Injuries from e-cigarettes increase amid rising popularity

A customer puffs on an e cigarette at the Henley Vaporium in New York City December 18, 2013. (REUTERS/Mike Segar)

Complaints of injury linked to e cigarettes, from burns and nicotine toxicity to respiratory and cardiovascular problems, have jumped over the past year as the devices become more popular, the most recent U.S. data show.

Between March 2013 and March 2014, more than 50 complaints about e cigarettes were filed with the U.S. Food and Drug Administration, according to data obtained through a public records request. That is on par with the combined number reported over the previous five years.

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The health problems were not necessarily caused by e cigarettes. And it is not clear that the rate of adverse events has increased. In 2011, about 21 percent of adult smokers had used e cigarettes, according to federal data, more than double the rate in 2010.

Still, David Ashley, director of the office of science at the FDA’s tobacco division, said the uptick is significant, especially in light of a recent report from the U.S. Centers for Disease Control and Prevention showing an increase in the number of e cigarette related calls to poison control centers.

«Both together does suggest there are more instances going on,» he said.

The FDA is poised to regulate e cigarettes and other «vaping» devices for the first time, potentially reshaping an industry that generates roughly $2 billion a year in the United States. Some industry analysts see e vapor consumption outpacing that of traditional cigarettes, now an $85 billion industry, within a decade.

E cigarettes are battery powered cartridges filled with a nicotine liquid that, when heated, creates an inhalable mist. Little is known about the long term health effects of the products, which were developed in China and moved into the U.S. market in 2007.

«Some evidence suggests that e cigarette use may facilitate smoking cessation, but definitive data are lacking,» Dr. Priscilla Callahan Lyon of the FDA’s Center for Tobacco Products wrote in a recent medical journal article.

Contradictory findings from preliminary studies have become ammunition in the lobbying campaign around the devices, which allow users to inhale nicotine without the damaging tar produced by conventional cigarettes.

Public health officials have said the devices may encourage

nonsmokers, particularly young people, to try conventional cigarettes. E cigarette advocates have argued that they provide a safer alternative for smokers.

The FDA has sponsored research to try to answer safety questions, and it is examining its database of adverse events for any trends that might raise concerns.

RESPIRATORY PROBLEMS

The complaints from the public filed with the FDA cited trouble breathing, headache, cough, dizziness, sore throat, nose bleeds, chest pain or other cardiovascular problems, and allergic reactions such as itchiness and swelling of the lips.

One person told the FDA that while eating dinner at a restaurant a customer at the next table was smoking an e cigarette.

«The vapor cloud was big enough to come over my table and the e cig smoker was ‘huffing’ it voraciously,» the person, whose name was redacted, wrote. «I got dizzy, my eyes began to water and I ended up taking my food to go because of the intense heartbeat I began to develop.»

One woman wrote that her husband began smoking e cigarettes liberally in his car and home after being told they were safe and that the vapor was «just like water.»

«My 4 year old has had a raspy voice since he started but I really didn’t think anything of it till last night my husband was just puffing away on that thing for hours and I woke up wheezing and unable to breathe.»

Miguel Martin, president of Logic Technology, one of the biggest U.S. e cigarette makers along with Lorillard Inc and privately held NJOY, said the spike in adverse event reports reinforces the importance of regulation, especially in areas governing manufacturing practices and labeling, where standards can vary dramatically.

«Clearly, because of the business opportunities, you have companies in an unregulated environment that are importing without checks and balances,» he said, adding that while Logic pays attention to quality control, «some other companies just are not having the same diligence or focus.»

MADE IN CHINA

Most e cigarettes are made in China and sold under more than 300 brands in the United States, some through retail stores, others online.

The quality of the products is inconsistent, however, making it difficult to tease out the cause of any health problems.

One smoker began using e cigarettes following dental surgery after the dentist said quitting smoking would speed the healing process, according to a report filed last October with the U.S. Consumer Product Safety Commission that was forwarded to the

FDA.

«It blew up in my mouth while inhaling, burning my stitches and gum, lip and fingers,» the report said.

Others complained of over heating devices.

«The electric cigarette gets hot when you use it and alters the taste buds,» wrote one consumer. «I just recently realized what was turning my taste buds black.»

It is not possible to draw general conclusions from individual case reports, but there is a growing recognition that the inconsistent quality of the devices, aside from any risk inherent in the inhalation of nicotine vapor, poses potential safety risks.

In a bid to address quality concerns, some e cigarette makers are beginning to make them, either partially or wholly, in the United States.

Reynolds American Inc, which began selling its Vuse e cigarettes in Colorado last July and expects to expand nationwide this summer, makes its products in Kansas and North Carolina, though it still imports its batteries from China.

The reason, Richard Smith, a Reynolds spokesman said, is that inconsistent quality is turning off potential customers.

«There has been a high level of trial among adult consumers but a low level of adoption,» he said.

While the cost may be higher than sourcing ready made products from China, the pay off, Reynolds is betting, will be customer loyalty. If a quality problem arises during the manufacturing process, Smith said, «we can identify and fix it.»

Smokin’ war in las vegas: are e-cigarettes tobacco product or not?

Is an e cigarette that delivers nicotine via an aerosol a tobacco product?

7 Eleven insists it is and wants Becker Enterprises to boot a local e cigarette operation out of the shopping center the two share based on a noncompete clause in the lease. To achieve that goal, 7 Eleven is suing Becker Enterprises, the landlord.

Matt Becker and his wife, April Becker, a lawyer who represents Becker Enterprises, take the position that Sky Vapors doesn t sell tobacco products.

So does the owner of Sky Vapors, Lonnie Paulsen Jr.

If it s a tobacco product, why is it not taxed as a tobacco product?

Statutes define a cigarette as having a tobacco leaf somewhere inside it or wrapped around it, April Becker said, revealing her legal defense.

It would be easier not to defend the lawsuit, but the Beckers are going to challenge it.

The judge has to define if it s tobacco, said Matt Becker, an ex smoker who has never used e cigarettes but disputed that they are a tobacco product. I would not go against any exclusivity agreement.

SKY VAPORS

Sky Vapors opened in September in a shopping center in the Lakes on the southwest corner of Sahara Avenue and Durango Drive. The small store at 8643 W. Sahara Ave. sits to the right of a 7 Eleven. Unless you re looking for it, it s easily overlooked. Inside, there is a counter with devices and two tables to test the liquid flavors. In a way, it seems like a private perfumery.

But in March, 7 Eleven said that since the store opened in 1986, there has been a noncompete clause that the landlord would not permit any other tenant within the shopping center to sell cigarettes and tobacco products, except vending machines.

The Beckers don t want to oust Sky Vapors because there have been a string of operations that have failed in that spot nine to be exact. And suddenly e cigarettes are hot sellers despite unresolved concerns about their negative aspects.

In fact, 7 Eleven sells a brand called NJOY for $8.64, with sales tax. But no tobacco tax was added on. Prepackaged with two e cigarettes, the sales clerk said it would be equal to a pack of cigarettes.

The package warns that the product is not a smoking cessation product and has not been tested as such.

Paulsen s products sell for $25 to $150. It s a bit more upscale with its containers and flavorings.

He said e cigarettes are for people who want to quit smoking.

That s how Paulsen, 32, got into the business. A cigarette smoker since the fourth grade, he was trying to quit and did, although it took a year.

It worked for me, and it s definitely the wave of the future, he said.

I don t sell nicotine. I give it away for free. He puffed a vapor plume 3 feet long using a container decorated with a rendition of Boris Karloff, part of his handcrafted horror series.

E CIGARETTES HOW THEY WORK

For those unfamiliar with electronic cigarettes They originated in the 1960s, faded in popularity and were revived in 2004 by the Chinese. In the United States, their popularity soared about two years ago.

They are battery powered devices that provide doses of nicotine and other additives to a user who inhales and exhales the aerosol.

Depending on the size of the device, the puff emerging can be dramatic, as Paulsen demonstrated.

The vapor that emerges from one s mouth is similar to a fog machine used at a concert, according to Paulsen, who estimated there are about 30 e cigarette stores in Las Vegas.

Nicotine is inserted into liquids and inhaled. The liquids are so flavorful that some people are stopping the nicotine entirely and just enjoying the vapors of flavors.

Sky Vapors flavor list includes Holy Grail, which tastes like a cigarette. Flavors range from sweets, fruits, drinks and fruit blends. There are so many choices that can be mixed, Paulsen has customers who can spend as long as two hours selecting their flavors.

The small store takes in about $8,000 a month in e cigarette and container sales with about 15 daily customers, Paulsen said. He contends his business draws more business to the 7 Eleven next door.

I don t see myself as a threat to them, he said.

He believes the lawsuit against Becker Enterprises is a test case for 7 Eleven. A spokeswoman for the company did not answer whether it is the first case involving an exclusivity agreement against an e cigarette competitor.

I m trying to help people live longer, Paulsen said.

Not everyone agrees.

FEDS HAVE HEALTH CONCERNS

The U.S. Centers for Disease Control and Prevention is concerned that e cigarettes are a gateway product that will entice young users to transition to cigarettes and is tracking the increasing use among young people from grades 6 to 12. The names and flavors seem designed to attract younger users, which is one of the concerns of Congress. Among the sweet flavors offered are honey, maple, chocolate, vanilla, bubble gum and cotton candy.

The center said the overall effect of e cigarettes on public health remains uncertain, but among the concerns are whether the nicotine used creates problems for adolescent brain development.

Recently, the center issued a report that said poison control centers are receiving more calls involving exposure to liquid nicotine. Half the calls involve children under 5. Some children have ingested or rubbed the products on their skin or in their eyes.

The U.S. Food and Drug Administration plans to set regulations for e cigarettes, but it hasn t done so yet.

Without any consistent federal regulation, and without definitive agreement about the product s effect on health, states have taken various actions. The most popular action seems to be banning sales to minors. The Nevada Legislature hasn t addressed the issue, according to a search of its website.

The case against Becker Enterprises was assigned to District Judge Michelle Leavitt, who is being asked to determine whether an e cigarette is a tobacco product and a lease breaker.

Meanwhile, recent news about the e cigarettes involved one exploding and setting a bartender s dress on fire in England last week.

And although less explosive, a congressional report last week called for regulation of the industry. The report is titled Gateway to Addiction.

Contact Jane Ann Morrison at jmorrison or 702 383 0275.