E-CIGS SAVE LIFES

You’ve probably heard in the news that the government wants to regulate electronic cigarettes as medicines to make them safer and more effective. That sounds like a good idea, but in fact it’s not what’s going to happen. If this becomes law most electronic cigarettes will be banned, and hundreds of thousands of people in the UK will go back to smoking tobacco.

Half of them will die.

Electronic cigarettes are not medicines. They are a new way of using nicotine, a legal drug which is safe when used normally. Don’t let them be banned by a badly thought out law.

About 1.3 million people in the UK now use electronic cigarettes regularly, and that number is doubling every year. You’ve probably seen people using them. Perhaps you know, or even live with, someone who has switched from smoking to ‘vaping.’

How much do you know about them, though?

Only what you’ve seen on TV and in the newspapers?

Sadly a lot of this is wrong. If you’ve seen news reports about electronic cigarettes you’ve probably seen these claims:

“We don’t know what’s in them.”

“They’re not regulated.”

“They’re being advertised to children.”

“They could be more dangerous than cigarettes.”

< >They cause cancer. “None of these things are true. Of course it’s easy for us to say that, however we have the evidence to back it up. Here are some points you probably haven’t seen in the news:

Electronic cigarettes don’t give off second hand smoke

Electronic cigarettes create no fire hazard

Electronic cigarette liquid is made with safe, medical grade ingredients

Using electronic cigarettes is up to 90% cheaper than smoking tobacco

Existing laws are enough to ensure that electronic cigarettes are safe

Yes, we have the evidence to back up these claims, too. Many health experts are strongly opposed to classing electronic cigarettes as a medicine.

They think, as we do, that this would be a public health disaster. We believe that once you’ve seen the evidence you will, too.



• Acetanisole

• Acetic Acid

• Acetoin

• Acetophenone

• 6-Acetoxydihydrotheaspirane

• 2-Acetyl-3- Ethylpyrazine

• 2-Acetyl-5-Methylfuran

• Acetylpyrazine

• 2-Acetylpyridine

• 3-Acetylpyridine

• 2-Acetylthiazole

• Aconitic Acid

• dl-Alanine

• Alfalfa Extract

• Allspice Extract,Oleoresin, and Oil

• Allyl Hexanoate

• Allyl Ionone

• Almond Bitter Oil

• Ambergris Tincture

• Ammonia

• Ammonium Bicarbonate

• Ammonium Hydroxide

• Ammonium Phosphate Dibasic

• Ammonium Sulfide

• Amyl Alcohol

• Amyl Butyrate

• Amyl Formate

• Amyl Octanoate

• alpha-Amylcinnamaldehyde

• Amyris Oil

• trans-Anethole

• Angelica Root Extract, Oil and Seed Oil

• Anise

• Anise Star, Extract and Oils

• Anisyl Acetate

• Anisyl Alcohol

• Anisyl Formate

• Anisyl Phenylacetate

• Apple Juice Concentrate, Extract, and Skins

• Apricot Extract and Juice Concentrate

• 1-Arginine

• Asafetida Fluid Extract And Oil

• Ascorbic Acid

• 1-Asparagine Monohydrate

• 1-Aspartic Acid

• Balsam Peru and Oil

• Basil Oil

• Bay Leaf, Oil and Sweet Oil

• Beeswax White

• Beet Juice Concentrate

• Benzaldehyde

• Benzaldehyde Glyceryl Acetal

• Benzoic Acid, Benzoin

• Benzoin Resin

• Benzophenone

• Benzyl Alcohol

• Benzyl Benzoate

• Benzyl Butyrate

• Benzyl Cinnamate

• Benzyl Propionate

• Benzyl Salicylate

• Bergamot Oil

• Bisabolene

• Black Currant Buds Absolute

• Benzyl Propionate

• Benzyl Salicylat

• Benzyl Propionate

• Benzyl Salicylate

• Bergamot Oil

• Bisabolene

• Black Currant Buds Absolute

• Borneol

• Bornyl Acetate

• Buchu Leaf Oil

• 1,3-Butanediol

• 2,3-Butanedione

• 1-Butanol

• 2-Butanone

• 4(2-Butenylidene)-3,5,5-Trimethyl-2-Cyclohexen-1-One

• Butter, Butter Esters, and Butter Oil

• Butyl Acetate

• Butyl Butyrate

• Butyl Butyryl Lactate

• Butyl Isovalerate

• Benzyl Propionate

• Benzyl Salicylate

• Bergamot Oil


• 2-Decenal

• Dehydromenthofurolactone

• Diethyl Malonate

• Diethyl Sebacate

• 2,3-Diethylpyrazine

• Dihydro Anethole

• 5,7-Dihydro-2-Methylthieno(3,4-D) Pyrimidine

• Dill Seed Oil and Extract

• meta-Dimethoxybenzene

• para-Dimethoxybenzene

• 2,6-Dimethoxyphenol

• Dimethyl Succinate

• 3,4-Dimethyl-1,2 Cyclopentanedione

• 3,5- Dimethyl-1,2-Cyclopentanedione

• 3,7-Dimethyl-1,3,6-Octatriene

• 4,5-Dimethyl-3-Hydroxy-2,5-


• 6,10-Dimethyl-5,9-Undecadien-


• 3,7-Dimethyl-6-Octenoic Acid

• 2,4 Dimethylacetophenone

• alpha,para-Dimethylbenzyl Alcohol

• alpha,alpha-Dimethylphenethyl Acetate

• alpha,alpha Dimethylphenethyl Butyrate

• 2,3-Dimethylpyrazine

• 2,5-Dimethylpyrazine

• 2,6-Dimethylpyrazine

• Dimethyltetrahydrobenzofuranone

• delta-Dodecalactone

• gamma-Dodecalactone

• para-Ethoxybenzaldehyde

• Ethyl 10-Undecenoate

• Ethyl 2-Methylbutyrate

• Ethyl Acetate

• Ethyl Acetoacetate

• Ethyl Alcohol

• Ethyl Benzoate

• Ethyl Butyrate

• Ethyl Cinnamate

• Ethyl Decanoate

• Ethyl Fenchol

• Ethyl Furoate

• Ethyl Heptanoate

• Ethyl Hexanoate

• Ethyl Isovalerate

• Ethyl Lactate

• Ethyl Laurate

• Ethyl Levulinate

• Ethyl Maltol

• Ethyl Methyl Phenylglycidate

• Ethyl Myristate

• Ethyl Nonanoate

• Ethyl Octadecanoate

• Ethyl Octanoate

• Ethyl Oleate

• Ethyl Palmitate

• Ethyl Phenylacetate

• Ethyl Propionate

• Ethyl Salicylate

• Ethyl trans-2-Butenoate

• Ethyl Valerate

• Ethyl Vanillin

• 2-Ethyl (or Methyl)-(3,5 and 6)-Methoxypyrazine

• 2-Ethyl-1-Hexanol, 3-Ethyl -2 -


• 2-Ethyl-3, (5 or 6)-Dimethylpyrazine

• 5-Ethyl-3-Hydroxy-4-Methyl-2 (5H)-Furanone

• 2-Ethyl-3-Methylpyrazine

• 4-Ethylbenzaldehyde

• 4-Ethylguaiacol

• para-Ethylphenol

• 3-Ethylpyridine

• Eucalyptol

• Farnesol

• D-Fenchone

• Fennel Sweet Oil

• Fenugreek, Extract, Resin, and Absolute

• Fig Juice Concentrate

• Food Starch Modified

• Furfuryl Mercaptan

• 4-(2-Furyl)-3-Buten-2-One

• Galbanum Oil

• Genet Absolute

• Gentian Root Extract

• Geraniol

• Geranium Rose Oil

• Lactic Acid

• Lauric Acid

• Lauric Aldehyde

• Lavandin Oil

• Lavender Oil

• Lemon Oil and Extract

• Lemongrass Oil

• 1-Leucine

• Levulinic Acid

• Licorice Root, Fluid, Extract

and Powder

• Lime Oil

• Linalool

• Linalool Oxide

• Linalyl Acetate

• Linden Flowers

• Lovage Oil And Extract

• 1-Lysine]

• Mace Powder, Extract and Oil

• Magnesium Carbonate

• Malic Acid

• Malt and Malt Extract

• Maltodextrin

• Maltol

• Maltyl Isobutyrate

• Mandarin Oil

• Maple Syrup and Concentrate

• Mate Leaf, Absolute and Oil

• para-Mentha-8-Thiol-3-One

• Menthol

• Menthone

• Menthyl Acetate

• dl-Methionine

• Methoprene

• 2-Methoxy-4-Methylphenol

• 2-Methoxy-4-Vinylphenol

• para-Methoxybenzaldehyde

• 1-(para-Methoxyphenyl)-1-Penten-3-One

• 4-(para-Methoxyphenyl)-2-Butanone

• 1-(para-Methoxyphenyl)-2-Propanone

• Methoxypyrazine

• Methyl 2-Furoate

• Methyl 2-Octynoate

• Methyl 2-Pyrrolyl Ketone

• Methyl Anisate

• Methyl Anthranilate

• Methyl Benzoate

• Methyl Cinnamate

• Methyl Dihydrojasmonate

• Methyl Ester of Rosin, Partially Hydrogenated

• Methyl Isovalerate

• Methyl Linoleate (48%)

• Methyl Linolenate (52%) Mixture

• Methyl Naphthyl Ketone

• Methyl Nicotinate

• Methyl Phenylacetate

• Methyl Salicylate

• Methyl Sulfide

• 3-Methyl-1-Cyclopentadecanone

• 4-Methyl-1-Phenyl-2-Pentanone

• 5-Methyl-2-Phenyl-2-Hexenal

• 5-Methyl-2-Thiophene-carboxaldehyde

• 6-Methyl-3,-5-Heptadien-2-One

• 2-Methyl-3-(para-Isopropylphenyl) Propionaldehyde

• 5-Methyl-3-Hexen-2-One

• 1-Methyl-3Methoxy-4-Isopropylbenzene

• 4-Methyl-3-Pentene-2-One

• 2-Methyl-4-Phenylbutyraldehyde

• 6-Methyl-5-Hepten-2-One

• 4-Methyl-5-Thiazoleethanol

• 4-Methyl-5-Vinylthiazole

• Methyl-alpha-Ionone

• Methyl-trans-2-Butenoic Acid

• 4-Methylacetophenone

• para-Methylanisole

• alpha-Methylbenzyl Acetate

• alpha-Methylbenzyl Alcohol

• 2-Methylbutyraldehyde

• 3-Methylbutyraldehyde

• 2-Methylbutyric Acid

• alpha-Methylcinnamaldehyde

• Methylcyclopentenolone

• 2-Methylheptanoic Acid

• 2-Methylhexanoic Acid

• 3-Methylpentanoic Acid

• 4-Methylpentanoic Acid

3-Dienyl Methan

• Pimenta Leaf Oil

• Pine Needle Oil, Pine Oil, Scotch

• Pineapple Juice Concentrate

• alpha-Pinene, beta-Pinene

• D-Piperitone

• Piperonal

• Pipsissewa Leaf Extract

• Plum Juice

• Potassium Sorbate

• 1-Proline

• Propenylguaethol

• Propionic Acid

• Propyl Acetate

• Propyl para-Hydroxybenzoate

• Propylene Glycol

• 3-Propylidenephthalide

• Prune Juice and Concentrate

• Pyridine

• Pyroligneous Acid And Extract

• Pyrrole

• Pyruvic Acid

• Raisin Juice Concentrate

• Rhodinol

• Rose Absolute and Oil

• Rosemary Oil

• Rum

• Rum Ether

• Rye Extract

• Sage, Sage Oil, and Sage


• Salicylaldehyde

• Sandalwood Oil, Yellow

• Sclareolide

• Skatole

• Smoke Flavor

• Snakeroot Oil

• Sodium Acetate

• Sodium Benzoate

• Sodium Bicarbonate

• Sodium Carbonate

• Sodium Chloride

• Sodium Citrate

• Sodium Hydroxide

• Solanone

• Spearmint Oil

• Styrax Extract, Gum and Oil

• Sucrose Octaacetate

• Sugar Alcohols

• Sugars

• Tagetes Oil

• Tannic Acid

• Tartaric Acid

• Tea Leaf and Absolute

• alpha-Terpineol

• Terpinolene

• Terpinyl Acetate

• 5,6,7,8-Tetrahydroquinoxaline

• 1,5,5,9-Tetramethyl-13-Oxatricyclo(,9))Tridecane

• 2,3,4,5, and 3,4,5,6-


• 2,3,5,6-Tetramethylpyrazine

• Thiamine Hydrochloride

• Thiazole

• 1-Threonine

• Thyme Oil, White and Red

• Thymol

• Tobacco Extracts

• Tochopherols (mixed)

• Tolu Balsam Gum and Extract

• Tolualdehydes

• para-Tolyl 3-Methylbutyrate

• para-Tolyl Acetaldehyde

• para-Tolyl Acetate

• para-Tolyl Isobutyrate

• para-Tolyl Phenylacetate

• Triacetin

• 2-Tridecanone

• 2-Tridecenal

• Triethyl Citrate

• 3,5,5-Trimethyl -1-Hexanol

• para,alpha,alpha-Trimethylbenzyl Alcohol

• 4-(2,6,6-Trimethylcyclohex-1-


• 2,6,6-Trimethylcyclohex-2-


• 2,6,6-Trimethylcyclohexa-1,


• Bisabolene

• Black Currant Buds Absolute

• Borneol

• Bornyl Acetate

• Buchu Leaf Oil

• 1,3-Butanediol

• 2,3-Butanedione

• 1-Butanol

• 2-Butanone

• 4(2-Butenylidene)-3,5,5-Trimethyl-2-Cyclohexen-1-One

• Butter, Butter Esters, and Butter Oil

• Butyl Acetate

• Butyl Butyrate

• Butyl Butyryl Lactate

• Butyl Isovalerate

• Butyl Phenylacetate

• Butyl Undecylenate

• 3-Butylidenephthalide

• Butyric Acid]

• Cadinene

• Caffeine

• Calcium Carbonate

• Camphene

• Cananga Oil

• Capsicum Oleoresin

• Caramel Color

• Caraway Oil

• Carbon Dioxide

• Cardamom Oleoresin, Extract, Seed Oil, and Powder

• Carob Bean and Extract

• beta-Carotene

• Carrot Oil

• Carvacrol

• 4-Carvomenthenol

• 1-Carvone

• beta-Caryophyllene

• beta-Caryophyllene Oxide

• Cascarilla Oil and Bark Extract

• Cassia Bark Oil

• Cassie Absolute and Oil

• Castoreum Extract, Tincture and Absolute

• Cedar Leaf Oil

• Cedarwood Oil Terpenes and Virginiana

• Cedrol

• Celery Seed Extract, Solid, Oil, And Oleoresin

• Cellulose Fiber

• Chamomile Flower Oil And Extract

• Chicory Extract

• Chocolate

• Cinnamaldehyde

• Cinnamic Acid

• Cinnamon Leaf Oil, Bark Oil, and Extract

• Cinnamyl Acetate

• Cinnamyl Alcohol

• Cinnamyl Cinnamate

• Cinnamyl Isovalerate

• Cinnamyl Propionate

• Citral

• Citric Acid

• Citronella Oil

• dl-Citronellol

• Citronellyl Butyrate

• itronellyl Isobutyrate

• Civet Absolute

• Clary Oil

• Clover Tops, Red Solid Extract

• Cocoa

• Cocoa Shells, Extract, Distillate And Powder

• Coconut Oil

• Coffee

• Cognac White and Green Oil

• Copaiba Oil

• Coriander Extract and Oil

• Corn Oil

• Corn Silk

• Costus Root Oil

• Cubeb Oil

• Cuminaldehyde

• para-Cymene

• 1-Cysteine Dandelion Root Solid Extract

• Davana Oil

• 2-trans, 4-trans-Decadienal

• delta-Decalactone

• gamma-Decalactone

• Decanal

• Decanoic Acid

• 1-Decanol


• Geranyl Acetate

• Geranyl Butyrate

• Geranyl Formate

• Geranyl Isovalerate

• Geranyl Phenylacetate

• Ginger Oil and Oleoresin

• 1-Glutamic Acid

• 1-Glutamine

• Glycerol

• Glycyrrhizin Ammoniated

• Grape Juice Concentrate

• Guaiac Wood Oil

• Guaiacol

• Guar Gum

• 2,4-Heptadienal

• gamma-Heptalactone

• Heptanoic Acid

• 2-Heptanone

• 3-Hepten-2-One

• 2-Hepten-4-One

• 4-Heptenal

• trans -2-Heptenal

• Heptyl Acetate

• omega-6-Hexadecenlactone

• gamma-Hexalactone

• Hexanal

• Hexanoic Acid

• 2-Hexen-1-Ol

• 3-Hexen-1-Ol

• cis-3-Hexen-1-Yl Acetate

• 2-Hexenal

• 3-Hexenoic Acid

• trans-2-Hexenoic Acid

• cis-3-Hexenyl Formate

• Hexyl 2-Methylbutyrate

• Hexyl Acetate

• Hexyl Alcohol

• Hexyl Phenylacetate

• 1-Histidine

• Honey

• Hops Oil

• Hydrolyzed Milk Solids

• Hydrolyzed Plant Proteins

• 5-Hydroxy-2,4-Decadienoic Acid delta-Lactone

• 4-Hydroxy-2,5-Dimethyl-3(2H)-Furanone

• 2-Hydroxy-3,5,5-Trimethyl-2-Cyclohexen-1-One

• 4-Hydroxy -3-Pentenoic Acid Lactone

• 2-Hydroxy-4-Methylbenzaldehyde

• 4-Hydroxybutanoic Acid Lactone

• Hydroxycitronellal

• 6-Hydroxydihydrotheaspirane

• 4-(para-Hydroxyphenyl)-2-Butanone

• Hyssop Oil

• Immortelle Absolute and Extract

• alpha-Ionone

• beta-Ionone

• alpha-Irone

• Isoamyl Acetate

• Isoamyl Benzoate

• Isoamyl Butyrate

• Isoamyl Cinnamate

• Isoamyl Formate, IsoamylHexanoate

• Isoamyl Isovalerate

• Isoamyl Octanoate

• Isoamyl Phenylacetate

• Isobornyl Acetate

• Isobutyl Acetate

• Isobutyl Alcohol

• Isobutyl Cinnamate


• Isobutyl Phenylacetate

• Isobutyl Salicylate

• 2-Isobutyl-3-Methoxypyrazine

• alpha-Isobutylphenethyl Alcohol

• Isobutyraldehyde

• Isobutyric Acid

• d,l-Isoleucine

• alpha-Isomethylionone

• 2-Isopropylphenol

• Isovaleric Acid

• Jasmine Absolute, Concrete and Oil

• Kola Nut Extract

• Labdanum Absolute and Oleoresin

• Lactic Acid

• Lauric Acid

• Lauric Aldehyde

• 2-Methylpyrazine

• 5-Methylquinoxaline

• 2-Methyltetrahydrofuran-3-One

• (Methylthio)Methylpyrazine (Mixture Of Isomers)

• 3-Methylthiopropionaldehyde

• Methyl 3-Methylthiopropionate

• 2-Methylvaleric Acid

• Mimosa Absolute and Extract

• Molasses Extract and Tincture

• Mountain Maple Solid Extract

• Mullein Flowers

• Myristaldehyde

• Myristic Acid

• Myrrh Oil

• beta-Napthyl Ethyl Ether

• Nerol

• Neroli Bigarde Oil

• Nerolidol

• Nona-2-trans,6-cis-Dienal

• 2,6-Nonadien-1-Ol

• gamma-Nonalactone

• Nonanal

• Nonanoic Acid

• Nonanone

• trans-2-Nonen-1-Ol

• 2-Nonenal

• Nonyl Acetate

• Nutmeg Powder and Oil

• Oak Chips Extract and Oil

• Oak Moss Absolute

• 9,12-Octadecadienoic Acid (48%)

And 9,12,15-Octadecatrienoic Acid (52%)

• delta-Octalactone

• gamma-Octalactone

• Octanal

• Octanoic Acid

• 1-Octanol

• 2-Octanone

• 3-Octen-2-One

• 1-Octen-3-Ol

• 1-Octen-3-Yl Acetate

• 2-Octenal

• Octyl Isobutyrate

• Oleic Acid

• Olibanum Oil

• Opoponax Oil And Gum

• Orange Blossoms Water, Absolute, and Leaf Absolute

• Orange Oil and Extract

• Origanum Oil

• Orris Concrete Oil and Root


• Palmarosa Oil

• Palmitic Acid

• Parsley Seed Oil

• Patchouli Oil

• omega-Pentadecalactone

• 2,3-Pentanedione

• 2-Pentanone

• 4-Pentenoic Acid

• 2-Pentylpyridine

• Pepper Oil, Black And White

• Peppermint Oil

• Peruvian (Bois De Rose) Oil

• Petitgrain Absolute, Mandarin Oil and Terpeneless Oil

• alpha-Phellandrene

• 2-Phenenthyl Acetate

• Phenenthyl Alcohol

• Phenethyl Butyrate

• Phenethyl Cinnamate

• Phenethyl Isobutyrate

• Phenethyl Isovalerate

• Phenethyl Phenylacetate

• Phenethyl Salicylate

• 1-Phenyl-1-Propanol

• 3-Phenyl-1-Propanol

• 2-Phenyl-2-Butenal

• 4-Phenyl-3-Buten-2-Ol

• 4-Phenyl-3-Buten-2-One

• Phenylacetaldehyde

• Phenylacetic Acid

• 1-Phenylalanine

• 3-Phenylpropionaldehyde

• 3-Phenylpropionic Acid

• 3-Phenylpropyl Acetate

• 3-Phenylpropyl Cinnamate

• 2-(3-Phenylpropyl)Tetrahydrofuran

• Phosphoric Acid

• 4-(2,6,6-Trimethylcyclohexa-1,


• 2,2,6-Trimethylcyclohexanone

• 2,3,5-Trimethylpyrazine

• 1-Tyrosine

• delta-Undercalactone

• gamma-Undecalactone

• Undecanal

• 2-Undecanone, 1

• 0-Undecenal

• Urea

• Valencene

• Valeraldehyde

• Valerian Root Extract, Oil

and Powder

• Valeric Acid

• gamma-Valerolactone

• Valine

• Vanilla Extract And Oleoresin

• Vanillin

• Veratraldehyde

• Vetiver Oil

• Vinegar

• Violet Leaf Absolute

• Walnut Hull Extract

• Water

• Wheat Extract And Flour

• Wild Cherry Bark Extract

• Wine and Wine Sherry

• Xanthan Gum

• 3,4-Xylenol

• Yeast



















































January 2014



This is an update of the briefing from June 2013 to take into account the revision of the Tobacco Products Directive.

•Nicotine containing products (NCPs) such as e-cigarettes are evolving and there is increasing evidence to suggest that some if not all products provide effective nicotine delivery.

•There is little real-world evidence of harm from e-cigarettes to date, especially in comparison to smoking.

•E-cigarettes are used by both smokers and ex-smokers, but there is little evidence of use by those who have never smoked or by children.

•ASH supports regulation to ensure the safety and reliability of e-cigarettes but, in the absence of harm to bystanders, does not consider it appropriate to include e-cigarettes under smoke free regulations.

•ASH supports regulation to ensure that e-cigarettes are safe, and effective.

ASH welcomes the guidance by the National Institute for Health and Clinical Excellence (NICE) on harm reduction, which supports the use of licensed nicotine products as an aid to cutting down or quitting smoking and as a substitute for smoking.

Nicotine Substitution

Smoking is the largest, preventable cause of premature mortality in the UK. The goal of public health is to diminish the harm caused by tobacco products. While the ideal remains that people should stop using tobacco completely and permanently, consensus currently supports a properly regulated harm reduction approach1, 2, and 3 – a framework by which the harmful effects of smoking are reduced without

Requiring the elimination of a behaviour that is not necessarily condoned. Such strategies have proved successful in the past, for example within the contexts of needle exchange programmes for illicit drug use and the promotion of safer sex to prevent HIV infection.4, 5

In 1976 Professor Michael Russell wrote: “People smoke for nicotine but they die from the tar.”6 Indeed, the harm from smoking is caused almost exclusively by toxins present in tobacco released

Through combustion. By contrast, pure nicotine products, although addictive, are considerably less harmful. Electronic cigarettes consequently represent a safer alternative to cigarettes for smokers who are unable or unwilling to stop using nicotine.

The National Institute for Health and Care Excellence (NICE) has developed guidance on a harm reduction approach to smoking.7 NICE’s recommendations aim to inform on how best to reduce illness

And deaths attributable to smoking through a harm reduction approach. As part of this guidance, NICE supports the use of licensed nicotine containing products (NCPs) to help smokers cut down, for temporary abstinence and as a substitute for smoking, possibly indefinitely.

What are e-cigarettes?

Electronic cigarettes, also known as electronic nicotine delivery systems (ENDS), 8 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 atomizer 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.9 some e-cigarettes also have an indicator light at the end that glows when the user draws on the device to resemble a lit cigarette. 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.

Are e-cigarettes safe to use?

A draft review by the WHO’s Tobacco Regulatory Group in 2009 notes that the extent of nicotine uptake and the safety of e-cigarettes have yet to be fully established.8 Certainly, in the absence of thorough clinical evaluation and long term population level surveillance absolute safety of such products cannot be guaranteed. By comparison, the harm from tobacco smoking – the leading cause of preventable death in the UK – is well established.

Most of the safety concerns regarding electronic cigarettes relate to the absence of appropriate product regulation and inconsistencies in quality control. The current lack of any authoritative oversight (although the MHRA is in the process of developing guidelines, see section on regulation) means that there is significant variability in device effectiveness, nicotine delivery and cartridge nicotine content both between and sometimes within product brands.9 Furthermore, a recent study by the US Food and Drug Administration (FDA) has raised some safety concerns over the presence of toxins, released in low concentrations, from the vaporization process of certain cartridges.10 However, one study showed that after switching from tobacco to electronic cigarettes nicotine exposure was unchanged while exposure to selected toxicants was substantially reduced.11

There is little evidence of harmful effects from repeated exposure to propylene glycol, the chemical in which nicotine is suspended.12, 13 One study concludes that e-cigarettes have a low toxicity profile, are well tolerated, and are associated with only mild adverse effects.14

Is there a risk to non-users from e-cigarette vapour?

Although e-cigarettes do not produce smoke, users exhale a smoke-like vapour which consists largely of water. Any health risks of second-hand exposure to propylene glycol vapour are likely to be limited to irritation of the throat. One study exposed animals to propylene glycol for 12 to 18 months at doses 50 to 700 times the level the animal could absorb

Through inhalation. Compared to animals living in normal room atmosphere, no localized or generalized irritation was found and kidney, liver, spleen and bone marrow were all found to be normal.12

The fact that e-cigarettes look similar to conventional cigarettes has been said to risk confusion as to their use in public places, such as on public transport.15, 16 However, given that the most distinctive feature of cigarette smoking is the smell of the smoke, which travels rapidly, and that this is absent from e-cigarette use, it is not clear how any such confusion

Would be sustained. Furthermore, the absence of risk from “second-hand” inhalation of vapour from e-cigarettes has been described as an “often unconsidered advantage” of e-cigarettes.17As an alternative to smoking, e-cigarettes are preferable in situations where second-hand smoke poses serious health risks to others, such as in vehicles or in the home.

Are e-cigarettes effective?

The degree of effectiveness depends on what effect is being measured. Public health professionals may be most concerned about their effectiveness in smoking cessation. There are four benefits most widely perceived by smokers: these are the degree to which they satisfy the desire to smoke (60% of smokers), help to cut down cigarettes (55%), help quit entirely (51%) and eradicate the smell of stale smoke (51 %).18,19 Effectiveness also varies between products and between users according to their experience in use.20

Currently in the UK, any nicotine-containing product which claims or implies that it can treat nicotine addiction is considered to be a medicinal product and is therefore subject to

Regulation by the MHRA. Consequently, e-cigarette manufacturers have avoided making such explicit claims. Furthermore, the WHO has stated that “the electronic cigarette is not a proven nicotine replacement therapy”.21

Nevertheless, survey data suggests that about 4 in1018 users do use them in an attempt to quit smoking and internet searches for the devices now exceed those for any other smoking cessation or nicotine replacement product.22 there is some evidence to suggest that e-cigarette use leads to abstinence among some smokers who had not intended to quit.23

Empirical data on the effectiveness of e-cigarettes as a stop-smoking aid is limited and the risks and benefits are still being studied. Some reports from the published literature suggest that electronic cigarettes are inefficient nicotine delivery devices and result in only modest and unreliable increases in plasma nicotine levels.24 Such findings appear to apply particularly to new users whereas studies using participants experienced in e-cigarette use have been found to derive more reliable nicotine intake levels.14 Whether experienced users are able to use these devices in a way in which their nicotine intake is maximized, or the variability is down

To such users preferring certain devices which might significantly differ from those used by inexperienced users, is yet to be determined.25, 26

Nevertheless, growing evidence suggests that e-cigarettes are becoming more reliable in their nicotine delivery and that they have a beneficial impact in reducing subjective cravings and,

In turn, number of cigarettes smoked.14 Moreover, some studies have demonstrated an ability for certain brands of e-cigarettes to reduce subjective nicotine cravings despite delivering low

Plasma nicotine levels.27

Another feature of e-cigarettes that apparently lends to their effectiveness is an ability to satisfy the “hand to mouth” behavioural component that is not sufficiently addressed in more traditional nicotine replacement therapies. This has been demonstrated by users exhibiting reduced cravings, withdrawal symptoms and number of cigarettes smoked per day even when given a placebo e-cigarette.14

The potential value, and perceived effectiveness, of electronic cigarettes in aiding smoking cessation has been assessed in user surveys. Caution must be exercised with this data as the sample was recruited from e-cigarette users’ websites. However, one such survey

conducted internationally reported that 72% of users believed that e-cigarettes were beneficial in reducing cravings and withdrawal symptoms while 92% declared that the devices had reduced the number of conventional cigarettes they smoked. Indeed, in the same survey, 96% of former smokers claimed that e-cigarettes had helped them quit, and 79% reported a fear that if they stopped using them they would start smoking again.9

Who uses e-cigarettes in the UK?

Public awareness of e-cigarettes has grown substantially in recent years with online media playing an integral role in the growing popularity of the product. Between the years 2009 and 2011 searches via the search engine Google using the terms ‘electronic cigarette’ increased by fifty fold, 28 a fact the industry has attempted to capitalize on by funding various online adverts, web-pages and social networking site groups.29 In addition to the influence of online media, there is also evidence to suggest that tighter tobacco control measures are also positively driving e-cigarette behaviour.30

According to a survey commissioned by ASH, 3% of smokers reported using e-cigarettes in 2010, a figure that increased to 7% in 2012 and 11% in 2013 (see figure 1). Similarly, the number of people reporting having tried e-cigarettes has increased significantly, more than doubling from 9% in 2010 to 22% in 2012 and 35% in 2013. Among children, current e-cigarette use is confined to those who have already tried smoking. 31, 32 (see figure 2)

ASH estimates that there are 1.3 million current users of e-cigarettes in the UK. This number is almost entirely made of current and ex-smokers; with perhaps as many as 400,000 people having replaced smoking with e-cigarette use. There is little evidence to suggest that anything more than a negligible number of non-smokers regularly use the product.33

For further information see ASH Factsheet: Use of e-cigarettes in Great Britain among adults and young people (pdf)


In December 2013 political agreement was reached on the Tobacco Products Directive (TPD) such that electronic cigarettes which are not licensed as medicines will be regulated under the TPD. The revised TPD is due to be voted on by the ENVI committee and the European Parliament early in 2014. Core requirements set out in the TPD are as follows:

•A limit on nicotine strength of 20mg/ml

•A size limit for e-liquids of 10 ml for dedicated refill containers and 2 ml for e-cigarette cartridges and tanks.

•Safety mechanisms (such as childproof fastening and opening) for e-liquid containers, cartridges and tanks.

•Warnings on the two largest surfaces of the packs and any outside packaging covering 30% of the external area. These must state either ‘This product contains nicotine which is a highly addictive substance’ or the above plus ‘It is not recommended for use by non-smokers’.

•Manufacturers and importers bear full responsibility for the quality and safety of their product and must notify detailed information about their products to competent authorities in each Member State.

•Prohibition on cross-border advertising promotion and sponsorship in line with that for tobacco products

•Member States will be able to introduce extra safeguards for example on age-limits and flavourings in e-cigarettes.

Once the Directive is adopted, member states will have two years to transpose the new rules into national law. Until then electronic cigarettes not licensed as medicines will continue to

Be subject to general consumer protection IA and it is the responsibility of trading standards officers to rule on their safety.

The MHRA has said that it “continues to encourage companies to voluntarily submit medicines license applications for electronic cigarettes and other NCPs as medicines”.34

ASH supports this recommendation. In the UK medicines regulation has some advantages for electronic cigarette manufacturers and importers over regulation under the TPD. For example as licensed nicotine products:

•Only 5% VAT is levied compared to 20% for consumer products.

•Products could be made available on prescription.

•Advertising, promotion and sponsorship are allowed.

•Limits of 20 mg/ml on strength, 10 ml on size of refill containers and 2 ml on cartridges or tanks would not be mandatory.

•Products would be widely available.

Following a referral from the Department of Health, NICE published guidance on tobacco harm reduction on 5th June 2013.7 This guidance recommended the use of licensed NCPs, which are nicotine replacement therapy products licensed by the MHRA (and do not at the current time include e-cigarettes) for harm reduction purposes. Such purposes include using licensed NCPs as a substitute for tobacco, possibly indefinitely, to cut down prior to quitting, to smoke less, or to temporarily abstain from smoking.

Currently, e-cigarettes are not regulated under smoke free law in the UK. In general, users are free to use them in most public places such as bars, restaurants and on public transport, although the managers of some premises have prohibited their use.

An oft quoted advantage of smoke free legislation is that it de-normalizes smoking, effectively distancing the behaviour from what is an accepted social norm. The ban on smoking in public places has reinforced in many people’s minds that such behaviour has gone from a

Normal, widely accepted activity to one that is abnormal and unaccepted. There are concerns that e-cigarettes will undermine this process, threatening the now established practice of smoke free public places, such as at work or on public transport. However to date there is little evidence to suggest this is the case.


ASH recognizes that whilst efforts to help people stop smoking should remain a priority, many people either do not wish to stop smoking or find it very hard to do so. For this group, nicotine substitution products which have been properly regulated to ensure product safety, quality and efficacy should be made available as an alternative to tobacco. Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe.

E-cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are likely to be a safer alternative to smoking. In addition, e-cigarettes reduce second-hand smoke exposure in places where smoking is allowed since they do not produce smoke. Nonetheless, nicotine is an addictive substance, e-cigarettes currently available are of highly variable safety and efficacy, and smokers are uncertain about the effectiveness of the product.

In the UK smoke free legislation exists to protect the public from the demonstrable harms of second-hand smoke. ASH does not consider it appropriate for electronic cigarettes to be subject to this legislation.


1 Royal College of Physicians. Harm reduction in nicotine addiction: helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians. London: RCP, 2007.

2 Actions on Smoking and Health. Beyond Smoking Kills: Protecting Children, Reducing Inequalities. London: ASH, 2008

3 British Medical Associations. E-cigarettes in public places and workplaces. A briefing from the BMA Occupa­tional Medicine Committee and the Board of Science. London: BMA, 2012

4 Hurley S, Jolley D and Caldor J. Effectiveness of needle-exchange programs for prevention of HIV infec­tion. The Lancet 1997; 349:1797-1800

5 Weller, S. A Meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Soc. Sci. Med. 1 993; 36: 1635-1644

6 Russell M. Low-tar medium-nicotine cigarettes: a new approach to safer smoking. British Medical Journal 1976; 1:1430-1433

7 Tobacco - Harm reduction NICE, 2013

8 Draft Abbreviated Advisory of the WHO Study Group on tobacco product regulation (WHO Oberg) concerning Electronic Nicotine Delivery Systems (ENDS), 2009

9 Gronkiewicz ML, Kuma T, Gadroon M, Kayak J, Consider L. Nicotine levels in electronic cigarettes. Nicotine Tub Res 2013; 15:158-66

10 Wiesenberger BJ. US Food and Drug Administration: evaluation of e-cigarettes. St Louis, MO: US Food and Drug Administration, Centre for Drug Evaluation and Research, Division of Pharmaceutical Analysis. 2009.

11 Gronkiewicz ML, Gadroon J, Jacob P, Peng M, Benefits N. Electronic cigarettes deliver similar levels of nicotine and reduce exposure to combustion toxicants after switching from tobacco cigarettes. Presented at the 18th an­nual meeting of the Society for Research on Nicotine and Tobacco, Houston, March 13-16, 2012, 40, NIPA-1

12 Robertson OH, Loosely CG, Puck TT et al. Tests for the chronic toxicity of propylene glycol and diethylene glycol on monkeys and rats by vapour inhalation and oral administration. J Pharmacology Expo There 1947; 91: 52–76.

13 Electronic cigarettes: A safe substitute? New Scientist 11 Feb 2009

14 Bullpen C, Corbie H, Thorley S, et al. Effect of an electronic cigarette on desire to smoke and withdrawal, user preferences and nicotine delivery: randomized cross-over trial. Tobacco Control 2010; 19: 98–103

15 King County bans public e-cigarette smoking. 15 Dec. 2010

16 Wirral pensioners kicked off public transport because of his electronic cigarette. Wirral News. 20 July 2012

17 Wagener TL, Siegel M, Borelli B. Electronic Cigarettes: Achieving a balanced perspective. Addiction 2012; 107: 91545-1548

18 Survey of smokers’ attitudes to e-cigarettes. Yugo 2010. Total sample size was 1380 UK adult smokers. Respondents were pre-screened for e-cigarette use such that 486 respondents had tried e-cigarettes and 894 respondents had not tried e-cigarettes. Fieldwork was undertaken between 9th - 16th April 2010. The survey was carried out online. The figures are unweight.

19 Gronkiewicz ML, Lingus EO, Hayek P. Patterns and effects of electronic cigarettes use and users beliefs about their safety and benefits. An internet survey. Drug Alcohol Rev 2013; in press

20 Folds J, Elder S, & Berg A. Electronic cigarettes (e-cigs): Views of aficionados and clinical/public health perspectives. Into J Clinical Practice 2011; 65: 1037–1042

21 World Health Organization. Report on the scientific basis of tobacco product regulation: third report of a WHO study group. Geneva, World Health Organization, 2009.

22 Etters J & Bullpen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction 2011; 106: 2017–28.

23 Pools R, Caponnetto P, Marjorie JB. Et al. Effect of electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health 2011; 11: 786. Doe: 10.1186/1471-2458-11-786

24 Vansickel AR, Cobb CO, Weaver MF, Isenberg TE. A clinical laboratory model for evaluating the acute ef­fects of electronic ‘cigarettes’: nicotine delivery profile and cardiovascular and subjective effects. Cancer Epidemiology Biomarkers Prep 2010; 19: 1945–53

25 Folds J, Elder S, & Berg A. Electronic cigarettes (e-cigs): Views of aficionados and clinical/public health perspectives. Into J Clinical Practice 2011; 65: 1037–1042

26 Trtchounian A, Williams M, & Talbot P. Conventional and electronic cigarettes (e-cigarettes) have different smoking characteristics. Nick & Tub Research 2011; 12: 905–912

27 Isenberg T. Electronic nicotine delivery devices: ineffective nicotine delivery and craving suppression after acute administration. Tobacco Control 2010; 19: 87–8

28 Yamen CK, Bitten A, & Bates DW. E-cigarettes: a rapidly growing Internet phenomenon. Ann Intern Med 2010; 153:607–9

29 Noel JK, Rees VW, Connolly GN. Electronic cigarettes: a new ‘tobacco’ industry? Tub Control 2011; 20: 81

30 Ayers JW, Rebels KM, Brownstein JS. Tracking the rise in popularity of Electronic Nicotine Delivery Systems (electronic cigarettes) using search query surveillance. Am J Prep Med 2011; 40: 448–53?

31 Dickel M, Morrison R & McNeill A. E-cigarettes: Prevalence and attitudes in Great Britain. Nicotine & To­bacco Research In press.

32 Survey fieldwork dates and sample size: Adults:

March 2010:             2,297 adult smokers

March 2012:             12,436 adults

February 2013: 12,170 adults

Children: March 2013: 2,178 children aged 11-18

Surveys were conducted online and results weighted to reflect the British population, as appropriate.

33 Gronkiewicz ML, Zielinska-Danch W. Electronic cigarette use among teenagers and young adults in Poland. Paediatrics 2012; 130: e879-85.

34 Nicotine containing products, MHRA, 2013ASH briefings are available on our website at

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