February 16, 2017
E-cigarettes has become a controversial substitute for traditional tobacco based cigarettes. Information from the 2014 National Youth Tobacco Survey show that e-cigarette use among high school students increased from 4.5% in 2013 to 13.4% in 2014, rising from approximately 660,000 to 2 million students. 1 Although controversy continues about the limited carcinogenic exposure of e-cigarettes compared to traditional tobacco products, a more alarming fact is the toxic exposure of liquid nicotine used by e-cigarettes.
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Liquid nicotine is extremely toxic by ingestion or by topical exposure to the skin. Data from the American Association of Poison Control Centers data has determined the number of cases has grown from 271 in 2011 to 2,886 in 2016. 2 Liquid nicotine is not regulated by any federal authority and the concentrations of solutions vary from 1.8% to 10%. The Food and Drug Administration does have plans for regulation but how it will approach this in the future is unknown. In addition, the surge in poisonings is primarily based upon a shift in technology. The initial devices were disposable that looked like traditional cigarettes, however, now the devices are reusable, larger devices that require a liquid. 3 Liquid nicotine availability on the internet is “out of control”. Products can be purchased in China or other liquid nicotine wholesalers. Since the product is not currently regulated, you do not know what you will get in the product including other toxins and impurities. Although smaller volumes can be purchased, you can also go “BIG” by buying the 1-gallon size but you can SUPERSIZE it and buy a 55-gallon drum for under $10,000. 4
Liquid nicotine can be absorbed by inhalation, ingestion or topically. Serious toxicity include bradycardia, nausea, hypotension, seizures and respiratory paralysis. 5 Pharmacists must be aware these products can be life threatening and should discuss safety measures including: locked storage of liquid nicotine to protect children and pets and use of gloves and eye protection for possible exposure. In addition, potential drug interactions should also be discussed with patients since many do not consider liquid nicotine interacting with any prescribed medications. As pharmacists, we need to routinely include questions about the use of e-cigarettes in all our patients with a smoking history.
- Centers for Disease Control and Prevention. E-cigarette use triples among middle and high school students in just one year. https://www.cdc.gov/media/releases/2015/p0416-e-cigarette-use.html. Accessed Feb 8, 2017
- American Association of Poison Control Centers. E-cigarettes and liquid nicotine. https://aapcc.s3.amazonaws.com/files/library/E-cig__Nicotine_Web_Data_through_01.2017_XlNCw67.pdf. Accessed Feb 8, 2017
- The New York Times. Selling a poison by the barrel: Liquid nicotine for e-cigarettes. https://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=0. Accessed Feb 9, 2017
- Vaporworld. https://www.vaporworld.biz/bulk/liquid-nicotine/55-gallon-drum-of-100mg-nicotine/. Accessed Feb 12, 2017
- Wikipedia. Nicotine poisoning. https://en.wikipedia.org/wiki/Nicotine_poisoning. Accessed Feb 12, 2017