e-Cigs: Dr. Peter Rice



Some Thoughts on e-Cigs and Cigarettes

My perspective on cigarettes and e-Cigs is different from that of most health professionals.  For example, many health professionals praised CVS/pharmacy when they decided to stop selling cigarettes – I disapproved.  While it is conflicting to see pharmacies – a profession encouraging good health – selling cigarettes, I would rather see patients continually bombarded with the message from pharmacists, “when you’re ready to quit, we’re ready to help”, because all smokers are ready to quit sometime. 

So now we have many health professionals advocating diligently to keep electronic cigarettes – e-Cigs – as hard to get as possible. I disagree.

e-Cigs are handheld devices which are filled with a liquid to be vaporized as it is inhaled. The devices can be used to dispense or administer a variety of liquids which contain medicinal or abusive drugs. When dispensing nicotine, they are called e-cigs, but the devices can be used for other substance as well.  Here in Colorado, for example, “vapes” can be used to administer marijuana cannabinoids.

Are You Ready to Quit?

Are You Ready to Quit?


Nicotine produces a variety of effects through its stimulation of nicotinic receptors at different sites.

  • At low nicotine doses, it’s effect on cell membrane ion flow makes nerve transmission easier, resulting in an increase in heart rate and blood pressure, an increase in stomach acid secretion, and increased intestinal and bowel activity. Nicotine acts in the adrenal gland to release epinephrine as well as other adrenal hormones affecting metabolism.
  • In the brain, nicotine releases the hormone vasopressin, increases the rate and depth of breathing through an increase in sensitivity to carbon dioxide, and decreases appetite by stimulating the vomiting center of the brain. Individuals using nicotine feel calmer after smoking, and nicotine use is associated with stressed individuals and stressful occupations.
  • And, of course, nicotine is associated with cancer.  But wait! Was that the nicotine or the tobacco? Nicotine is the addictive drug. The carcinogenic components of tobacco smoke are what irritates the nose, throat and lungs causing cancer.

My viewpoint on cigarettes and e-cigs is not entirely without emotion. My dad, a child of the depression and WWII veteran, smoked from the time he entered the Navy at age 17. Back in the day, those in the military were actively encouraged to smoke. He smoked up to 4 packs a day until he died of lung cancer just shy of his 75th birthday.

That being said, I would MUCH rather see individuals using e-cigs than smoking cigarettes.

While there may be issues with what ingredients are added to the liquids in e-cigs, I believe that e-cigs are much safer than cigarettes. It’s a cleaner habit, and has much less impact due to second hand smoke. I have also spoken with users who say that they have successfully decreased their nicotine use by adjusting downward the amount of nicotine they are receiving with each inhalation.

A recent Wall Street Journal piece commented on FDA regulations that will make it harder to develop and market e-cigs, driving nicotine users back to cigarettes and playing into the hands of tobacco companies.  This is likely based on the notion that making e-cigs less available and less attractive will discourage their use, but it is very bad policy to encourage tobacco use when a safer alternative is available.

The very best strategy is not to start using either tobacco or e-cigarettes.

If it’s too late for that, talk to your prescriber or pharmacist about strategies to quit when you’re ready.

Like I mentioned earlier, when you’re ready to quit, your pharmacist is always ready to help. Take good care of yourself.

References:

The FDA’s Vaporous Thinking About E-Cigs
http://www.wsj.com/articles/the-fdas-vaporous-thinking-about-e-cigs-1462487690
 

Dr. Peter J. Rice

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.
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