The benefits and risks of electronic cigarette use are, as of 2013, uncertain, but they are likely safer than smoking tobacco. Laws vary widely concerning their use and sale, and are the subject of pending legislation and ongoing debate.
The World Health Organization states that as of July 2013, no rigorous studies have been conducted to determine if electronic cigarettes are a useful method for helping people to stop smoking.
The British Medical Association state that there is emerging evidence of smoking cessation benefits, but has concerns that they are subject to less regulation that of conventional nicotine replacement therapy, such as the nicotine patch and the gum, (for example nicotine CQ) and that there is no peer-reviewed evidence of their safety or efficacy. They recommend a "strong regulatory framework" for e-cigarette distribution in order to ensure their safety, quality, and that their marketing and sales are restricted to adults. The BMA encourages health professionals to recommend conventional nicotine replacement therapies, but for patients unwilling to use or continue those methods, they say health professionals may present e-cigarettes as a lower-risk option than tobacco smoking.
A 2011 review published in the Journal of Public Health Policy states that electronic cigarettes may aid in smoking cessation and are likely to be more effective at this than traditional treatment. The American Association of Public Health Physicians (AAPHP) view electronic cigarettes as similar to other nicotine replacement therapy and recommend them as a harm reduction method for those who have failed to quit by other means. In one study, 31% of users had ceased smoking six months after beginning use of electronic cigarettes and a further two-thirds had reduced their tobacco consumption.
Electronic cigarettes should theoretically have fewer toxic effects than traditional cigarettes. Nevertheless, concrete evidence is insufficient as of 2013, although tentative evidence suggests they are safer than real cigarettes, and possibly as safe as other nicotine replace,net products.
The electronic systems appear to generally deliver less nicotine than smoking. The amount of nicotine delivered is believed to vary between different brands of electronic cigarettes.
A preliminary analysis of e-cigarette cartridges by the FDA identified that some contain tobacco- specific nitrosamines (TSNAs), known cancer-causing agents. The FDA's analysis also detected diethylene glycol, a poisonous liquid, in one of the cartridges manufactured by Smoking Everywhere and nicotine in some cartridges claimed to be nicotine-free. Further concerns were raised over inconsistent amounts of nicotine delivered when drawing on the device. In some e-cigarettes, "Tobacco-specific impurities suspected of being harmful to humans – anabasine, myosmine, and ß-nicotyrine – were detected in a majority of the samples tested." It is not clear if these chemicals were detectable in exhaled vapor. The UK National Health Service noted that the toxic chemicals found by the FDA were at levels one-thousandth that of cigarette smoke, and that while there is no certainty that these small traces are harmless, initial test results are reassuring.
Most electronic cigarettes take an overall cylindrical shape. Common components include liquid, a cartridge, an atomizer, and a power source. Many electronic cigarettes are composed of streamlined replaceable parts, while disposable devices combine all components into a single part that is discarded when its liquid is depleted.
Cartridge: The cartridge generally serves as both a liquid reservoir and mouthpiece (though some devices have separate mouthpieces). It is designed to allow the passage of liquid into the atomizer, and vapour from the atomizer to the user's mouth. Some models employ a tank that holds loose fluid, while some use a foam material to hold liquid in place. When liquid is depleted, users can refill the cartridge or replace it with another ready-filled cartridge.
Atomizer: The atomizer is the central component. It generally consists of a small heating element responsible for vaporizing liquid, as well as a wicking material that draws liquid in. "Dripping" atomisers forgo a fluid reservoir, instead requiring periodic manual moistening of the wick.
Cartomizer: Since atomizers tends to lose efficiency over time due to a buildup of sediment, or "burn out" entirely, some models employ a disposable "cartomizer" component that also doubles as the device's cartridge. The piece consists of a heating element surrounded by a liquid-soaked poly-foam.
Power: Most portable devices contain a rechargeable battery which tends to be the largest component of an electronic cigarette. The battery may contain an electronic airflow sensor whereby activation is triggered simply by drawing breath through the device, while other models employ a power button that must be held during operation. An LED to indicate activation may also be employed. Some manufacturers also offer a cigarette pack-shaped portable charging case (PCC), which contains a larger battery capable of charging e-cigarettes. Devices aimed at enthusiasts may sport additional features, such as variable power output and support of a wide range of internal batteries and atomizers.
Liquid for producing vapor in electronic cigarettes, commonly known as e-juice or e-liquid, is a solution of propylene glycol (PG), vegetable glycerin (VG), and/or polyethylene glycol 400 (PEG400) mixed with concentrated flavors; and optionally, a variable concentration of nicotine.
The solution is often sold in a bottle or in pre-filled disposable cartridges. They are manufactured with various tobacco, fruit, and other flavors, as well as variable nicotine concentrations (including nicotine-free versions). The standard notation "mg/ml" is often used in labeling for denoting nicotine concentration, and is sometimes shortened to a simple "mg".
Electronic cigarette sales increased from 50,000 in 2008 to 3.5 million in 2012. As of 2011, in the United States, one in five adults who smoke have tried electronic cigarettes. In the UK 11% of regular smokers were using electronic cigarettes in 2013 and 24% had used them in the past. 1% of non-smokers had tried them and 0% were currently using them.
Among grade 6 to 12 students in the United States, those who have ever used the product increased from 3.3% in 2011 to 6.8% in 2012. 10% of students who have used e-cigs have never smoked. A 2013 UK survey by Action on Smoking and Health found that among non-smokers under 18, 1% reported having tried e-cigarettes "once or twice," 0% reported continuing use, and 0% intended to try them in the future. ASH concluded that among children who have heard of e-cigarettes, sustained use is rare and confined to children who smoke or have smoked
The earliest electronic cigarette can be traced to Herbert A. Gilbert, who in 1963 patented a device described as "a smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper with heated, moist, flavored air." This device heated the nicotine solution and produced steam. In 1967, Gilbert was approached by several companies interested in manufacturing it, but it was never commercialized and disappeared from the public record after 1967.
Hon Lik, a Chinese pharmacist, is widely credited with the invention of the first generation electronic cigarette. In 2000, he came up with the idea of to vaporise a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution. This design produces a smoke-like vapour that can be inhaled and provides a vehicle for nicotine delivery into the bloodstream via the lungs. He also proposed using propylene glycol to dilute nicotine and placing it in a disposable plastic cartridge which serves as a liquid reservoir and mouthpiece.
The device was first introduced to the Chinese domestic market in May 2004 as an aid for smoking cessation and replacement. The company that Hon Lik worked for, Golden Dragon Holdings, changed its name to Ruyan (literally "Resembling smoking"), and started exporting its products in 2005–2006 before receiving its first international patent in 2007.
Several e-cigarette models marketed by tobacco companies were launched or are set to launch in 2013, including the Vuse, MarkTen, and Vype. Blu, a prominent e-cigarette producer, was also acquired by Lorillard Inc., a tobacco industry leader, in 2012.
Because of the relative novelty of the technology and the possible relationship to tobacco laws and medical drug policies, electronic cigarette legislation and public health investigations are currently pending in many countries. Current regulations vary widely, from regions with no regulations to others banning the devices entirely.
The European Economic Area
Whether electronic cigarettes could be regarded as falling under Directive 93/42/EEC on medical devices depends on the claimed intended use and whether this intended use has a medical purpose. "It is for each national authority to decide, account being taken of all the characteristics of the product, whether it falls within the definition of a medicinal product by its function or presentation."
- In Austria nicotine-containing cartridges are classified as medicinal products and e-cigarettes for nicotine inhalation as medical devices.
- In the Czech Republic, the use, sale and advertising of electronic cigarettes is legal.
- In Denmark, the Danish Medicines Agency classifies electronic cigarettes containing nicotine as medicinal products. Thus, authorization is required before the product may be marketed and sold, and no such authorization has currently been given. The agency has clarified, however, that electronic cigarettes that do not administer nicotine to the user, and are not otherwise used for the prevention or treatment of disease, are not considered medicinal devices.
- In Estonia, the Estonian State Agency of Medicines had previously banned e-cigarettes, but the ban was overturned in court on 7 March 2013.
- In Finland, the National Supervisory Authority of Welfare and Health (Valvira) declared that the new tobacco marketing ban (effective 1 January 2012) will also cover electronic cigarettes, resulting in that Finnish stores or webstores can't advertise e-cigarettes because they might look like regular cigarettes. In theory, e-cigarettes with nicotine-free cartridges may still be sold, as long as their images and prices are not visible. Ordering from abroad remains allowed. Sale of nicotine cartridges is currently prohibited, as nicotine is considered a prescription drug requiring an authorization that such cartridges do not yet have. However, the Finnish authorities have decided that nicotine cartridges containing less than 10 mg nicotine, and e-liquid containing less than 0,42 g nicotine per bottle, may be legally brought in from other countries for private use. If the nicotine content is higher, a prescription from a Finnish physician is required. From a country within the European Economic Area a maximum of one year's supply may be brought in for private use when returning to Finland, while three months' supply may be brought in from outside the EEA. Mail order deliveries from EEA countries, for a maximum of three months' supply, are also allowed.
- In Germany, the sale and use of electronic cigarettes is legal.
- In Hungary, the sale and use of electronic cigarettes is illegal.
- In Ireland, the sale and use of electronic cigarettes is legal.
- In Italy, by a Health Ministry decree (G.U. Serie Generale, n. 248 del 23 ottobre 2012) electronic cigarettes containing nicotine cannot be sold to individuals under 16 years old.
- In Latvia, e-cigarettes are legal.
- In the Netherlands, use and sale of electronic cigarettes is allowed, but advertising is forbidden pending European Union legislation.
- In Norway the sale and use of electronic cigarettes are legal, but nicotine cartridges can only be imported from other EEA member states (e.g. the UK) for private use.
- In Poland, the sale and use of electronic cigarettes are legal.
- In Portugal, the sale and use of electronic cigarettes are legal.
- In the United Kingdom, the use, sale and advertising of electronic cigarettes is legal. Electronic cigarettes are also allowed to be used inside pubs, coffee shops, etc. where the smoking of tobacco is illegal.
The FDA classified electronic cigarettes as drug delivery devices and subject to regulation under the Food, Drug and Cosmetic Act (FDCA) before importation and sale in the United States. The classification was challenged in court, and overruled in January 2010 by Federal District Court Judge Richard Leon, citing that "the devices should be regulated as tobacco products rather than drug or medical products." Judge Leon ordered the FDA to stop blocking the importation of electronic cigarettes from China and indicated that the devices should be regulated as tobacco products rather than drug or medical devices.
In March 2010, the U.S. court of Appeals for the District of Columbia stayed the injunction pending an appeal, during which the FDA argued the right to regulate electronic cigarettes based on their previous ability to regulate nicotine replacement therapies such as nicotine gum or patches. Further, the agency argued that tobacco legislation enacted the previous year "expressly excludes from the definition of 'tobacco product' any article that is a drug, device or combination product under the FDCA, and provides that such articles shall be subject to regulation under the pre-existing FDCA provisions.". On 7 December 2010, the appeals court ruled against the FDA in a 3–0 unanimous decision, ruling the FDA can only regulate electronic cigarettes as tobacco products, and thus cannot block their import. The judges ruled that such devices would only be subject to drug legislation if they are marketed for therapeutic use – E-cigarette manufacturers had successfully proven that their products were targeted at smokers and not at those seeking to quit. The District of Columbia Circuit appeals court, on 24 January 2011, declined to review the decision, blocking the products from FDA regulation as medical devices.
With an absence of federal regulations, many states and cities have adopted their own e-cigarette regulations, most commonly to prohibit sales to minors, including Maryland, Kentucky, Minnesota, New Jersey, New Hampshire, Tennessee, Utah, Wisconsin, California, and Colorado. Other states are considering similar legislation.
- California Governor Arnold Schwarzenegger vetoed a bill that would regulate the sale of electronic cigarettes within the state on grounds that "if adults want to purchase and consume these products with an understanding of the associated health risks, they should be able to do so."
- New Jersey voted in 2009 to treat the electronic cigarette in the same category as tobacco products by including them under the New Jersey Smoke-Free Air Act, which prohibits smoking in indoor work and public places. Assemblywoman Connie Wagner sponsored the legislation, arguing "that young people who use these things will get hooked on the nicotine and eventually move onto the real thing".
- In New Hampshire, the sale of electronic cigarettes to minors is illegal as of July 2010.
- Arizona is planning to ban the sale of electronic cigarettes to minors.
- In Washington, the King County board of health has banned smoking of electronic cigarettes in public places, and prohibited sales to minors. Neighboring Pierce County also prohibits sales to minors, but allows e-cigarette use in places such as bars and workplaces.
- In Maryland, sales to minors are banned.
- Iowa requires retailers in Linn County to have a retail tobacco license.
- New York State banned the smoking of e-cigarettes within 100 feet of a public or private school entrance in September 2012, and banned e-cigarette sales to minors starting on the first of January 2013.