What are electronic cigarettes?

Electronic cigarettes, also known as electronic nicotine delivery systems (ENDS) or e-cigarettes, are often designed to look and feel like cigarettes. They have been marketed as cheaper and healthier alternatives to cigarettes and for use in places where smoking is not permitted since they do not produce smoke.

A typical e-cigarette consists of three main components:

  • a battery
  • an atomiser
  • and a cartridge containing nicotine

Most replaceable cartridges contain nicotine suspended in propylene glycol or glycerine and water. The level of nicotine in the cartridges may vary and some also contain flavourings. When a user sucks on the device, a sensor detects air flow and heats the liquid in the cartridge so that it evaporates. The vapour delivers the nicotine to the user. There is no side-stream smoke but some nicotine vapour is released into the air as the smoker exhales.

The Irish Cancer Society cannot recommend e-cigarettes as a smoking cessation aid until further evidence on the long-term risks becomes available.”

E-cigarettes are sold as superior alternatives to cigarettes, not as smoking cessation aids or as a form of nicotine replacement therapy (NRT). E-cigarettes claim to satisfy nicotine addiction, deliver a “hit” of nicotine. Therefore the user is still left with their nicotine addiction.

NRT medicines such as patches, gums inhalers and lozenges are designed to deliver a slower background dose of nicotine to help relieve cravings during an effort to quit smoking and nicotine use completely. There is considerable evidence that the best outcomes for smokers who want to quit is achieved through a combination of behavioural support and medication. NRT products are proven methods of smoking cessation, using these products as directed can double a smokers chances of quitting.

Irish Cancer Society Position on Electronic Cigarettes

The Irish Cancer Society cannot recommend e-cigarettes as a smoking cessation aid until further evidence on the long-term risks becomes available.

Irish Cancer Society recommends a cautious approach by Government and regulatory bodies regarding electronic cigarettes, given a lack of evidence on potential long-term risks.

While recent studies have shown the potential of e-cigarettes in reducing harm, and the Society acknowledges that e-cigarettes are less harmful than tobacco, currently we do not believe they should be recommended as a smoking cessation device until there is further research into the long-term health implications of their use.

There is no long-term evidence as to the safety of these products, and, there is emerging, but as of yet, limited, evidence that for adolescents e-cigarettes may act as a “gateway” to tobacco usage, especially among those in their late teens who otherwise, according to research, did not intend to smoke tobacco.

The Society also maintains concerns that the use and marketing of e-cigarettes, may “re-normalise” smoking after a long period of de-normalisation brought about in large part to public health programmes and legislation which have helped changed attitudes towards smoking. The Society hopes that the transposition of the Tobacco Products Directive into Irish law in 2016, and its stricter rules on advertising of electronic cigarettes and refill containers will help mitigate a renormalisation impact somewhat.

Are electronic cigarettes (ENDS) safe?

The safety of e-cigarettes has not been scientifically demonstrated.

The potential risks they pose for the health of users remain undetermined. Furthermore, scientific testing indicates that the products vary widely in the amount of nicotine and other chemicals they deliver and there is no way for consumers to find out what is actually delivered by the product they have purchased.

Most ENDS contain large concentrations of propylene glycol, which is a known irritant when inhaled. The testing of some of these products also suggests the presence of other toxic chemicals, aside from nicotine. In addition, use of these products -when they contain nicotine- can pose a risk for nicotine poisoning (i.e. if a 9 - 10 year old child of 30 Kilos of weight swallows the contents of a nicotine cartridge of 24 mg this could cause acute nicotine poisoning that most likely would cause its death) and a risk for addiction to non-smokers of tobacco products. Nicotine, inhaled, ingested or in direct contact with the skin, can be particularly hazardous to the health and safety of certain segments of the population, such as children, young people, pregnant women, nursing mothers, people with heart conditions and the elderly. E-cigarettes and their nicotine cartridges and refill accessories must be kept out of the reach of young children at all times in view of the risk of choking or nicotine poisoning.

As e-cigarettes do not generate the smoke that is associated with smoking tobacco, their use is commonly believed by smokers to be safer than smoking tobacco. This illusion of ‘safety’ of e-cigarettes can be enticing to smokers; however, the chemicals used in electronic cigarettes have not been fully disclosed, and there are no adequate data on their emissions.

Is use of electronic cigarettes (ENDS) an effective method for quitting tobacco smoking?

Whilst there are anecdotal stories that e-cigarettes may have helped some smokers to quit, there are no properly conducted scientific studies which prove that they are an effective aid for sustained smoking cessation.

What should smokers do who wish to quit smoking?

Until such time as e-cigarettes are deemed to be safe and effective by a competent regulatory authority, smokers should be advised to use other forms of properly regulated nicotine replacement therapies and other such medications as advised by their doctor. In addition they should seek the help of their doctor, pharmacist, dentist or local smoking cessation advisor for advise on how to quit smoking.

Position Paper on Electronic Cigarettes

Our Position Paper on Electronic Cigarettes was published in December 2014.

Here is a brief summary of the main points:

  • According to research commissioned by the Irish Cancer Society, there are approximately 134,000 e-cigarette users in Ireland.
  • Research into the long-term effects of their using e-cigarettes is not yet available.
  • The Irish Cancer Society cannot recommend the use of e-cigarettes without guarantees on their long-term safety.
  • In the absence of proven safety and efficacy, the Society wants the Department of Health to regulate e-cigarettes as medicinal product.
  • The Irish Cancer Society is committed to a reduction in the rate of smoking in Ireland and has been a tireless advocate of the Government’s goal of a Tobacco Free Ireland by 2025. We recommend that smokers seeking to quit do so by giving up immediately and permanently.
  • The Irish Cancer Society wants to ensure marketing of e-cigarettes ‘denormalises’ smoking rather than renormalise it.
  • The Irish Cancer Society believes the workplace smoking ban should not be undermined and therefore supports employers who keep their workplaces free of e-cigarette use.

Read the position paper here.

More information

For information and support on how to quit smoking, call the HSE Quit Team on Freefone 1800 201 203 or visit Quit.ie.

(Source: Who Health Organisation Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS) July 2013)

Date Last Revised: 
Wednesday, December 17, 2014