Monday, 24 March 2014

Nicotine poisoning; the anti-e-cig-movements new favourite argument?

Responsible adults is the key to avoid nicotine poisoning.
photo credit: lindsay-fox via photopin cc
The gateway argument has been the anti-e-cigarette-movements favourite argument for a while now, urging us to think of the children that would doubtlessly start using e-cigarettes and then move on to traditional cigarettes, or even worse, according to some of the most delusional anti-e-cig advocates, to harder drugs. However, this argument has been properly ripped apart by people like Clive Bates and Dr. Michael Siegel (read and lately. In my opinion Dr. Glantz himself is kind of responsible for destroying the credibility of this argument totally by publishing his infamous report that, as I've written about earlier (, despite failing to provide data to support the argument, claims to prove it by deliberately misusing the data they actually did have.

Now, however, I'm a bit worried by a new kind of propaganda emerging in the media. Yesterday this headline was screaming against us from the New York Times: Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes. To be fair, however, the article itself is not as bad as the headline would suggest. It does recognize that most of these poisonings are due to the lack of proper regulations and careless adults, and it has some statements that supports reasonable regulations. However I am afraid such headlines, and the scaremongering cited in there, will be picked up by the anti-ecig-movement and used to support their crusade against vaping. It might very well become the anti-e-cig-movements new favourite argument.

I did some google searches on the topic and I noticed several newspapers and websites have published stories on the topic last week. A press release from Minnesota seems to be a favourite source of information. Read about it here (among other places): The case in Minnesota is that the number of reported incidents of nicotine poisoning by e-liquid among teens and children has jumped from 5 to 50 from 2012 to 2013. Sounds bad huh? Well, first of all we see e-cigarette use booming around the world so an increase in poisoning cases are not unexpected, and e-cigarettes are not even close the the number of poisoning cases from other household products. But does that mean we shouldn't worry about this? Not at all... we need to take this seriously of course. We should start out by trying to figure out the reasons why kids get poisoned, and what we can do about it.

On thing I notice is that 50% of the cases are children younger than 3 years. These kids are not capable of opening a child proof bottle, so all these cases are caused irresponsible adults, either leaving childproof bottles opened in reach of children, or leaving bottles that are not childproof in their reach. 9 of the cases were teenagers meaning that 16 we're kids older between 3 and 13 years old. The reasons for these poisoning could very well be the same as for the ones under 3 years, but it could also be that these children actually had bought the e-liquid, as there is no age limit. Other reasons for poisonings could be unsafe bottles (leaking), unsafe equipment, and that people are really not aware what is in the bottles and how to treat them. The solution to all of this is reasonable regulation, with emphasis on reasonable. That means labelling and information requirements, reasonable nicotine concentration limits and age limits on sales.

Over-regulation or banning will on the other hand lead to more cases of poisoning. I've earlier written about the consequences of over-regulation, and in addition to forcing a lot of ex-smokers back to cigarettes and denying heavy smokers the option of e-cigarettes, over-regulation or banning will have negative impacts on the safety of e-cigarettes. Some examples:
  • One of the worst consequences is a thriving black market. A black market is by it's nature not at all regulated and will supply a lot of unsafe equipment, unlabelled e-liquid bottles with nicotine concentrations off the chart and no information to the customers whatsoever. 
  • Regulating the sizes of bottles and cartridges, like the TPD does, will also have negative consequences on safety. It will lead to more bottles and cartridges around the house (easier to loose, misplace), or carried around. Filling will also need to happen more often, leading to even more risk.
  • Limiting the nicotine content too low (like 20ml/mg in the TPD) will have a couple of negative effects as well: It will force a lot of people to get their products from a black market, which is as I said above not good, but it will also lead to more filling, more frequent use and more e-liquid around children.
Nicotine poisoning from e-liquid is a matter we really do need to take into consideration. And the e-cigarette industry (well most of it anyway) and vapers do take this seriously and most important, they do know what measures need to be taken to ensure safety in this matter. This brings further support to the claim that vapers should write the laws on vaping, because the regulators have shown that they do not understand this. The EU rules on nicotine concentration and bottle and cartridge sizes are perfect examples of over-regulation that will work against its intention. The rules were put there to enhance safety (at least that is what the EU claim), but will in fact lead to less safety. Another example is that the EU (and the American Cancer Association) is against age limiting, while the the e-cigarette industry is currently self regulating and the great majority of vendors enforce an age limit on e-liquid and vaping equipment. Almost all the e-liquid I buy also has good labelling with ingredients and health warnings. In conclusion, the e-cigarette industry, and the vapers do need to worry about the children... and they do that today. And, unlike the regulators, they do understand the safety aspects of vaping and e-cigarettes.


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