Two new studies which looked at the contents of e-cigarette liquids in the US and Australia have found a range of chemicals – many of them dangerous. Most of these substances are not identified on the liquids' packaging, raising concerns about what people are inhaling into their bodies.
Are e-cigarettes safe?
In short, no. There is no way yet to know all of the long-term risks of e-cigarette use, but several dangerous health outcomes have been identified.
The NHMRC warns that there is insufficient evidence to indicate that e-cigarettes will help tobacco smokers stop. For non-smokers, e-cigarette use can lead to later taking up of traditional cigarettes. Young Australians who vape are three times more likely to smoke tobacco cigarettes later on.
E-cigarettes that contain nicotine are illegal in NSW, unless prescribed by a doctor. However, testing has shown that e-liquid labelled 'nicotine-free' can have high nicotine levels. People can think they are using nicotine-free vapes and can unknowingly quickly develop a nicotine addiction.
There are also many unknowns about the long-term effects of vaping, such as possible connections to cancers.
We know of several conditions caused by vaping, such as symptoms of bronchitis and shortness of breath and the severe lung illness E-cigarette or Vaping Use-Associated Lung Injury (EVALI).
There have also been cases of the lithium batteries that power e-cigarettes exploding due to overcharge, puncture, external heat, short circuit and other causes. In severe cases, this can cause second and third degree burns and may require skin grafts for the injured person.
What is in e-cigarette liquid?
Several analyses have found that the ingredients listed on e-cigarette liquid packaging is inaccurate and/or incomplete.
In addition to nicotine, the US study from Johns Hopkins University found nearly 2,000 chemicals, the vast majority of which are unidentified. Along with caffeine, the team found three industrial chemicals, a pesticide, and two flavorings linked with possible toxic effects and respiratory irritation.
The 2021 Australian study, commissioned by Lung Foundation Australia and the Minderoo Foundation, analysed 65 samples of 'non-nicotine' Australian e-liquids. Every sample contained at least one potentially harmful chemical and all samples were mislabeled, highlighting concerns that consumers are misinformed. Six of the samples contained nicotine, despite being marketed as nicotine-free.
Many chemicals identified in e-cigarette liquid have not been tested for how safe they are when inhaled, despite being tested for safety when eaten. For these chemicals, there is no, or very little, data on the likely harm they may do over time. Just because something may be safe to eat, doesn't mean it's safe to breathe in concentrated doses.
Here are a few other chemicals that someone might not realise they're inhaling:
- Diacetyl – often added to enhance the taste of flavoured liquids. Inhaling it causes inflammation and can cause permanent scaring in the smallest branches of the airways, making breathing difficult. Symptoms include coughing, wheezing, chest pain and shortness of breath.
- Formaldehyde – a toxic chemical that can cause lung disease and contribute to heart disease.
- Acrolein – most often used as a weed killer and can also damage lungs. Trans-cinnamaldehyde is a derivative of acrolein.
- Benzene – a chemical found in car exhaust fumes, causes cancer, anemia and a weakened immune system, among other effects.
- Menthol – can cause skin irritation and in large doses, the same chemical reaction that provides its signature cooling sensation can lead to seizures, coma and death.
- Eugenol – which is also used to euthanise fish, has been linked to liver damage.
- 2-chlorophenol – commonly used in insecticides, herbicides, and disinfectants can irritate and burn the skin and eyes, while breathing it in can irritate the nose, throat and lungs causing coughing, wheezing and/or shortness of breath.
Get help quitting
Quitline counsellors are available to answer any questions you may have about e-cigarettes on 13 7848 (13 QUIT). They can also help you think of ways to approach a conversation with your child or loved one about vaping.
The Aboriginal Quitline is also available on 13 7848. Run by Aboriginal Advisors, the Aboriginal Quitline is a telephone-based confidential advice and support service.
For people who are attempting to quit tobacco, using nicotine replacement therapy (NRT) products such as lozenges, gums, nasal sprays and patches, are safer and are proven to help you quit. The NSW Cancer Institute iCanQuit website provides information on quitting methods, links to support groups and top tips to help you quit.
For free and confidential advice 24/7 call the Alcohol and Drug Information Service (ADIS) on 1800 250 015. Counsellors are available to provide information, referrals, crisis counselling and support. Or start a Web Chat with an ADIS counsellor online Monday to Friday, 8.30am – 5pm.
