The runaway epidemic of e-cigarette use among teens has been grabbing news headlines since 2015. But despite concerns from parents and health care researchers about the potential health risks, many people mistakenly believe that e-cigarettes are safe.

The phrase “e-cigarettes may be safer than cigarettes” is the statement that tobacco and e-cigarette companies want us to use to distract us from the real issue. It didn’t happen overnight. The industry has been training the public for years to believe that they care about public health by declaring their commitment to “a smoke-free future” or what Philip Morris calls its future “beyond cigarettes.” Smoke and cigarettes are the bad guys, they’ve declared, so those new “smoke free” products that don’t involve tobacco rolled up in a piece of paper and set on fire must be the good guys.

We’ve all been duped. I fell into the trap myself as I was trying to make sense of the unregulated JUUL epidemic and the flood of news articles about teenage nicotine addiction. Never mind smoke free—the issue is nicotine addiction and the dangerous chemicals contained in e-cigarettes that have yet to be thoroughly investigated. Nicotine is one of the most addictive substances on earth, and JUUL products deliver twice as much nicotine as any other e-cigarette product. When we allow vaping advocates and e-cigarette companies to use the defense “e-cigarettes are safer than cigarettes,” we’re letting the industry win.

Any company that sells and promotes an addictive substance is exploiting the user’s loss of control to ensure customer loyalty, i.e., a constant revenue stream, with complete indifference to the potential health hazards their product may cause. And each addicted customer pays into the advertising and promotion that expands the company’s reach to recruit more addicts.

There’s open debate about whether switching to e-cigarettes is an effective way to stop smoking. A recent British study published in the New England Journal of Medicine found that smokers had twice as much success staying tobacco-free when they used e-cigs than using other nicotine replacement therapies. But the rates were still low: only 18 percent were tobacco-free after a year.  There are other smoking cessation medications that don’t require people to inhale metal fumes associated with e-cigarettes. And 80 percent of people in this study were still on e-cigarettes at one year compared to nine percent of patch users.

This comparison about relative safety needs to start from the perspective of the individual. That’s the only perspective that really matters in the end. What are the forms of nicotine that almost any smoker can get within 10 minutes of their apartment or house? There are three: cigarettes, e-cigarettes, and Nicotine Replacement Therapy (NRT). Let’s compare these three options. The first two are intensely addictive, and in comparison, NRT has low to no addiction potential. The critical factor that makes something addictive is how quickly it’s absorbed into your blood stream and how rapidly it gets to your brain. The smoke from cigarettes and vapor from e-cigarettes get absorbed rapidly through the huge surface area of your lungs, flooding your brain with a surge of nicotine in seconds. By contrast, NRT contains a regulated, measured form of “clean” nicotine that is slowly absorbed either through the skin (as a patch) or via the mouth (as gum or lozenge), and therefore has a very low addiction potential.

When you smoke cigarettes, you inhale tar laced with dozens of carcinogens in addition to carbon monoxide. E-cigarettes, far from being “clean” or “safe,” contain a super-heated metal coil that releases metal fumes when it vaporizes the nicotine fluid. Metal particles as well as chemicals used to flavor e-cigs can damage the lining cells of your airways. A study by Harvard scientists found the chemicals in 90 percent of e-cigarettes they tested. Co-author Joseph Allen, an assistant professor, said: “workers are warned about the dangers of inhaling the same flavoring chemicals. Why aren’t e-cig users receiving the same warnings?”

Your lungs should be breathing in only clean, fresh air. Any other inhaled pollutant can cause acute or chronic inflammation, and in the case of cigarettes, multiple forms of cancer. The true health effects of  e-cigarettes are only beginning to be studied.

As a pulmonary specialist, my ultimate goal for smokers is to see them leave their nicotine addiction behind, not just switch from one nicotine addiction to another. Most smokers have a desire to quit. Nicotine addiction is intense, and quitting isn’t easy, but it can definitely be done. Don’t help these companies by trading one form of nicotine addiction for another. Take the right step and end the devastating impact of nicotine addiction altogether by remembering that there are safer and better choices out there that don’t involve inhaling harmful substances. I’ve never met a smoker who regretted quitting. But I’ve met too many who regretted continuing their addiction until it was too late.

Paul Brunetta, MD

Additional Links

Parents Against Vaping e-Cigarettes (PAVE) have created a cheat sheet to educate parents about the potential dangers of e-cigarettes. It’s available for download.





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