The US Food and Drug Administration (FDA) has said it plans to establish “a maximum level of nicotine” to reduce addiction to cigarettes and other burnt tobacco products. “The goal of the potential rule would be to reduce youth use, addiction, and death,” the FDA says.
Nicotine is not one of the carcinogens that makes cigarettes so toxic, but it is the ingredient that makes smoking highly addictive and a hard habit to quit. The proposed action, however, does not address nicotine in e-cigarettes or vaping products, which have exploded in popularity among teens and young adults in recent years.
Separately, the FDA issued “market denial orders” to JUUL Labs Inc. for all of their e-cigarette devices currently marketed in the United States, effectively banning their products. As a result, JUUL should stop selling and distributing these products, and those currently on the US market should be removed, the FDA said.
In taking this action, the FDA cited some of the company’s study findings that raised concerns “particularly regarding genotoxicity and potentially harmful chemicals leaching from the company’s proprietary e-liquid pods. society”.
There is also no way to know “potential harms from using other authorized or unauthorized third-party e-liquid pods with the JUUL device or using JUUL pods with an unlicensed device. JUUL,” the agency said.
While JUUL products make up about 40% of the US e-cigarette market, other vaping devices containing nicotine and other chemicals remain on the market.
Cancer and cardiovascular disease experts at Baptist Health agree that the FDA’s proposal to reduce nicotine levels in traditional tobacco products, including cigarettes, is a good first step, but it fails to address the problem of e-cigarette addiction, where the amount of nicotine is higher and even adjustable in some vaping devices.
“It’s a positive step, but you can’t regulate nicotine in cigarettes and not regulate nicotine in e-cigarettes,” said Mark Dylewski, MD, chief of general thoracic surgery at the Miami Cancer Institute, who is part of Baptist Health. “It means absolutely nothing. So it’s important for the community to understand the difference and the risks associated with combustible tobacco products and e-cigarettes. E-cigarettes have a high level of nicotine that is highly addictive.
Each year, 480,000 people die prematurely from smoking-associated disease, making smoking the leading cause of preventable disease and death in the United States. Smoking is the cause of the majority of lung cancer cases, and lung cancer remains the deadliest cancer.
Vaping products, or e-cigs, entered the market a few years ago with the original intention of helping current smokers of traditional tobacco products quit with a less potent product as a “bridge” to a healthier lifestyle. But the big problem with vaping devices is their intensity of nicotine delivery. And because these products are heavily marketed to young adults, they become their first nicotine product, says Christina Michael, MD, a cardiologist at Bethesda Hospital East, part of Baptist Health.
“There are definitely people who use e-cigarettes as their first introduction to nicotine, and there are definitely people who use e-cigarettes to try to quit traditional cigarettes,” says Dr. Michael. “The problem for regulators is that e-cigarettes endanger young people and non-smokers because they are introduced to nicotine products through e-cigarettes. Thus, these companies were marketing to young people who are not nicotine users and introducing them to the world of nicotine and nicotine addiction.
The possible long-term link between vaping products and cancer has not yet been established because e-cigarettes have only been on the market for a few years. In 2019, reports surfaced across the country of patients, mostly teenagers and young adults, presenting to the emergency room with severe shortness of breath, often after suffering for several days from vomiting, fever and fatigue. . They all had one thing in common: they had used vaping devices that may have been modified or obtained from dubious, off-the-market sources.
“It is important that we try to educate people that e-cigarettes can be very harmful, in that people use e-cigs without knowing that they can potentially provide them with more nicotine,” explains Dr. Dylewski. “They become more addictive. And then they go back to using combustibles and replenish that addiction by using combustible cigarettes more frequently. And then the risks of cancer, coronary heart disease, and peripheral vascular disease increase because they use cigarettes more fuels.
Dr. Michael: “The reason cardiologists care is that there is a clear association. Young people who use electronic cigarettes are much more likely to become cigarette smokers. They take the habit of smoking and develop a nicotine addiction due to the use of electronic cigarettes. And it’s a gateway to combustible tobacco products, which are linked to very harmful cardiovascular effects.