Calls to poison centers about e-cigarettes have surged


This photo illustration shows a woman smoking a "Blu" e-cigarette (electronical cigarette). (Paul J. Richards/AFP/Getty Images)

Calls to poison centers across the country involving e-cigarettes have surged in recent years as the products have gained in popularity, according to figures released Thursday by the Centers for Disease Control and Prevention.

Between September 2010 and February this year, the volume of calls involving e-cigarettes rose nationally from about one per month to 215 per month, even as reports involving conventional cigarettes showed no similar increase, the agency said. It also said the actual number of cases is probably much higher, given that not every case is reported to poison control.

Pubic health officials and anti-smoking advocates say the increase is particularly troubling because more than half of the calls involve children younger than 6, who can suffer serious health consequences from the liquid nicotine used in e-cigarettes.

“We’re tremendously concerned,” James Perrin, president of the American Academy of Pediatrics, said in an interview. “This stuff is in­cred­ibly toxic, and it’s also not regulated in any way. . . . The public is really remarkably unaware of the serious dangers of this.”

For years, the debate over e-cigarettes has centered on whether they provide a safer alternative to traditional cigarettes and an effective way for some smokers to wean themselves off tar-laden tobacco while still getting a nicotine fix.

That fight, which shows no signs of being resolved in the short term, overlooks what health professionals say is an obvious danger made clear by Thursday’s CDC numbers: Liquid nicotine, which is heated to create e-cigarette vapors, is a highly toxic substance that’s readily available on store shelves in flavors as varied as bubble gum, chocolate mint and cherry.

“We sometimes forget that nicotine itself is a poison. . . . It’s such a highly concentrated substance that it’s more likely to cause symptoms at a lower dose,” said Ashley Webb, director of the Kentucky Regional Poison Control Center in Louisville, where calls related to e-cigarettes so far this year have approached the total for 2013.

Webb said 60 percent of the calls to her center involve children younger than 6. Typically, symptoms include vomiting, stomach pain and increased heart rate, and enough liquid nicotine can prove lethal. Children typically get sick after ingesting the liquid, although it also can be absorbed through the skin, Webb said.

Although the Food and Drug Administration has said it intends to regulate the e-cigarette industry, it has been slow to act. In the meantime, critics say, no regulations exist that would force liquid nicotine manufacturers to use child-resistant packaging or detailed warning labels.

Cynthia Cabrera, executive director of the Smoke-Free Alternatives Trade Association, said the e-cigarette industry supports such measures and has been working to set industry standards for safe packaging and labeling.

But Cabrera said it is also important to keep Thursday’s numbers in perspective. She said the increase in poison control calls is not surprising when viewed alongside the sharp rise in the popularity of e-cigarettes and is actually modest given such widespread use of the products. “Having a knee-jerk reaction at something without looking at the data carefully is disturbing,” she said. “We need to not take things out of context.”

In addition, Cabrera said the benefits many consumers have claimed to get from using e-cigarettes must be weighed against the relatively small number of accidental incidents linked to the products. She also said parents bear some responsibility for keeping liquid nicotine out of the hands of children, just as they would with cleaning products or medications.

“If they are not designed for children, children should not have access to them,” Cabrera said. “Once it gets into a home, we depend on the parents and the adults to make sure they treat the products with care.”

The data behind Thursday’s numbers came from poison centers in every state and the District. From fall 2010 through February, the centers reported 2,405 e-cigarette calls and 16,248 involving traditional cigarettes, but the percentage of calls involving e-cigarettes rose steadily in that time and shows little sign of abating.

“Use of these products is skyrocketing,” CDC director Tom Frieden said in a statement Thursday, “and these poisonings will continue.”

Brady Dennis is a national reporter for The Washington Post, focusing on food and drug issues.
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