e-cigarettes: accidents waiting to happen

We all know smoking is bad for us, and we all know that giving it up is a good idea. E-cigarettes have been around for a good few years now, and they seem to be the answer to a lot of our prayers to some people: That lovely nicotine hit, without having to traipse outside, and without any of the nasty tar or other chemicals that makes smoking bad for you.

There's currently a bit of a kerfuffle going on about them as the EU look into tighter regulation of them. A quick search on Twitter reveals lots of folk stating that they save thousands of lives, are much safer than other pharmacological smoking cessation methods, and are totally safe, therefore shouldn't be banned by the EU. Others have covered the fact that e-cigarettes are unregulated, that they may actually contain chemicals and ingredients which can be carcinogenic, that they might have adverse safety effects so I'm not going to cover all of those potential issues here. .But there is one aspect of their use which I think is easily forgotten about, but has the potential to be very worrying.

It seems that e-cigarettes come in a variety of forms- none of which are regulated. Some are disposable, some have refillable cartridges, and some require refilling with a liquid. There are even some sites which encourage mixing your own nicotine liquid: a complicated process requiring mixing a nicotine concentrate with a flavouring and a diluent using a dropper.

Now, as a fairly young pharmacist (or so I keep telling myself), it has been a long time since I compounded any medicines myself, but I do remember doing so in university and I have a pretty good idea of how to work out and produce mixtures. I'm a keen baker, so used to following recipes which can be complex at times. And yet a quick glance at some of the mixing guides for nicotine liquids makes me worried. They look complicated enough for a pharmacist like me to follow, never mind anyone else. Milligrams, drops, milliliters, colours, parts etc are all terms used on the same instruction sheet, and the medicines safety part of me is crumpled and crying in a corner, wailing "HIGH RISK COMPOUNDING PROCEDURE!" loudly to anyone who will listen. And yet, because these things aren't considered a medicine, anyone can sell this stuff, and anyone can buy it. There are risks at every step of producing these mixes: not understanding the instructions, not accurately measuring amounts, mixing up the different liquids, storage of the liquids, spillages etc etc. Some sites even suggest using a syringe- complete with needle- to inject the nicotine solution into devices. A little bit of me is dying inside. 

Even the ready made liquids are problematic enough. They come in little eye-dropper type bottles, and are often pleasantly flavoured. In short, they're probably rather attractive to children. 

In my day job, which partly involves advising on poisoning cases, I have come across quite a few cases where nicotine liquid intended for use in e-cigarettes has been accidentally ingested. A lot of people don't know that nicotine itself can be horribly toxic, particularly for children. It only takes a small amount orally to get some pretty nasty, potentially fatal effects. And yet, freely available to buy without any regulation at all, a variety of attractively flavoured and packaged -and really highly concentrated- nicotine liquids are sitting ready to be bought by eager punters. You can even buy multi-packs of large bottles of highly, highly concentrated nicotine liquid. They don't even have child-resistant tops on them- and why should they, as they're not even considered a medicine? The websites selling these things aren't particularly clear about the dangers of them- again, why should they be, when they're trying to sell them as a safe alternative to smoking?

I've had a quick look around the medical literature and as of yet there is very little information published on this aspect of e-cigarette usage. And that's part of the problem: the technology has been widely adopted without a thorough understanding of all the different aspects of its safety. Even if they were tightly regulated and highly safe, this aspect of accidents with refills will still remain, and in my opinion it is only a matter of time until there are some very serious accidents of this nature. 

So, whilst e-cigarettes might be a useful ally in giving up smoking for some people, we really need to put some thought into the safety issues surrounding them, and not just the obvious ones which might affect the person using them.

All of this is without even considering the fact that using them can sometimes make you look a bit daft, especially the ones that light up at the end like a pretend-y cigarette. Others, frankly, look like "discreet" vibrating devices for ladies. You'd be better off with those yummy candy cigarettes from the eighties, if you ask me- they look more like an actual cigarette than most of the e-cigs and they're a whole lot cheaper too. 


Minor Update (2nd May 2015): Some time has passed since I wrote this, and I think my fears have started to be borne out in the evidence. Poisons Centres around the world are starting to report evidence of toxicity. Deaths in both humans and animals are being reported. Its a real shame that it came to this, but hopefully with proper regulation the safety of e-cigarettes can be improved.