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Electronic cigarette

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Electronic cigarette resembling a tobacco cigarette.

An electronic cigarette, also known as an e-cigarette, personal vaporiser or PV, is an electronic inhaler that vaporises a liquid solution into an aerosol mist, simulating the act of tobacco smoking. Electronic cigarettes are no longer marketed as smoking cessation aids or tobacco replacement in most countries. There may be similarities between conventional and some electronic cigarettes in the physical design and the nicotine release, which may approximate the same amount of nicotine as a conventional cigarette. There are many electronic cigarettes that do not resemble conventional cigarettes at all.

The benefits and risks of electronic cigarette use are uncertain among health organizations and researchers. Limited controlled studies are available due to its recent invention. Laws vary widely concerning the use and sale of electronic cigarettes and accompanying liquid solutions, with pending legislation and ongoing debate.

History

The earliest electronic cigarette can be traced to Herbert A. Gilbert,[1] 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.[2][3][4][5][6][7]

Hon Lik, a Chinese pharmacist, is widely credited[8][9][10] with the invention of the first generation electronic cigarette.[11] In 2000, he came up with the idea of using a piezoelectric ultrasound-emitting element to vaporise a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution.[12] 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. These inventions are the basis of the present-day electronic cigarettes.

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 (如烟, literally "Resembling smoking"), and started exporting its products in 2005–2006[13] before receiving its first international patent in 2007.[14]

Components

A disassembled cigarette-styled electronic cigarette.
A. LED light cover
B. battery (also houses circuitry)
C. atomizer (heating element)
D. cartridge (mouthpiece)

An electronic cigarette contains three essential components: a plastic cartridge that serves as a mouthpiece and a reservoir for liquid, an "atomizer" that vaporises the liquid, and a battery.

Cartridge

The cartridge, a small plastic, glass or metal container with openings at each end, serves as both a liquid reservoir and mouthpiece. It allows the passage of liquid into the atomizer, and vapour from the atomizer to the user's mouth, without any leakage of liquid into the mouth.

Most models utilise a plastic sponge to keep the liquid in place, but it is common to find a refillable tank that holds the liquid, with a separate tunnel connecting to the atomizer. When the liquid is depleted, users can refill it or replace with another ready filled cartridge. Some users forgo liquid reservoirs and drip liquid directly onto the atomizer in a method known as "dripping".

A single cartridge can have the same number of puffs as 20 cigarettes. [12]

Atomizer

A battery connected to a USB charger

The atomizer contains a small heating coil that vaporizes the liquid, and generally consists of a simple filament and wicking metal mesh or silica wick to draw the liquid in. It is positioned in the center of the three components that make up the entire electronic cigarette cylinder: the cartridge attaches to one end, and the power unit to the other. The atomizer's filament will lose efficiency over time due to a build-up of sediment, or it "burns out" entirely, requiring replacement. In some models, the cartridge and atomizer component are integrated into what is known as a cartomizer.

Cartomizer

The term cartomizer describes the combination of atomizer and cartridge in the same unit. A cartomizer consists of a heating element surrounded by a poly-foam soaked in the liquid. This combination is mainly used in the devices that are manufactured to look like cigarettes, and is covered by Gamucci's patent.[15]

When the cartomizer has been used it can simply be disposed of and replaced with a new one. This is much easier than having to refill your cartridge and clean and replace the atomizer every now and then.[16]

Battery

Most portable power contain a lithium-ion rechargeable battery which makes up the largest component of an electronic cigarette. The battery may contain an electronic airflow sensor: activation is triggered simply by drawing breath through the device. Other models come with a power switch, which must be held during operation. A LED to announce activation may also be equipped in the front of the power unit casing.

Batteries are usually charged via an AC outlet, car charger socket or USB. Some manufacturers also offer a cigarette pack-like portable charging case (PCC), which contains a larger battery to charge smaller batteries of individual e-cigarettes.

Liquid

Liquid for producing vapour in electronic cigarettes, known as e-juice or e-liquid, is a solution of propylene glycol (PG) and/or vegetable glycerin (VG) and/or polyethylene glycol 400 (PEG400) mixed with concentrated flavors, and optionally, a variable percentage of a liquid nicotine concentrate.

The solution is often sold in a bottle or in disposable cartridges. Many manufacturers offer dozens of flavors which resemble the taste of regular tobacco, menthol, vanilla, coffee, cola and various fruits, but nicotine concentrations vary by manufacturer. The standard notation "mg/ml" is often used in labelling, sometimes shortened to a simple "mg" (milligram).[17] Nicotine-free solutions are also common.

Some electronic cigarette users prefer to make their own e-juice in a form known as "DIY".[18]

Most e-liquids do not contain beta-carboline alkaloids found in tobacco along with nicotine.

Kits

There are dozens of e-cigarette models which are sold online and in stores, all under hundreds of different brand names. Most electronic cigarette users initially purchase starter kits that contain a battery, USB charger and a selection of cartomizers (cartridges). Some kits also include a portable charging case (PCC).

Disposables

In addition to the kits, there are disposable electronic cigarettes which were first invented and bought to market by the Gamucci brand in 2008. These feature a battery, atomizer, and cartridge all in one piece. Unlike the kits, the entire electronic cigarette is discarded when the cartridge becomes empty. Disposable electronic cigarettes are typically marketed to those new to the electronic cigarette market.[citation needed]


Health concerns

E-Cigarettes may contain ingredients that are known to be toxic to humans. Because clinical studies about the safety of e-cigarettes have not been submitted to the U.S. Food and Drug Administration (FDA), users in the Unites States may have no way of knowing if they are safe, which chemicals they contain and how much nicotine they are inhaling.[19]

Proponents of electronic cigarettes often claim that electronic cigarettes deliver the experience of smoking while eliminating the smell and health risks associated with tobacco smoke.[20][21] The base liquids - which include propylene glycol (PG), vegetable glycerin (VG), and sometimes polyethylene glycol 400 (PEG400) - have been widely used as a food additive, as a base solution for personal care products such as toothpaste, and in medical devices such as asthma inhalers. However, the health effects of inhaling nicotine vapour into lungs are a subject of uncertainty. [22]

The fact that e-cigarettes may resemble real tobacco cigarettes has been noted by both supporters and detractors. While e-cigarettes may give nicotine addicts more or less the same amount of nicotine as a conventional cigarette, they do not produce the same toxic smoke that can cause lung disease and cancer when inhaled over time. Since there are no products of combustion to be inhaled, no tobacco toxins are inhaled besides nicotine.[23]

World Health Organization

The World Health Organization stated in September 2008 that no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy. WHO does not discount the possibility that the electronic cigarette could be useful as a smoking cessation aid, but insisted that claims that electronic cigarettes can help smokers quit need to be backed up by clinical studies and toxicity analyses and operate within the proper regulatory framework.[24]

United Kingdom

In draft guidance on tobacco harm reduction the body responsible for drafting healthcare guidelines in England and Wales, NICE argues that there is limited evidence on the efficacy, safety and quality of other nicotine containing products such as electronic cigarettes.[25] NICE also states that little is known about the extent to which electronic cigarettes deliver nicotine to the circulation. They recommend the usage of licensed nicotine replacement therapies as part of any quit attempt or tobacco harm reduction approach. The British Medical Association advises doctors not to recommend the use of electronic cigarettes as aids to smoking cessation or as a harm reduction approach. A summary of the BMA briefing states:[26]

  • e-cigarettes are not regulated as a tobacco product or as a medicine in the UK and there is no peer-reviewed evidence that they are a safe and effective nicotine replacement therapy
  • the use of e-cigarettes may undermine smoking prevention and cessation by reinforcing the normalcy of cigarette use in public and workplaces
  • health professionals should not recommend the use of e-cigarettes as smoking cessation aid or a lower risk option than continuing to smoke due to a lack of evidence of their safety and efficacy.

US Food and Drug Administration

In May 2009, the US Food and Drug Administration (USFDA) Division of Pharmaceutical Analysis tested 19 varieties of electronic cigarette cartridges produced by two vendors NJOY and Smoking Everywhere.[27] Diethylene glycol, a poisonous and hygroscopic liquid, was detected in one of the cartridges manufactured by Smoking Everywhere .[27] Tobacco-specific nitrosamines (TSNAs), known cancer-causing agents, were detected in all of the cartridges from one brand and two of the cartridges from the other brand[clarification needed]. Nicotine can also be traced in some claimed nicotine-free cartridges.[27] Further concerns were raised over inconsistent amounts of nicotine delivered when drawing on the device.[28] In some e-cigarettes, "Tobacco-specific impurities suspected of being harmful to humans—anabasine, myosmine, and β-nicotyrine—were detected in a majority of the samples tested." It is not clear if these chemicals were detectable in exhaled vapour. [29][30]

In July 2009, the FDA publicly discouraged the use of electronic cigarettes and raised concerns that electronic cigarettes may be marketed to young people and lack appropriate health warnings.[31]

The Electronic Cigarette Association criticized the FDA testing as too "narrow to reach any valid and reliable conclusions."[27] Exponent, Inc., commissioned by NJOY to review the FDA's study in July 2009, objected to the FDA analysis of electronic cigarettes lacking comparisons to other FDA-approved nicotine replacement therapy products where similar levels of TSNA were detected. Exponent concluded that the FDA's study did not support the claims of potential adverse health effects from the use of electronic cigarettes.[32][33][34]

Furthermore, FDA methods "have been lambasted in journals" by some medical and health research experts who noted that potentially harmful chemicals were measured at "about one million times lower concentrations than are conceivably related to human health."[35]

Additionally, The Tobacco Products Scientific Advisory Committee of the FDA is alleged to have several members who maintain consulting relationships with various pharmaceutical companies who manufacture smoking cessation products. If these allegations are true, this might represent a potential conflict of interest.[36]

American Association of Public Health Physicians

As of April 2010, The American Association of Public Health Physicians (AAPHP) supports electronic cigarettes sales to adults "because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years." However, the AAPHP is against sales to minors.[37] The AAPHP recommends that the FDA reclassify the electronic cigarette as a tobacco product (as opposed to a drug/device combination).[38][39]

Boston University School of Public Health study

A study by researchers at the Boston University School of Public Health in 2010 concluded that electronic cigarettes were safer than real cigarettes and may aid in breaking the habit of smoking. Researchers said that while further studies on electronic cigarettes were needed, "few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns." Electronic cigarettes were found to be "much safer" than traditional tobacco ones, and had a level of toxicity similar to existing nicotine replacements.[40][41][42]

According to this report, the level of carcinogens in electronic cigarettes is up to 1,000 times lower than regular cigarettes, and early evidence shows that electronic cigarettes may help people to stop smoking by simulating a tobacco cigarette.[40][41]

Health Canada

On 27 March 2009, Health Canada issued an advisory against electronic cigarettes. The advisory stated, "Although these electronic smoking products may be marketed as a safer alternative to conventional tobacco products and, in some cases, as an aid to quitting smoking, electronic smoking products may pose risks such as nicotine poisoning and addiction."[43] Canadian Customs now confiscate any parcel containing e-cigarettes with nicotine and notify the receiving party via a mail letter. The parcel is returned to the sender only at the request of the receiving party or otherwise destroyed.[44]

Health New Zealand

In 2008, Dr. Murray Laugesen of Health New Zealand Ltd. published a report on the safety of Ruyan electronic cigarette cartridges. His study was funded by e-cigarette manufacturer Ruyan, but Laugesen claims that his research is independent.[45] The presence of trace amounts of TSNAs in the cartridge solution was documented in the analysis. The results also indicated that the level of nicotine in the electronic cigarette cartridges was not different from the concentration of nicotine found in nicotine patches.[45] John Britton, a lung specialist at the University of Nottingham, UK and chair of the Royal College of Physicians Tobacco Advisory Group, commented, "If the levels are as low as in nicotine replacement therapy, I don’t think there will be much of a problem."[45] The study's detailed quantitative analysis concluded that carcinogens and toxicants are present only below harmful levels. It concluded: "Based on the manufacturer’s information, the composition of the cartridge liquid is not hazardous to health, if used as intended."[46]

Other reports

Dr. Konstantinos Farsalinos of the Onassis Cardiac Surgery Center in Athens reported to the annual meeting of the European Society of Cardiology that a small short-term trial had shown significantly better cardiac performance of ecigarette users in comparison to tobacco smokers. Farsalinos warned that larger studies were required to measure the long-term health impact of ecigarettes, but expressed some optimism: "Considering the extreme hazards associated with cigarette smoking, currently available data suggest that electronic cigarettes are far less harmful and substituting tobacco with electronic cigarettes may be beneficial to health." Another small study, also in Greece, reported earlier in 2012 the devices had little short-term impact on lung function.[47]

A report from a UK Government advisory unit favoured the adoption of "smokeless nicotine cigarettes" over the traditional "quit or die" approach, believing this would save more lives.[48]

While electronic cigarettes may deliver nicotine to the user in a manner similar to that of a nicotine inhaler, no electronic cigarette has yet been approved as a medicinal nicotine replacement therapy (NRT) product or subjected to the necessary clinical testing for such approval. Doubts have even been raised as to whether electronic cigarettes actually deliver any substantial amount of nicotine.[49]

Research carried out at the University of East London on the effects of using an electronic cigarette to reduce cravings in regular tobacco smokers showed that there was no significant reported difference between smokers who inhaled vapour containing nicotine and those who inhaled a placebo vapour containing no nicotine. The report concluded that although electronic cigarettes can be effective in reducing nicotine-related withdrawal symptoms, the nicotine content does not appear to be of central importance, and other smoking related cues (such as taste or vapour resembling smoke) may account for the reduction in discomfort associated with tobacco abstinence in the short term.[50][51]

In an online survey from November 2009 among 303 smokers, it was found that e-cigarette substitution for tobacco cigarettes resulted in reduced perceived health problems when compared to smoking conventional cigarettes (less cough, improved ability to exercise, improved sense of taste and smell).[52]

Trace amounts of 'volatile organic compounds', namely formaldehyde, as well as traces of ketones, mercury and tetramethylpyrazine, have been found in electronic cigarette vapour, but the quantities are significantly smaller than the quantities found in tobacco smoke and do not pose a significant health risk.[53][54]

Usage

In the United States as of 2011 about one in five adults who smoke have tried electronic cigarettes.[55] There were journalistic reports in 2013 that electronic cigarettes were beginning to gain cultural acceptance with sales growing rapidly.[56]

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. As flavored tobacco cigarettes (except menthol) have been banned in the US, and roll-your-own (RYO) products are seeing massive increases in taxes (e.g., Iowa), electronic cigarettes remain a viable alternative to tobacco for many Americans.

European Union

The EU Directive 2001/95/EC(6) on general product safety, applies in so far as there are no specific provisions with the same objective in other EU law. This directive provides for restrictive or preventive measures to be taken if the product is found to be dangerous to the health and safety of consumers.

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."[57]

Because of this vague EU position, member countries in the European Economic Area currently have varying rules.

United States

Individual states have differing legal treatment of electronic cigarettes.

On 22 September 2009, under the authorization of the Family Smoking Prevention and Tobacco Control Act, the FDA banned flavored tobacco (with the notable exception of menthol cigarettes) due to its potential appeal to children.[58] Wagner says that the use of flavorings, such as chocolate, could encourage childhood use and serve as a gateway to cigarette smoking.[58]

The Food and Drug Administration (FDA) classified electronic cigarettes as drug delivery devices and subject to regulation under the Food, Drug, and Cosmetic Act (FDCA) prior to importation to and sale in the United States. The classification was challenged in court, and overruled in January 2010 by Federal District Court Judge Richard J. Leon, citing that "the devices should be regulated as tobacco products rather than drug or medical products."[59] 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.[60]

In March 2010, a US Court of Appeal 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."[61] 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.[62] 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 declined to review the decision blocking the products from FDA regulation as medical devices on 24 January 2011.[63]

Concerns about public safety have been raised. However, some former smokers say they have been helped by e-cigarettes, and scientists at the University of California, Berkeley said that e-cigarettes had great potential for reducing the morbidity and mortality related to smoking.[64]

The European Economic Area

  • In Austria nicotine-containing cartridges are classified as medicinal products and e-cigarettes for nicotine inhalation as medical devices.[65]
  • 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.[66] The use of electronic cigarettes has not been prohibited in Copenhagen Airport, but at least one airline (Scandinavian Airlines) has decided to ban their use on board flights.[67]
  • In Estonia, It is legal to buy nicotine containing e-liquids for personal use from another citizen or from outside the country as long as the package is sent as a private citizen and contains no more than 100ml of e-liquid per month (up to 500ml at a time). The nicotine amount within the e-liquid is unregulated. Commercial sale of nicotine containing e-liquid is illegal, commercial sale of electronic cigarette hardware and non nicotine e-liquids is legal.
  • 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,[68] 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.[69][70]
  • In Germany, sale of electronic cigarettes and nicotine-containing cartridges is not forbidden. The electronic cigarette ban outspoken by the health minister of NRW on the press conference on 16 December 2011 is not a legally binding ban but merely exercised free speech.[71]
  • In Ireland, the sale and use of electronic cigarettes is legal. As they are not considered a tobacco product, they can be displayed where on sale along with prices.
  • 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, the Ministry of Health has warned that the e-cigarette can cause harm to cardiovascular, hepatic and renal systems,[72] however, e-cigarettes are legal, and are sold in most shopping centers and at Riga's airport, as well as via the internet to individuals at least 18 years old.
  • In the Netherlands, use and sale of electronic cigarettes is allowed, but advertising is forbidden pending European Union legislation.[73]
  • In Norway electronic cigarettes and nicotine 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.

United States

  • 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."[74]
  • In 2009, New Jersey voted to treat the electronic cigarette in the same category as tobacco products by including under the New Jersey Smoke Free Air Act. Assemblywoman Connie Wagner sponsored the legislation arguing that they "looked like the real thing"; she also objected to the potential appeal of flavored electric cigarettes to children.[75]
  • The sale of electronic cigarettes to minors in New Hampshire was legal. A group of students and a group called "Breathe New Hampshire" were concerned that electronic cigarettes will serve as a gateway to smoking cigarettes through appearing to be trendy: one compared electronic cigarettes to "having a new cell phone. It’s cool. It’s electronic." They launched petitions to the state government to ban the sale of electronic cigarettes to minors.[76] It is now illegal to sell e-cigarettes to minors as of July 2010.[77]
  • Arizona has a planned ban of selling electronic cigarettes to minors.[78]
  • In Washington, the King County board of health has banned smoking of electronic cigarettes in public places, and prohibited sales to minors.[79] Neighboring Pierce County also prohibits sales to minors, but allows e-cigarette use in places such as bars and workplaces.[80]
  • In Maryland HB1272 was introduced by Delegate Aruna Miller and was passed by the General Assembly that bans the sale of electronic cigarettes to minors.
  • In Oregon in February 2012, Continental Airlines flight 1118 was diverted back to its airport of origin when an unruly passenger with unspecified mental disorders refused to stop using his e-cigarette. The passenger was detained by fellow passengers and later pled guilty to charges of interfering with a flight crew.[81][82] FAA had not ruled on E-cigarette use on airplanes at the time of the incident, but airlines were and are permitted to establish their own more-restrictive policies on E-cigarette use on planes; Continental (now United Airlines) has a company policy banning them. [83]
  • In Iowa in 2012, the Linn County commissioners approved a decision to regulate the retail sale of electronic cigarettes like tobacco cigarettes. As a result of this decision, retailers who sell electronic cigarettes to persons in Linn County are required to have a retail tobacco license.[84]
  • 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 1 January 2013.[85]

Other countries

  • In Australia, the Federal Department of Health and Ageing classifies every form of nicotine, except for replacement therapies and cigarettes, as a form of poison.[86][87] In the state of Victoria, the Therapeutic Goods Administration has said that there were no laws preventing the importation of e-cigarettes bought over the internet for personal use, unless prohibited by state and territory legislation.[88]
  • In Brazil, the sale, importation and advertising of any kind of electronic cigarette is forbidden. The Brazilian health and sanitation federal agency, Anvisa, found the current health safety assessments about e-cigarettes to not be yet satisfactory for commercial approval eligibility.[89]
  • In Canada, as of March 2009, while the importation, sale, and advertising of electronic cigarettes containing nicotine is not endorsed, the products may be sold and used. Health Canada has advised Canadian consumers not to purchase or use any electronic smoking products, citing the prohibition of electronic smoking products containing tobacco in the Food and Drugs Act.[43]
  • In China, the sale and use of electronic cigarettes is legal. [citation needed]
  • In Egypt, the Egyptian Ministry of Health technical committee has rejected applications for marketing authorization of electronic cigarettes on the grounds that they contain harmful chemicals, and lack safety and toxicity data. [citation needed]
  • In Hong Kong the sale and possession of nicotine-based electronic cigarettes, classified as a Type I Poison, is governed under the Pharmacy and Poisons Ordinance. Sale or possession is not authorized and both are considered punishable with a fine of up to HK$100,000 and/or a prison term of 2 years. However, the law does not cover any non-nicotine inhalers.[90]
  • In India, the use of electronic cigarettes is currently legal. Under the Indian Health Law of 2006, tobacco smoking has been banned in public. Since e-cigarettes avoid the use of tobacco, they do not fall under this law.[91]
  • In Lebanon, the council of ministers has banned the sale and use of electronic cigarettes, starting 21 September 2011.[citation needed]
  • In Malaysia, the sale of e-cigarettes is an offence under the Poisons Act 1952 and the Control of Drugs and Cosmetics Regulations 1984. Those found guilty of selling and distributing the product (as well as liquid nicotine for use in electronic cigarettes) will be fined no more than RM3,000, be jailed for no more than two years, or both.[92] The Malaysian Health Minister stated that e-cigarettes containing liquid nicotine is more harmful than normal cigarettes and warned Malaysians to avoid them.[93]
  • In Mexico, the Federal Commission for the Protection Against Sanitary Risks, announced that according to Mexican Law, the selling and promotion of non-tobacco objects that include elements generally associated with tobacco products are forbidden.[94]
  • In Nepal, under current cigarette laws, the use and sale of e-cigarettes is permitted. [citation needed]
  • In New Zealand, the Ministry of Health has ruled that the Ruyan e-cigarette falls under the requirements of the Medicines Act, and cannot be sold except as a registered medicine. Since the ruling, Ruyan has obtained registration, and sale is currently allowed in pharmacies.[17]
  • In Pakistan, the import and sale of electronic cigarettes is legal, but Pakistan Medical and Dental council find that the current health safety assessments of e-cigarettes to not yet be satisfactory. [citation needed]
  • In Panama, the importation, distribution and sale of electronic cigarettes have been prohibited since June 2009. The Ministry of Health cites the FDA findings as their reasoning for the ban.[95]
  • In Singapore, the sale and importation of electronic cigarettes, even for personal consumption, is illegal. According to Health Minister Khaw Boon Wan, electronic cigarettes are the industry's attempt to attract new users and were marketed to appeal to younger customers, including women.[96]
  • In South Korea, the sale and use of electronic cigarettes is legal, but is heavily taxed. Electric cigarette possession among teenagers remains an issue.[97]
  • In Switzerland, the sale of nicotine-free electronic cigarettes is legal. The use and importation of electronic cigarettes containing nicotine is legal, but they cannot be sold within the country.[98] As of December 2011, the tobacco tax does not apply to e-cigarettes and respective liquids containing nicotine.[99]

Other non-tobacco nicotine inhalation technologies

There are other technologies currently under development which seek to deliver nicotine for oral inhalation which simultaneously mimic the ritualistic and behavioural aspects of traditional cigarettes.

Propellant-based nicotine delivery

An alternative nicotine delivery platform based on existing asthma inhaler technology is under development by a UK-based healthcare company, Kind Consumer Limited. The technology is currently under development and the company has submitted a Marketing Authorisation Application to the UK MHRA for licensing of the technology as an approved nicotine containing product. The technology is under licence to Nicoventures Limited a subsidiary of British American Tobacco who are responsible for the launch and commercialisation of the technology as an approved nicotine replacement therapy product.

Nicotine pyruvate technology

Philip Morris International bought the rights to a nicotine pyruvate technology developed by Jed Rose at Duke University.[100] The technology is based around the chemical reaction between nicotine acid and a base which produces a nicotine pyruvate vapour for inhalation.[101] It has undergone preliminary clinical evaluation which has shown delivery of nicotine to the lungs.[102]

See also

References

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Further reading

  • Erbach, Gregor. "Electronic cigarettes" (PDF). Library Briefing. Library of the European Parliament. Retrieved 27 March 2013.
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