Written by Vikram Krishnasamy, MD, MPH

Affiliation: Johns Hopkins General Preventive Medicine Residency. The views expressed in this editorial are personal and do not reflect the views of Johns Hopkins.

We need a ban on e-cigarette use indoors and in public places. The rules for e-cigarettes should be the same as traditional cigarettes. And, why shouldn’t the rules be the same?

E-cigarettes have grown rapidly in popularity over the last several years catching many in the medical community off-guard. Estimates now peg the size of the industry in the United States at between one and two billion dollars. Although this pales in comparison to the size of the traditional tobacco industry, the swift rise in popularity of e-cigarettes has raised concerns about safety and about marketing claims.

E-cigarettes are typically cigarette-sized contraptions that are usually metal or plastic. They contain a chamber that holds a nicotine solution which can be bought in a number of strengths and flavors. There is no tobacco, which advocates argue is a benefit of using e-cigarettes. A vapor is emitted but the components of this vapor remain unclear and vary depending on the brand of device and the ingredients of the nicotine solution.

The frightening aspect of the rapid emergence of e-cigarettes: the negative effects remain unclear. And, as a consequence, there is not yet any regulation in place. The FDA thankfully put forward a preliminary regulatory proposal this past April. In it, the FDA takes steps that are similar to traditional cigarettes. Sales to minors will be banned. Additionally, products must carry warnings that nicotine is addictive. And, manufacturers must also include the ingredients of their products. This is a step in the right direction.

But, more needs to be done and urgently. Proponents of e-cigarette use argue that they will help people quit tobacco use. However, there is no evidence that this actually occurs when compared with nicotine patches according to a recent Lancet study. Additionally, advocates of cigarette use also argue that they are safer than traditional cigarettes.

While e-cigarettes might not carry the same risk profile as smoking, they carry a different set of risks due to the compounds in the nicotine cartridges and the heating elements. The New York Times recently reported on two forthcoming studies in the journal Nicotine and Tobacco Research. These studies found some e-cigarettes can release the chemical formaldehyde. Formaldehyde is a well-known chemical carcinogen. And, the FDA has only so far taken steps to regulate what goes in e-cigarettes and not the vapors emitted from them. It is as if we decide to regulate what goes into gasoline but not the emissions from automobiles.

Additionally, reports to poison control centers around the country are on the rise from exposure to the liquid nicotine vials, which can lead to seizures and even death. According to a CDC report, children under the age of five are involved in just over half the cases reported to poison control centers. The dangers of liquid nicotine lie in the multiple ways of exposure. The nicotine can be inhaled, consumed, or directly absorbed through the skin. The solutions open up whole new avenues of toxic exposures to nicotine.

In Baltimore city, 28% of residents smoke, higher than the national rate of 18%. With e-cigarettes, manufactures have engaged in youth marketing and produced a myriad of flavors, increasing their chances of hooking our youth on highly addictive nicotine compounds. This is a trend we do not want. Moreover, the use of e-cigarettes is significantly cheaper than a pack per day traditional cigarette habit, opening the door to long-term use. New York City and Chicago have already enacted laws to treat e-cigarette use the same as regular cigarettes by banning their use in indoor and public places. Baltimore should follow suit.

The ills of tobacco affect this city everyday and we certainly do not need to re-glamorize the use of cigarettes. A ban on smoking in Baltimore city has been in place since 2008. It is time for laws to catch up with e-cigarettes.