Oh for the blithe days of yesteryear when club-goers could press glowing e-cig tips against their foreheads, demonstrating to bouncers that they weren’t smoking banned traditional cigarettes. Not long ago, high school kids on the subway could exhale a smug, cherry-flavored fog, savoring the shocked expressions of passengers who hadn’t yet figured out that these kids weren’t really smoking—it was just some harmless vapor. But as the use of e-nicotine continued to grow exponentially (doubling every year) and the products remained almost completely unregulated, lawmakers got nervous. The results? In LA, NYC and Chicago, e-cigs are now banned wherever traditional smokes are.
Not everyone’s happy about that; the NYC Citizens Lobbying Against Smoker Harassment has sued NYC, seeking to overturn the city’s recent ban on e-cigarettes (these are probably people who are used to tilting at windmills). But more surprising is the fact that some mental health professionals also want to prevent bans on e-cigarettes. It seems that they and the tobacco industry have long known that there’s a particular arena in which nicotine has genuine therapeutic use: to alleviate symptoms in mentally ill patients, most particularly schizophrenics.
According to Helen Redmond of the Silver School of Social Work at NYU, “the mentally ill remain the single largest demographic of smokers, accounting for 44-46% of cigarettes sold in the US.” Big Tobacco is aware of the connection the mentally ill have with nicotine and even once created a Merit cigarette campaign that “showed a double image of a pack of Merits and read, “Schizophrenic…for New Merit, having two sides is just normal behavior.’”
Redmond is among the mental health professionals who want e-cigarettes to be available to their patients. The anti-smoking brigade, they say, has demonized nicotine. Yes, it is poisonous and addictive but it can also be genuinely therapeutic. Redmond points out that schizophrenics have ineffective “sensory gating, the ability to make sense of stimuli in the environment.” However, says Gunvant Thaker of the Maryland Psychiatric Research Center, “when schizophrenic patients smoke or are given nicotine gum, this deficit of sensory gating is reduced or normalized.”
Just Don’t Spill It
But many others seem to believe the public ban might have come just in time and wonder if it’s enough. E-vapor is getting bad buzz about second-hand effects. Also, when e-cigarettes first came out, the nicotine fluid inside was sealed within a non-refillable container. After 200 puffs, the e-smoke was tossed and another one bought. But now (oh, addicts and their fiddly fetishes!), e-cigs are refillable. And for those refills, people can buy gallons of liquid nicotine from hundreds of vendors. However, the New York Times wrote that some of these vendors “are selling liquid and they don’t have a clue what is in it.” Harvard Medical School’s health publications noted that “electronic cigarettes deliver an array of other chemicals, including diethylene glycol (a highly toxic substance), various nitrosamines (powerful carcinogens found in tobacco), and at least four other chemicals suspected of being harmful to humans.”
Given that around two million liters of this liquid will be sold this year, that’s a little unnerving. Add to that the fact that there are no regulations about childproof caps or warning labels or even the most basic of manufacturing standards.
But what if it turns out that what you’re buying is free of these chemicals and contains only lovely uncorrupted liquid nicotine? Yes, we all know it’s addictive—that’s why you’re buying it. But nicotine is also a poison. Agatha Christie—WWI nurse and a lady who knew her stuff—offed several characters with it. What makes nicotine particularly dangerous is that you don’t even need to ingest or inhale it. For a toxic overdose of liquid nicotine, all someone needs to do is spill some on you.
And that’s pretty easy, as anyone who’s ever tried to pour something from a gallon jug into a shot glass can attest. Plus, sometimes people don’t know they’ve just doused themselves in a 10% solution of poison; the Times piece mentioned a Kentucky woman who was admitted to a hospital after developing symptoms of cardiac arrest. Turns out her e-cig had broken in her bed and she’d absorbed the nicotine fluid through her skin. That’s the problem with fiddly things—sometimes you fiddle ‘em wrong.
That woman was lucky, though. She only poisoned herself. In Israel, a toddler ingested a small amount of nicotine liquid from her grandfather’s e-cigarette refill bottle. Medical help was quickly summoned and the girl was at first described only as “dazed” but soon her condition worsened and little Naomi “rapidly deteriorated…despite desperate efforts by doctors, she died.” As Lee Cantrall, director of the San Diego Division of the California Poison Control System, says of liquid nicotine use in the US, “It’s not a matter of if a child will be seriously poisoned of killed…it’s a matter of when.” And just how much liquid nicotine can kill a child? Less than a tablespoon.
Do E-Cigs Have a Place?
It seems pretty clear that the FDA should clamp down hard on the sales of an addictive liquid poison that’s being regulated less intensely than a bottle of Tide. How about getting rid of e-cigs altogether and going back to the previous nicotine supply sources that were sold as smoking cessation products—like the nicotine gum that allegedly comforts schizophrenics? Unfortunately, the mentally ill like that stuff just as much as the rest of the population—in other words, not much. Which returns us to addicts and their fiddly fetishes: Chewing nicotine gum simply doesn’t provide the sense of retreat, of ritual and ceremony that smoking proffers. People want to smoke but without the tar or chemicals. And mental health workers, faced with patients who’ve been self-medicating for years with cigarettes, increasingly feel that e-cigarettes must be part of the equation—ideally, a regulated, responsibly marketed and monitored e-cigarette that will provide their patients with the sought-after therapeutic benefits along with the experience of smoking.
Viewed in this light, banning the use of e-cigarettes is refusing millions of patients suffering from mental illness access to a therapeutic drug—one that for decades has been heavily marketed in their direction. Helen Redmond believes that “it is unethical to deny them access to a nicotine delivery device that could save their lives.”
Between the current Wild West marketing of e-cigarettes and the enormous demand for a less deadly form of ingesting nicotine, it seems clear that we should be fighting for thoughtful and controlled legislation of these devices, rather than treating them as the devil we know and outright banning them. Or must the cure for nicotine craving remain as deadly as the cause?
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