When the door to our clinic opened one day about two years ago, I was happy to see a patient I had not seen in quite a while. He dropped over to say goodbye. He had a pharyngeal tumor and a history of smoking up to four packs per day, so he assumed an ugly end was coming. He was excited, though, to tell us that he had kicked a 50 year addiction to tobacco. How? He pulled an electronic cigarette from his pocket and demonstrated it for us. I was intrigued. I researched this product before adding it in the clinic to help others put down their cigarettes. So far, it has helped many to break this habit and turn toward health and self control.
Since the earliest colonial years of this country, tobacco and its products have been part of our culture. People smoked cigars and cigarettes for hundreds of years without realizing what they were doing to their health or innocent bystanders.
The cigarette industry lied to us repeatedly about the health hazards of cigarette smoke as well as the addictive nature of nicotine. Eventually, an official from a large American tobacco company made a telling comment to a European committee considering ways to save their failing retirement system. He suggested that if they allowed more sales of American cigarettes, the retirement system would have fewer beneficiaries to fund. His clever marketing ploy opened a new line of inquiry, and the cigarette industry began losing lawsuits.
In 1988 the US Surgeon General issued a report to make three salient points. First, cigarettes and other tobacco products are addictive. The use of this term puts tobacco juice squarely into the language we use for drug abusers. Second, nicotine is the addictive agent. Third, the pharmacological and behavioral processes that lead to nicotine addiction are very similar to those associated with heroin and cocaine.
Addiction to nicotine is a serious matter. Like other addictions, there are strong cravings for the drug when it is withdrawn. When people try quit smoking, relapses are frequent. Addicted smokers will continue their habit despite the well-known hazards to their health and all of those around them. I continue to be astounded when I see people with chronic lung disease such as asthma, emphysema, and chronic bronchitis continue to smoke and to expose young children and spouses to this filthy habit.
In treating drug addiction, sometimes people are treated by substituting another "safer" narcotic that satisfies the craving. Withdrawal is done in a controlled fashion with careful observation of the person who is addicted. There is a similar strategy used to withdraw someone from other psychoactive drugs prescribed for a host of psychological issues.
Similarly, some people have broken away from smoking cigarettes by using other vehicles, such as nicotine gum or gels that deliver nicotine into the blood without the hazard of smoke in the lungs. Hopefully, the dosage of nicotine can be slowly decreased until the cravings are controlled. Eventual freedom from this powerful addiction is the goal.
Along came technology to save us. The electronic cigarette came on the scene in 2007. These clever devices use a battery to heat liquid nicotine inside a tube that is designed to look like a cigarette. The appearance and the fact that it is handled like a real cigarette seem to satisfy an oral fixation among smokers. When the "smoker" inhales on the electronic cigarette (of course, former president Clinton would not inhale), a controlled dose of nicotine is delivered via the lungs. What is exhaled is water vapor, not smoke. Cancer risk to the user is reduced about 1000 times without secondhand smoke to disturb the rest of us.
For some reason, teenagers for decades have thought that smoking looks "cool." Accordingly, there is an attraction for the e-cigarette in this age group. Their utilization of this product has significantly increased in the past 3 to 5 years. They cannot buy cigarettes legally, but e-cigarettes are not currently regulated by the Food and Drug Administration (FDA) because they do not contain any tobacco.
The FDA is seeking fervently to regulate e-cigarettes because they assert that e-cigarettes are technically drug delivery devices. The FDA actually seized some e-cigarettes recently and drew a lawsuit from two manufacturers in the District of Columbia. The manufacturers won their case over the FDA, as the judge ruled "there is no basis for the FDA to treat electronic cigarettes ... as a drug-device combination when all they purport to do is offer consumers the same recreational effects as a regular cigarette."
This fight is likely to go on. Government agencies thrive and delight in regulating various aspects of our lives. Freedom loving Americans will continue to resist big government. The e-cigarette is stuck in the middle of a much larger fight in American culture right now.
Meanwhile, this is a legal product. Yes, it should be out of the hands of teenagers because nicotine is still addictive. Until serious safety hazards are proven, however, it remains a useful tool in breaking a horrible addiction to a nasty, stinking, expensive, deadly habit.
The gentleman I mentioned in the first paragraph went to surgery. The pharyngeal tumor was benign, but there were others that might threaten him later. Meanwhile, he is free from a drug habit, a terrible and deadly addiction that is perfectly legal.