Is it time to quit vaping? What the science says

Vaping has been linked to deaths in the United States, but advocates say it can help people quit smoking. Photograph: Moment/Getty
THE BACKLASH AGAINST VAPING – ONCE HAILED AS A RISK-FREE WAY TO QUIT SMOKING – IS GROWING. AUSTRALIA, INDIA AND MORE THAN 20 OTHER COUNTRIES HAVE BANNED OR RESTRICTED E-CIGARETTES. SHOULD IRELAND?

Almost 250,000 of us do it regularly. There’s a shop selling the equipment for it on the main street of every town. In the space of a decade, the industry in Ireland has mushroomed into a €92 million-a-year business employing hundreds of people.

But with concerns mounting over safety, is it time we called time on vaping?

For years, the jury has been out on the use of e-cigarettes. The technology was new, and it took time to do the research. The consensus was that they were certainly safer than traditional cigarettes – not much of a claim, given tobacco eventually kills half of those who use it.

Vaping has begun to look less like an innocent newcomer. Alarming reports came from the US of a mysterious lung disease linked to nicotine inhalation devices. New research pointed to intrinsic harms linked to the activity

As a smoking cessation tool, vaping has undoubtedly helped many break their tobacco habit. Though the evidence from research remained patchy, most people were prepared to give the new kid on the block the benefit of the doubt.

But over the past year, vaping has begun to look less like the innocent newcomer. Alarming reports came from the US of a mysterious lung disease linked to nicotine inhalation devices. New research pointed to intrinsic harms linked to the activity. The extent to which vaping has become established among American teenagers has been laid bare.

So what do these trends mean for Ireland? Should we – smokers, non-smokers, parents – be worried? The Government will next year introduce laws banning the sale of e-cigarettes to under-18s, but should it be doing more?

Are we at risk of “an entire generation of children becoming addicted to nicotine”, as the US surgeon general has warned of his own country?


250,000
Number of Irish people (5% of population) who use e-cigarettes

€92m
Value of the Irish vaping market

17%
Proportion of Irish people who smoke (10% of these also vape)

28%
Proportion of US high school students who vape


DAMIEN SWEENEY smoked for 20 years, often up to 30 cigarettes a day. After his father died of a smoking-related illness in his 50s, Sweeney started trying to quit.

“I tried everything – patches, hypnosis, cold turkey – but nothing worked. Then, three years ago, I quit using a vaping device. I was really sceptical, but the transition was so easy.”

These days, the 43-year-old from Co Donegal is an ardent vaping advocate, one of four founders of the New Nicotine Alliance, a registered charity whose stated main objective is “the promotion of tobacco harm reduction by providing information on safer options for nicotine users”.

“The most important voice in this debate is the consumer’s, but we are being left out of them. Politicians don’t understand what vaping has done for people,” he says, before attempting to reject or debunk a lot of the reported research on the issue.

“Consumers need a voice and that’s what we want to give them. Decisions are being made without a second thought for the 246,000 people that use these products, 99 per cent of whom are former or current smokers.”

Sweeney is critical of much of the coverage of vaping, claiming it is “badly researched and reported”. “The result has been people returning to smoking and an ever growing number of people believing, incorrectly, that vaping is as dangerous or more dangerous than smoking.”

His organisation receives no funding “from anyone”, he says.

DESPITE THESE ASSERTIONS, the case against e-cigarettes is certainly growing. More than 40 deaths have been reported in the US this year from a vaping-related lung disease; thousands others have reported symptoms including coughs, shortness of breath, chest pain and vomiting.

In most of these cases, the finger of blame has been pointed at vitamin E acetate, an additive found in some products containing THC, the psychoactive compound in cannabis. Many victims had bought their vaping supplies on the black market, and unwittingly ended up with their lung tissue cloaked in this sticky additive.

This couldn’t happen here, the Irish vaping industry says, because such additives are banned from use in their products and EU regulations are far stricter than in the US. It is also worth noting that cannabis is not legal in Ireland – for now – while it is on sale in many parts of the US.

Vaping-related lung injuries in the US have grabbed headlines, but the industry is facing a potentially bigger problem from studies that point to other long-term harms caused by inhaling vapours

Vaping-related lung injuries in the US have grabbed the headlines, but the industry is facing a potentially bigger problem from studies that point to other long-term harms caused by inhaling vapours. Last month, German cardiologists found e-cigarettes damage the brain, heart, blood vessels and lungs through toxic chemicals produced in the vaping process.

This was a limited study, with much of the research performed on mice, but the finding that just one vaping episode increases heart rates and caused the arteries to stiffen was certainly concerning.

Another study published last month found one of the chemicals in e-cigarettes may cause potentially life-threatening inflammation in patients who are susceptible to an immune response. Also last month, scientists from New York University School of Medicine found mice exposed to e-cigarettes for 54 weeks had an increased risk of lung cancer.

Big business: an e-cigarette production line in China. Photograph: Gilles Sabrie/New York Times
Big business: an e-cigarette production line in China. Photograph: Gilles Sabrie/New York Times

It’s still early days. E-cigarettes contain dozens of chemicals, and scientists are still trying to find out whether some of these could cause cancer. In contrast, there are thousands of chemicals in cigarettes, and 70 cause cancer, Prof Luke O’Neill of Trinity College Dublin’s department of biochemistry points out.

One chemical used in some e-cigarette flavourings is diacetyl, which has been linked to a disease known as popcorn lung, in which the air sacs in the lung are scarred, giving rise to a persistent dry cough. British public health experts have dismissed any link between the condition and vaping, but cases continue to appear in the literature; only last month, Canadian doctors said a teenager had developed a vaping-related lung injury similar to popcorn lung.

However, diacetyl has been banned in the EU since 2016, so it is hard to see this condition arising this side of the Atlantic.

In the US, regulation is light, higher amounts of nicotine are allowed in vaping devices than in Europe, and e-cigarettes have been aggressively promoted to all sectors of the population, including the young; 28 per cent of American high school students say they have vaped in the 30 days prior to being surveyed.

The EU, in contrast, has imposed stricter rules on e-cigarettes that prevent the use of certain dangerous chemicals and has so far prevented the mixing of vaping fluids with other, often toxic additives. Aside from some experimentation, Europe doesn’t seem to have a major problem with teen vaping.

THE RISE OF VAPING has thrown health advocates into a quandary. For decades they struggled against Big Tobacco; then, just when victory was at hand and smoking had been all but vanquished, along came a 21st-century, technology-driven variation of smoking, albeit without the ingestion of harmful tar.

Worse, from their perspective, many of the companies selling e-cigarettes today are their old adversaries in “Big Tobacco”. Small wonder many health groups are sceptical about the claims made for vaping and see e-cigarettes as a “Trojan horse” for traditional smoking.

This is the case in Ireland, where groups such as the Irish Heart Foundation and the Irish Cancer Society have urged caution about vaping. In the UK, in contrast, public-health doctors are outright enthusiastic about e-cigarettes being used to wean smokers off tobacco.

The UK anti-smoking lobby group Ash describes e-cigarettes as ‘a very effective aid’ for smokers trying to quit and says vaping is ‘much less risky’ than smoking

In England, vaping forms part of stop-smoking campaigns. Two hospitals have opened vape stores. The UK anti-smoking lobby group Ash describes e-cigarettes as “a very effective aid” for smokers trying to quit and says vaping is “much less risky” than smoking. Public Health England has championed its cause, saying it is “95 per cent less risky” than smoking and runs blogs to counter “myths, inaccuracies and misconceptions” about vaping.

In contrast, Ash’s Irish wing, while accepting e-cigarettes are less harmful than tobacco, stresses the lack of research to date on their long-term impact, and points to studies showing they are less effective than other smoking cessation tools at helping people quit smoking for good.

“We are divided,” says Dr Garrett McGovern, an addiction counsellor in Dublin who is generally pro-vaping. “It’s obvious events in the US has coloured what is going on here. The public health community is not well disposed to vaping, and neither is the Health Services Executive (HSE).

“You have to remember, though, that traditional cigarettes are vicious. If vaping is the only thing that works for a smoker trying to quit, it’s hard to argue against it.”

Five per cent of Irish people use e-cigarettes and a further 12 per cent had tried them at some point, according to the latest Department of Health’s Health Ireland Survey. As with smoking, usage is higher in more deprived areas.

The rise in vaping is to some extent offsetting the decline in smoking – where prevalence is now down to 17 per cent of the population. Among those aged between 25 and 34, 8 per cent are vaping.

And while e-cigarettes are sold as smoking cessation aids, the survey shows 10 per cent of current smokers are also vaping.

Recent studies indicate that e-cigarette-industry funding is more likely to lead to results that indicate that e-cigarettes are harmless

“There are varying opinions on vaping in the medical worlds, with a lot of confusion and mixed messages out there,” says Dr Des Cox, a paediatric respiratory consultant at Crumlin children’s hospital and chair of the tobacco advisory group at the Royal College of Physicians in Ireland.

Cox say he’s “pretty sure” vaping is harmful, but he would like to see more independent, long-term research on its effects.

HSE figures show the number of e-cigarette products has tripled in the past year, to 5,362, due to new market entrants and new product varieties.

Cox says he cannot understand why flavoured e-cigarettes, “which are clearly geared to the youth market”, are sold here.

The EU has stronger regulations than the US on what chemicals vaping products can contain
The EU has stronger regulations than the US on what chemicals vaping products can contain

A scan of vaping websites shows a preoccupation with fancifully-named flavourings. One reads like a wine catalogue, with its promise of “notes of tropical fruits” and “a crisp finish” for different flavoured vaping pods. Another features product names such as Vampire Vape, Suicide Bunny and Bubblegum, though the company has said none of its products are targeted specifically at children.

Although vaping started as something of a cottage industry, and many shops are run by small business-holders, tobacco companies are increasingly prominent. Blu vaping products, for example, are made by the company behind John Player and Gauloise cigarettes. Juul, the biggest e-cigarette brand in the US, launched in Ireland earlier this year and is part-owned by the makers of Marlboro cigarettes.

This trend has only heightened suspicion about the tobacco industry’s motives. “Recent studies indicate that e-cigarette industry funding is more likely to lead to results that indicate that e-cigarettes are harmless,” the authors of the German research mentioned above noted in their paper.

Simon Carroll of PJ Carroll, which has been selling e-cigarettes for 16 months,  says vaping is a big opportunity. ‘The plan is to give smokers a choice by providing them with a product that is potentially less harmful’

PJ Carroll has been manufacturing cigarettes in Ireland for 200 years and selling e-cigarettes for the past 16 months. Country manager Simon Carroll says tobacco remains the company’s “bread and butter” but vaping presents a “big opportunity”.

“The plan is to give smokers a choice by providing them with a product that is potentially less harmful.”

With 41 per cent of smokers saying they have successfully quit and more than half saying they have never tried an e-cigarette, Carroll reckons up to 180,000 smokers could be lured away from tobacco through e-cigarettes.

His company, now owned by British American Tobacco, has “absolutely no interest” in selling vaping products to non-smokers, he declares, and supports moves by the Government to ban sales to under-18s. However, he says restrictions on flavours are “not the answer”; the makers of nicotine replacement products also market flavoured versions, he points out.

CHANGE IS IN THE AIR as the backlash against vaping grows. Australia, India and more than 20 other countries have banned or restricted e-cigarettes. In Ireland, the Government is planning a ban on sales to under-18s and may take further action, depending on the recommendations of a research study it has commissioned. Lobbying of ministers is intensifying, with backbenchers often seeking to facilitate the contacts.

In the meantime, Prof Cox advises ex-smokers who have switched to vaping not to go back to tobacco over the concerns that have been raised. As for current smokers wishing to quit, he suggests they consider other, well-research alternatives to help them on their journey.