‘It’s like smoking 20 cigarettes a day’: the risks of e-cigarettes that have become ‘fashionable’ among young people and teenagers

Treating addiction to electronic cigarettes has become routine for cardiologist Jaqueline Scholz. “More and more I receive young people aged 16 to 24 in my office who use this product and have a nicotine rate in their body equivalent to the consumption of more than 20 cigarettes a day”, she calculates.

To give you an idea, the Brazilian smoker consumes an average of 17 “conventional” cigarettes a day, according to a survey by the Inca (National Cancer Institute).

Director of the Incor Tobacco Treatment Outpatient Clinic (Instituto do Coração), the doctor is concerned about the appeal of these devices, especially among teenagers and young adults.

A survey published this year showed that almost one in five Brazilians aged 18 to 24 have used electronic cigarettes at least once in their lives, even though the marketing of this product is prohibited by Anvisa (National Health Surveillance Agency).

“Our country had a very low rate of smoking initiation among adolescents, but we see that this policy is at risk now”, analyzes Scholz, who is also a professor at the Faculty of Medicine at USP (University of São Paulo).

“If we don’t take care of this problem now, the use of these devices has everything to become an epidemic soon”, he adds.

In an interview with BBC News Brazil, the specialist listed all the risks and controversies of electronic cigarette use and the impact it can have on health.

Wolf in lamb skin?

Scholz points out that, since the appearance of the first versions about 20 years ago, these devices have always been promoted based on the argument that they would be less harmful to health.

“It is still said that, because they do not have combustion and do not produce smoke, these devices would supposedly be safer”, he contextualizes.

The cardiologist recalls that this information served as the basis for selling electronic cigarettes in many countries as a kind of “harm reduction”, or a treatment for individuals who wanted to quit smoking.

The big issue, she argues, is that there aren’t enough scientific studies to support such claims – and all advertising related to these products seems to be more aimed at winning over new users (especially young people), and virtually ignores this possible therapeutic bias. .

“Several countries, such as the United Kingdom itself, accepted this argument and released e-cigarettes. What happened in these places was an increase in the prevalence of smokers”, notes Scholz.

For the doctor, it makes no sense to see the electronic cigarette as a medical treatment and leave it only in the hands of people, so that they can decide when and how to use it. “If the purpose of this product was really therapeutic, it could not be sold anywhere, as it is now.”

“It would have to be prescribed after a medical evaluation, in which the professional would conclude that the patient cannot stop smoking with the other methods we have to offer. From there, it would be possible to indicate the dosage and correct use of this substance”, complements.

The doctor says knowingly: she leads one of the most successful outpatient smoking treatment clinics in the country. By combining medication, behavioral changes and monitoring, she manages to get up to 70% of patients to kick the habit.

Scholz points out that, in addition to not fulfilling the therapeutic promises, electronic cigarettes can go the opposite way and be harmful to health.

Conditioning and addiction stimulation

The doctor draws attention to three of the main ingredients that appear in these devices: propylene glycol, nicotine and aromatic substances.

Propylene glycol works as a kind of vehicle, capable of diluting and carrying nicotine through our body.

Nicotine, in turn, is a psychoactive substance originally found in tobacco, which causes a very strong dependence.

During the use of electronic cigarettes, it is inhaled through the mouth, passes through the lungs, falls into the bloodstream and ends up in the brain, where it causes a momentary feeling of well-being.

Finally, we have the aromatic substances, which imitate the most diverse smells, ranging from mint to creme brulée.

Scholz points out that these three ingredients can pose health risks in different ways.

“For starters, the scents make these devices more socially acceptable. After all, the smell of mint, honey or strawberry is much more pleasant than conventional cigarettes.”

And this attribute, argues the cardiologist, increases curiosity and takes away the fear of a younger audience, which since childhood is used to hearing about the harmful effects of “traditional” smoking.

“Propylene glycol, on the other hand, is widely used in the food industry, and people simply assumed that, as it is safe to be consumed in food, it will not hurt when inhaled,” he says.

“But we don’t have enough studies on this, especially because these devices today bring so many additives that we don’t have an exact idea of ​​the chemical reactions that take place there, at a high temperature.”

“And we’ve already seen some studies that have detected carcinogenic substances in the bladder and urine of e-cigarette users”, adds the specialist.

Dependence and damage to vital organs

To close the list, you can’t forget about nicotine.

“The new generations of electronic cigarettes bring nicotine salts that are increasingly smaller and delivered in high amounts, which increases dependence”, says Scholz.

The doctor says that, when receiving a user of these devices in her office, she always performs a quick urine test, which measures the amount of nicotine that the individual has in the body.

“It is very common for young patients, aged 16 to 24, to have a nicotine level that is equivalent to smoking more than 20 conventional cigarettes a day”, he calculates.

In fact, the very mechanism of these devices facilitates constant use. In addition to not having any unpleasant smell, it does not need to be turned on or off. “This is a product that you can use over and over again. You put it in your pocket, take a puff, and put it away. Then you can pick it up again whenever you want,” explains Scholz.

“This creates a conditioning routine, and the person starts using electronic cigarettes on the street, at work, in the school bathroom, lying in bed…”

In addition to being addictive, nicotine also has effects on important organs such as the heart and lungs.

“Nicotine is not an innocuous substance. It increases heart rate, alters blood pressure and can damage the endothelium, the inner layer of blood vessels”, he lists.

“Therefore, the cardiac risk of an e-cigarette user is about the same as that of someone who smokes conventional cigarettes.”

“In the lungs, nicotine nanoparticles can enter the alveoli, cause respiratory spasms and even inflammatory diseases”, adds the doctor.

“A few years ago, we had a series of cases of this type, especially in the United States, that drew attention. A part of these patients used other substances, but about a third used exclusively nicotine.”

How to solve this problem?

Scholz welcomes the recent decision by Anvisa, which maintained the ban on electronic cigarettes in Brazil.

“It was the best thing to do. If this product was released, it would turn into a wasteland in terms of new users”, he considers.

“From the moment this decision enters into force as a definitive law, the tendency is for us to have an improvement in the inspection of the sale and use of these devices in public places.”

The main companies in the sector were against Anvisa’s position.

In a note sent to BBC News Brasil, BAT Brasil (British American Tobacco Brasil), known as Souza Cruz and the largest tobacco industry in the country, highlighted that Anvisa’s recent decision is “another step in the regulatory process and does not represent the conclusion agency end.” For the company, the release would bring greater sanitary control to the production and sale of electronic cigarettes.

“We understand that Anvisa, by keeping the issue in the Regulatory Agenda, will continue to evaluate the scientific evidence that substantiated the decision of about 80 countries that have already regulated these products. electronic cigarettes in Brazil, which continues to grow, supplied by smuggled products and without any sanitary control”, he said.

“An adequate regulation would guarantee to millions of adult consumers of electronic cigarettes in Brazil the access to the legal product, with known composition and origin, quality parameters, inspection and sanitary monitoring”, concluded the company.

Japan Tobacco International criticized the fact that the use of these electronic devices is “fueled by illicit trade”. Philip Morris Brasil declared that it will continue “the dialogue on the regulation of heated tobacco”, which is a “different product from the so-called electronic cigarettes”.

Heated tobacco, as mentioned by the company, is a device that does not bring different aromas, but carries nicotine.

Finally, Scholz points out that, for e-cigarette users who want to quit, there are scientifically validated treatments. “We have therapeutic resources and several trained outpatient clinics throughout Brazil, including the Unified Health System (SUS)”, informs the cardiologist.

“It is possible to alleviate the suffering of people, who remain in abstinence, and achieve good results”, he concludes.

This text was originally published here.