Is vaping a friend or foe?

Vaping consists of inhaling an aerosol produced by a flavoured vaping product generally containing propylene, vegetable glycerol, wax, herbs, and numerous additives and flavours, plus a variable amount of nicotine. Many users also use vaping to inhale cannabis.

Other than nicotine and propylene glycol, a common food additive, the American Lung Association lists the following chemicals as having been found in e-cigarettes [3]:

• Carcinogens including acetaldehyde and formaldehyde
• Acrolein – a herbicide
• Diacetyl
• Diethylene glycol
• Heavy metals such as nickel, tin, lead
• Cadmium
• Benzene

For those trying to quit smoking, vaping offers an alternative to nicotine-containing gum, patches, or lozenges. Many studies, though not all, have shown a beneficial effect of vaping on smoking cessation [1]. But vapes still contain nicotine, meaning they still have a strongly addictive nature, and cause an increased risk of heart attack [4]. One benefit is, of course, the lack of smoke: since combustion by-products are not produced, vaping should reduce the risk of lung cancer compared to tobacco smoking. Although a number of chemicals and fine particles are produced by vaping, the reduced lung cancer risk theoretically also applies to second-hand vapour.

Earlier studies demonstrated potential benefits to smoking cessation [5]. Current research, however, remains inconclusive [6]. It is evident that quitting smoking completely would the ideal option, but over the long term, it is probable that vaping is preferable to smoking traditional tobacco products. It’s important to note that combining cigarettes and vaping may give you the worst of both worlds: dual use has been shown to having combined adverse effects on pulmonary and cardiovascular health[7].

It’s a totally different situation when people, especially young adults, take up recreational vaping after having never been smokers in the first place. Health authorities believe that vaping has created a new generation of young nicotine addicts, many of whom will eventually begin to smoke tobacco products [8].

Most worryingly, critics allege that the emerging e-cigarette industry is specifically targeting a more youthful clientele, with their slickly designed vape pens (some resembling USB keys) and on-trend flavours such as mango, cool mint, and crême brûlée. The California-based e-cigarette maker Juul Labs, which enjoys a market share of 70%, was being sued in three U.S. states in 2019 for its deceptive marketing practices targeting minors.

Increasing awareness of the health issues around vaping took on added urgency last year, with the sudden increase in reports of sometimes-lethal lung injuries affecting nearly 3,000, mostly young, Americans. The condition known as EVALI (e-cigarette or vaping-associated illness) was lethal for 47 of those affected [9].

The exact cause of this e-cigarette induced inflammation of the pulmonary bronchioles is not yet known, nor are the reasons behind the timing of this sudden outbreak. Given that vaping has been around since 2004, health researchers in the US have focused on identifying chemicals that have been introduced only recently to the products. One of the chemicals they have singled out is Vitamin E acetate, a sticky substance that is safe when used in skin creams, but when inhaled, could possibly interfere with lung function. But it may not be the sole culprit: cannabis extracts were also used by a vast majority of EVALI victims and most of them were heavy e-cigarette users [9].

Vaping is both federally and provincially regulated. Canada regulates vaping products according to many regulations including [10]:

• Tobacco and Vaping Products Act
• Vaping Products Labelling and Packaging Regulations
• Regulations Excluding Certain Vaping Products Regulated Under the Food and Drugs Act from the Application of the Tobacco and Vaping Products Act
• Canada Consumer Product Safety Act
• Food and Drugs Act
• Non-smokers' Health Act

With the goal of discouraging the adoption of e-cigarettes among youth and non-smokers, these regulations include such provisions as:

• vaping products cannot be sold or given to anyone under 18 years of age.
• vaping products should not contain flavours that appeal to youth.
• promotion of vaping products should not mislead consumers about their potential health effects.

The Non-smoker’s Health Act restricts tobacco use and vaping in federally regulated workplaces like banks, ferries, commercial aircraft, and federal government offices. Quebec’s Tobacco Control Act, adopted in November 2015, regulates e-cigarettes with or without nicotine the same way it regulates tobacco products. Among numerous provisions, Quebec’s regulation prohibits:

• the online sale of e-cigarettes.
• advertisement in newspapers and magazines that have less than 85% adult readership.
• access to vape shops and the display of e-cigarettes in retail outlets accessible to people under 18 years of age.
• use of e-cigarettes in places where smoking is prohibited.

Unlike traditional tobacco products, the addition of flavour to electronic cigarettes is not restricted in Quebec [11].

There’s no single black-and-white answer to whether vaping is a good or an evil. For former smokers that were not able to quit smoking, vaping can be considered a friend , if it is being done responsibly.
For all those youngsters that never smoked before, but became addicted to nicotine or developed or died from ELIVA, it seems more clear that the answer would be: “vaping is a terrible foe”.