Is vaping safer than smoking?

The outbreak of serious vaping-related lung injuries in the US and Canada is almost certainly due to black-market THC (cannabis) oils sold by street dealers, NOT nicotine e-liquid.

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Vaping is not risk-free, but most scientists agree that it is far safer than smoking. According to the UK Royal College of Physicians report in 2016:

‘the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco’

There is still some uncertainty about long-term safety as vaping has only been around about 10 years but the evidence so far is pointing towards it being much safer than smoking.

This is not surprising as most of the harm from smoking is due to the tar, carbon monoxide and 7,000 other toxic chemicals produced by burning tobacco. Vaporisers do not contain tobacco and there is no combustion or smoke. According to Public Health England

Vapour contains small amounts of toxins such as formaldehyde, acetaldehyde, cadmium and nitrosamines which are associated with cancer. However, these toxins are found at much lower levels than in tobacco smoke and mostly below the levels which cause harm. Watch this short video from Public Health England which demonstrates the dramatic difference between smoke and vapour.

‘the constituents of cigarette smoke that harm health – including carcinogens – are either absent in e-cigarette vapour or, if present, they are mostly at levels much below 5% of smoking doses (mostly below 1% and far below safety limits for occupational exposure)’

The overall cancer risk from long-term vaping has been estimated at less than 0.5% of the risk from smoking.

Further confirmation of the reduced harm from vaping is the dramatic reduction in exposure to carcinogens and toxins (biomarkers) measured in the blood and urine of vapers compared to tobacco smokers.

The small health risks from vaping should be compared to the substantial risks from smoking. Two out of three long-term smokers will die from a smoking-related disease.

‘electronic cigarette use releases negligible levels of nicotine into ambient air with no identified health risks to bystanders’

Nevertheless, indoor vaping is best avoided around children, pregnant women and people with heart or lung disease.

Health benefits of switching

Based on reports from research studies so far, smokers can expect significant health improvements after switching to vaping, such as:

Chemicals in vapour

Although nicotine is the main addictive chemical in tobacco, it has relatively minor health effects except in pregnancy, where it can harm fetal development. The UK Royal Society for Public Health says nicotine is ‘no more harmful to health than caffeine’ and by itself is fairly harmless.

‘The long-term adverse effects of nicotine are likely to be minimal’

There is no evidence that nicotine causes cancer in humans, according to the US Surgeon General and the International Agency for Research on Cancer. It also does not cause lung disease.

Nicotine does have some relatively minor effects on the cardiovascular system. It causes a temporary increase in the heart rate and blood pressure and may induce an irregular heartbeat (arrhythmia). Nicotine also increases the body’s resistance to the hormone insulin, leading to increased blood sugar (glucose) levels. However, these effects from nicotine are much less from vaping than they are from smoking tobacco.

In animal studies, there is some evidence that nicotine may be harmful to the developing adolescent brain. However, it is unclear how this research in animals translates to humans. There is no evidence of harm to the adolescent brain in humans so far. It is important to note that nicotine replacement therapy products (patches, gum, lozenges etc) are approved for use in adolescence from the age of 12 and appear to be well tolerated.

Nicotine also has positive effects as well. It can improve concentration, fine motor coordination, memory and cognition (brain function). It also helps with weight control and is a mental stimulant. There are a number of diseases known to be improved by nicotine, including ADHD, schizophrenia, Parkinson’s disease and ulcerative colitis.

For more about the health effects of nicotine, click here.

Other chemicals

Small amounts of potentially toxic chemicals and some carcinogens are present in vapour. These chemicals include:

Carbonyls such as formaldehyde, acetaldehyde and acrolein
Nitrosamines such as NNN and NNK
Toxic metals, such as cadmium, nickel and lead
Volatile organic compounds such as toluene, benzene
These chemicals are from

The breakdown of chemicals in the e-liquid (PG and VG) when it is heated
Trace amounts of metals leached from the vaping device itself
Contaminants in the nicotine liquid
Although some of these chemicals are potentially harmful, they are generally less than 1% of the concentrations in smoke. In larger doses, they are known causes of cancer, heart and lung disease.

Author
Dr Tom Bracewell

BMBS, MRCP (2016), MRCGP, FRACGP

Dr. Tom Bracewell is a dual UK and Australian qualified General Practitioner (GP; Family Doctor) with a keen interest in various medical areas, including smoking cessation, acute and emergency care, sports medicine, and pediatrics. Additionally, Tom is passionate about exploring the efficiencies and advancements that digital health can bring to patient populations. He obtained his medical degree from the University of Nottingham and gained valuable experience working in hospitals across Yorkshire, Nottinghamshire, and London, where he worked in different hospital specialties.

During his General Practice training at the Whittington Hospital in North London, Tom embarked on an 18-month endeavor in Melbourne, where he worked in the fast-paced emergency department of The Northern Hospital. This experience not only allowed him to gain invaluable expertise in acute and emergency care but also provided insights into rural medicine. After returning to the UK to complete his GP qualification, he decided to return to Melbourne in 2021 to continue his career in General Practice. With over 10 years of experience spanning hospital medicine, digital health, and general practice, Tom brings a wealth of expertise to his patients.

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