
The smoking cessation program at Our Lady of the Lake follows methods currently endorsed by the U.S. Department of Health and Human Services. The program offers free help to anyone who began smoking before Sept. 1, 1998, a condition of a legal judgment of the Scott versus American Tobacco Company class action lawsuit.
In the smoking cessation program, patients usually use a combination of behavioral therapy and nicotine replacement.
Behavioral therapy attempts to break the habit of smoking. Counselors encourage smokers to move their cigarettes and smoking paraphernalia to an inconvenient place — outside the home or in the trunk of the car.
"That takes a little more effort to light up that cigarette," Carter says.
If the smoker chooses to light up on a schedule, such as a smoke break at work, counselors encourage taking a walk or taking part in some other activity.
For nicotine replacement, a pill, patch or gum is used to cut down on cravings.
"If you’re out taking that walk and you’re still thinking about that cigarette, here is that piece of gum to help get you over that hump," Carter says.
Varied treatments target different smokers. Chantix, a popular pill, is not used for those who have suffered post-traumatic stress disorder. Smokers with a heart condition are steered away from nicotine patches.
A Centers for Disease Control study found that just 6 percent of smokers quit for good. The Smoking Cessation Program has a 15 percent success rate, Carter says.
Patients respond favorably when the program's counselors focus on their health, not shame or embarrassment.
"That needs to be the motivation, not the embarrassment," Carter says. "That is the same with any other addict. You have to realize you are affecting your health negatively. That is where the area for improvement has to be."
Help to quit smoking
To learn more about the Smoking Cessation Program, visit smokingcessationtrust.org or call Our Lady of the Lake at (225) 757-2474.
This article was updated on June 14, 2017, to include additional information about the possibility of using e-cigarettes as a smoking cessation tool.