Electronic cigarettes: the new face of nicotine.

A rugged actor with a prematurely lined face and raspy voice expounds on the virtues of regaining our freedom. A flaxen-haired actress waxes poetic on the sex appeal of puffing up in a bar. These are not images pulled from the archives of the golden age of television, when advertising tobacco products on the airwaves was unregulated, but rather from a new, and relatively unregulated, chapter in the saga of nicotine-containing products: electronic cigarettes. Electronic cigarettes, or “e-cigarettes,” have been on the market since 2007 and are catapulting into the mainstream. As their popularity skyrockets, however, so too does the need for product and marketing regulations at the federal level and sales restrictions to minors at the state and local levels. In lieu of tobacco, e-cigarettes consist of a liquid cartridge, which typically contains nicotine derived from tobacco, with an atomizer and a rechargeable battery; when the user draws on the device, it atomizes the liquid and delivers a vapor, in lieu of smoke, to the user. E-cigarette users “vape” the atomized contents of the cartridge, which can have flavors ranging from “plain tobacco” to bubble gum or peach schnapps. (Of note, the sale of flavored cigarettes [other than menthol] has been banned since the 2009 Family Smoking Prevention and Tobacco Control Act because of their known appeal to young buyers.) Once rare, these products have become much more visible over the past few years, particularly with the aid of television commercials for “blu eCigs” (owned by the Lorillard Tobacco Company), filling a void in televised cigarette commercials since their ban in 1970. Due to their novelty and the initial uncertainty of these products as drugs, devices, or tobacco products, e-cigarettes have yet to receive any federal oversight. E-cigarettes, with nicotine derived from tobacco, would need to be included in the Family Smoking Prevention and Tobacco Control Act’s definition of “tobacco products” to qualify for federal oversight, but the US Food and Drug Administration (FDA) has yet to include them in that definition. As such, they cannot currently be regulated like other tobacco products, with measures such as warning labels regarding addiction, restrictions on product marketing, and biochemical testing to ensure truth in labeling. The FDA also regulates medical devices and drugs, but e-cigarettes cannot be considered medical devices or nicotine replacement therapy, such as nicotine patches or gum, unless the manufacturers decide to market these products as such. AUTHORS: Emily K. Duffy, MD, and Brian P. Jenssen, MD