Friday, August 03, 2012

Kentucky Center for Smoke-free Policy Warns of Cancer Risk from Nicotine Exhaled by Vapers; Why Isn't the Center Also Warning the Public about the Cancer Risks of Nicotine Inhaler Use in Public Places?

Last week, the Kentucky Center for Smoke-free Policy sent a letter to a hotel at which a vapers' convention was held last weekend, urging the hotel not to allow vaping inside the building because of what the Center alleged were the carcinogenic effects of exhaled nicotine produced by electronic cigarette users.

The Center director warned that: "nicotine is also found in the vapor. Nicotine creates a sticky residue that reacts with a normal substance in the air to form cancer-causing agents that off-gas into the indoor air and cling to carpets, drapes, and other surfaces."

The Rest of the Story

If the Kentucky Center for Smoke-free Policy is correct, then the use of nicotine inhalers such as Pfizer's Nicotrol poses a grave danger to the public, as the nicotine exhaled by users may "react with a normal substance in the air to form cancer-causing agents that off-gas into the indoor air" and put people at risk of cancer.

After all, users of Nicotrol are also inhaling an aerosol mist that contains nicotine. If they, like vapers, are exhaling large amounts of nicotine that may react with ambient nitrous oxide to form carcinogens, then anyone who lives with a Nicotrol user or is exposed to Nicotrol use in a public place may be exposed to carcinogens.

Surely, the Kentucky Center for Smoke-free Policy would want to warn the public about this risk, call for a ban on Nicotrol use in public places, and urge Nicotrol users not to use the inhaler inside the home where the exhaled nicotine might react to form carcinogens.

However, I can find no evidence that the Kentucky Center for Smoke-free Policy is making any effort to warn the public about the potential carcinogenic risks associated with the use of Nicotrol. This is shocking, given the number of people using Nicotrol and the efforts to which the Center is going to warn people about similar risks associated with the use of electronic cigarettes, which deliver similar amounts of nicotine to the user.

Clearly, if the exhaled vapor from electronic cigarette users poses a public health risk because of nicotine reacting with ambient nitrous oxide to form carcinogens which off-gas into the indoor air, then Nicotrol inhalers pose a similar risk and the FDA should reconsider its decision to approve the marketing and sale of Nicotrol inhaler systems, as cancer is obviously not an acceptable side effect of an FDA-approved medication.

Before all of you Nicotrol users out there start to panic, you ought to know the rest of the story. First of all, there is no credible evidence that even with thirdhand smoke, the deposition of nicotine on surfaces and its reaction with ambient nitrous oxide results in levels of, and exposure to carcinogens that are substantial enough to pose a risk to humans. So even if nicotine was present in appreciable amounts in "secondhand vapor," there is no documentation that it would pose any risk.

Second, and most importantly, there is no evidence, and little reason to believe, that there is any substantial release of nicotine into the air as a result of vaping. Unlike cigarette smoking, where nicotine is present in the sidestream smoke, there is no sidestream vapor produced by an electronic cigarette. Instead, the vapor is directly inhaled and so the only "secondhand" exposure is that resulting from the exhaled vapor from the user.

It is important to now recognize that nicotine is readily absorbed in the lungs. In fact, nearly 90% of inhaled nicotine is absorbed by the smoker and therefore, the levels of nicotine in exhaled smoke are quite low. The same phenomenon would also be true with vaping. The vaper is going to absorb the overwhelming majority of nicotine so there will be very little nicotine in the exhaled vapor. This is why any carcinogenic risks resulting from exhaled nicotine are likely to be negligible. And this is in fact why the FDA is not concerned about any potential carcinogenic risks resulting from the widespread use of Nicotrol inhalers.

The rest of the story is that in its zeal to eliminate electronic cigarette use, the Kentucky Center for Smoke-free Policy has completely lost its consideration for the scientific evidence. It appears to be driven more by ideological considerations than by science. This is not the first anti-smoking group to place its agenda above the science, but it is a particularly important example, because the results of this group's misrepresentation of the scientific evidence could be substantial. By convincing vapers that they face a substantial risk of cancer, the Center may actually succeed in getting many vapers to discontinue electronic cigarette use, which likely means a return to cigarette smoking. And how ironic that would be.

Not only is the Kentucky Center for Smoke-free Policy inexplicably biased in its treatment of electronic cigarettes compared to Nicotrol inhalers, but it has also lost its adherence to rigorous science in apparent deference to the need to promote a pre-ordained policy agenda.

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