Royal College of Physicians - What you need to know about electronic cigarettes

Published: 20 March 2014

Electronic cigarettes have become a staple of everyday UK life in a remarkably short time, but questions about their safety, efficacy and legal status still need to be answered. Dr Ilze Bogdanovica, Professor Linda Bauld and Professor John Britton from the UK Centre for Tobacco and Alcohol Studies review the facts and give their views.

Electronic cigarettes – commonly known as e-cigarettes – are novel nicotine delivery devices that were developed in China more than 10 years ago. Most first-generation devices bore a physical resemblance to cigarettes (so-called cigalikes), but a wide range of larger designs known by various names including personal vapourisers and clearomisers has since been introduced.

E-cigarettes have been available in the UK since around 2005, and since then sales and use have risen dramatically. This rapid proliferation in the UK and elsewhere has provoked extensive debate on the role of e-cigarettes in health and society. Although some claim that uncertainty about their effects and role in tobacco control precludes e-cigarettes from being endorsed on health grounds, others argue that any products that offer a significantly lower hazard alternative to tobacco should be welcomed.

Potential benefits

According to data from the Smoking Toolkit Study, the proportion of smokers in England who have used an e-cigarette in the past three months increased from around 2% in May 2011 to more than 15% in November 2013 – equivalent to around 1.3 million smokers in the UK. Use does not seem to vary by sex or socioeconomic status. Use among non-smokers in the UK, and particularly among young non-smokers, is rare. Although data for prevalence suggest that growth stalled in late 2013, some people have forecast that use of these products will soon overtake that of cigarettes.

Most smokers who use e-cigarettes do so to help them to cut down or stop smoking, though some report use predominantly to replace cigarettes at times when smoking is not allowed or accepted. Smokers smoke for nicotine, but are killed by the carcinogens, carbon monoxide and many other toxins that accompany nicotine in tobacco smoke. Because e-cigarettes deliver nicotine in vapour rather than smoke, their emissions are limited to those contained in, or generated from, the nicotine solution used in the device.

Although data for e-cigarette emissions are sparse, those available suggest that nicotine, propylene glycol, glycerine, flavours (sometimes) and a range of contaminants or products of the heating process, including tobacco-specific nitrosamines, carbonyls, volatile organic compounds and metals, are present in the vapours. Although less pure than the vapour produced by a medicinal nicotine inhaler product (such as the Nicorette Inhalator), e-cigarette emissions are much less hazardous than tobacco smoke.

The main benefit of e-cigarettes, therefore, is that they provide inhalable nicotine in a formulation that mimics the behavioural components of smoking but has relatively little risk. And for the smoker who cannot quit, or wants to continue to use nicotine in a manner that resembles smoking, e-cigarettes are an obvious choice. Switching completely from tobacco to e-cigarettes achieves much the same in health terms as does quitting smoking and all nicotine use completely. Furhtermore, e-cigarettes tend to be cheaper than is tobacco smoking, and risks associated with passive exposure to e-cigarette vapour are far less than those associated with passive exposure to tobacco smoke.

Potential hazards

The potential hazards of e-cigarettes fall into three broad categories: those from the product itself, those arising from the relationship between use and tobacco smoking, and those from the exploitation of e-cigarettes to promote tobacco smoking.

Given the likely low hazard of inhaled nicotine, potential risks to health from the product arise almost entirely from the other constituents of vapour. The main component is propylene glycol, which is thought to be safe, although adverse lung effects from sustained long-term inhalation cannot be ruled out. Similar concerns apply to other constituents, but again the risks are probably slight. Thus, even in the absence of regulation to ensure product standards, the direct hazard to users – irrespective of smoking status – and others, from e-cigarettes is low. However, the introduction of product standards to avoid or minimise contamination could further reduce any ill effects.

The greater potential risks, and much of the controversy, arise from the relationship between e-cigarette use and tobacco smoking. There are concerns about sustained dual use in smokers who might otherwise have quit completely and also that continued use of e-cigarettes might make relapse to smoking more likely among those who have quit tobacco completely. Although it is too early to tell whether smokers who quit smoking with e-cigarettes are more likely to relapse than are those who use other methods, no evidence as yet shows that dual use results in reduced quit rates.

For non-smokers, the worry is that using e-cigarettes will either lead to nicotine addiction and sustained use or act as a gateway to smoking. Again, no evidence suggests that either of these outcomes is occurring to an appreciable degree. Some non-smoking young people are trying e-cigarettes, but in very small numbers, and any gateway risk should be assessed in the context that nearly one in five 16–19 year olds in Britain has already become a regular tobacco smoker. Given the small risks of exclusive e-cigarette use, progression to tobacco use will thus be a problem only if it adds to the total number taking up tobacco smoking.

In practice, new users of e-cigarettes are probably most likely to come from the same population of young people who currently experiment with tobacco. The available data suggest that, in any case, young non-smokers are not keen on e-cigarettes, and data from Poland suggest that most of the interest in young age groups arises, as in adults, from those who already smoke tobacco.

Much concern has been expressed that use of e-cigarettes in public, especially in places where tobacco smoking is prohibited, undermines the denormalisation of smoking achieved in recent years and hence promotes smoking. Concerns about renormalisation through use in places where smoking is prohibited assume that e-cigarettes and tobacco cigarettes look so similar that non-smokers, and particularly children, cannot tell the difference, which is unlikely. E-cigarettes – especially later generation products – clearly look different, and the odourless vapour that they produce is quite different from tobacco smoke.

Advertising for e-cigarettes, much of which is reminiscent of that for cigarettes from decades ago, could actually promote tobacco smoking, some argue. This issue could be resolved by appropriate regulation and prescreening, as applies to medicines, but action is probably needed to prevent inappropriate advertising. Perhaps of more concern is the fact that these effects are a key driver of the growing involvement of multinational tobacco companies in the e-cigarette market, providing these companies with opportunities to circumvent restrictions imposed by the Framework Convention on Tobacco Control on engagement of the tobacco industry with policy-makers. This issue of tobacco industry manipulation to undermine tobacco control policy should be resolvable through stricter adherence to the convention.

E-cigarettes as cessation or harm reduction products

Although evidence is limited, first generation cigalike products probably deliver a similar amount of nicotine to Nicorette Inhalators, and are about as effective – but no more effective – as cessation therapy as are transdermal nicotine patches. Later generation vapourisers might be more effective in terms of nicotine delivery, which is likely to improve further as the technology develops. The strength of e-cigarettes in health terms probably lies less in their ability to compete as pharmacological therapies than in their consumer acceptability, wide availability, non-medical image and price advantage over cigarettes. Although trends in the use of nicotine products in smokers show that e-cigarettes have displaced some conventional use of nicotine replacement therapy, particularly over-the-counter sales, they seem to have led to a substantial increase in the proportion of smokers and ex-smokers using an alternative source of nicotine.

E-cigarettes thus appear to be providing smokers with a valuable alternative route to smoking cessation. However, switching to e-cigarettes without behavioural support is probably far less effective than use in conjunction with the support currently offered alongside licensed drugs by NHS Stop Smoking Services. Unfortunately, the unlicensed status of e-cigarettes precludes endorsement by the NHS or organisations such as the National Institute for Health and Care Excellence (NICE). This situation will probably change this year, however, when the first licensed e-cigarettes are likely to emerge on the market.

UK regulation

E-cigarettes are marketed in the UK as consumer products, and are thus exempt from medicines and tobacco regulations. Suppliers have no obligation to provide data for the performance of the products they sell, and few do. In 2013 the Medicines and Healthcare Products Regulatory Agency announced their intention to regulate e-cigarettes as medicines from 2016, using a streamlined light touch approach to apply medicines standards of purity and delivery, and prescreen advertising to prevent marketing abuse.

In a parallel development, under the revised European Union Tobacco Products Directive, unlicensed e-cigarettes will become subject to tobacco regulation, which prohibits advertising, requires a health warning to be printed on packs, and will impose as yet unspecified purity standards from 2017. Although medicines licensing increases manufacturing costs, licensed products in the UK qualify for 5% rather than 20% sales tax, will be available on prescription through health services as well as on general sale, and can be advertised as cessation or harm reduction products. It is therefore likely that while some suppliers will opt for regulation as a tobacco product, others will opt for medicines regulation. In either case, these forms of regulation will resolve many of the concerns outlined above.

Despite the controversies, it is clear that e-cigarettes are far less hazardous than is tobacco. With more than a million UK smokers using them to help to cut down or quit smoking, they are proving to be valuable harm reduction and cessation products and could make a substantial contribution to reducing the burden of death, disability and poverty currently caused by tobacco smoking. Health professionals should embrace this potential by encouraging smokers, particularly those disinclined to use licensed nicotine replacement therapies, to try them, and, when possible, to do so in conjunction with existing NHS smoking cessation and harm reduction support. E-cigarettes will save lives, and we should support their use.


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Electronic Cigarette/Ecig/Vapouriser, Eliquid/Ejuice and Nicotine Regulation

Because electronic cigarettes do not contain tobacco they are not regulated in most countries yet. Many people use e-cigarettes or personal vapourisers to quit smoking it has been suggested they should come under current nicotine replacement therapy (NRT) guidelines. Vapourizers or vapourisers are other terms giving to the same or similar products previously mentioned as electronic cigarettes e-cig e-cigarette ecig . A common question is: are electronic cigarettes safe. There is no definitive answer yet as more research is needed. It is suggested that e-cigs are a safer alternative to traditional tobacco products. In Australia ecigs are growing in popularity, vaping has formed a subculture with the legality of nicotine importation varying state to state. 

Are Electronic Cigarettes Safe?

There is a significant increase of electronic cigarette users in the past couple of years but there are still people who are asking “are electronic cigarettes safe.’’ The devices look like tobacco cigarettes but, instead of smoke, they emit oil based vapor flavored with nicotine contained in a cartridge. Users inhale the vapor the same way they smoke a traditional cigarette.

E-cigarettes have become too popular that even tobacco companies are thinking of going into the business themselves. The devices are endorsed by many celebrities and appeals to many demographics. 

E-cigarettes are smokeless alternatives to cigarettes. Most of the new users switched from cigarettes to avoid the health hazards connected with smoking such as high risks of cancer from the toxins and tar released by burning tobacco.


Are electronic cigarettes safe?

E-cigarettes can contain nicotine but in its isolated form, it is relatively harmless. It is only harmful when mixed with inhaling the tobacco smoke from traditional cigarettes, which contain thousands of chemicals. E-cigarettes remove all other harmful ingredients and isolate nicotine to provide a safer alternative. It is another nicotine delivery device that is as safe as patches. 


Electronic cigarettes are small battery-operated devices that heats up liquid nicotine and turn it into vapour. The other ingredients include water, propylene glycol and flavouring. These are proven safe for human consumption.


The medical world still has no clear answer to the question are electronic cigarettes safe. The devices are tobacco-free, and former smokers have claimed that they used e-cigarettes to weed out the bad habit. There are safety researches in progress to determine whether they are nontoxic and safe for daily use.


Electronic cigarettes decrease the cravings smokers experience such as the need to put something in their mouth and hold something between their fingers. This makes the device more effective than gum or patches. You don’t need a health professional to prescribe an e-cigarette in order to use one as part of nicotine replacement therapy.


Second-hand vapor from electronic cigarettes are safer than smoke from traditional cigarettes because they don’t contain harmful pollutants and toxic compounds that are by-products of tobacco combustion. 


Most proponents claim that the answer to the question are electronic cigarettes safe, is a resounding yes. Industry-sponsored researches have shown e-cigarettes to be safe for use, This is why consumers must buy their e-cigarettes from reputable sources.


Evidence suggests that e-cigarettes are safer compared to regular cigarettes. Tests are conducted to answer the burning question are electronic cigarettes safe and the answer is yes. Switching to e-cigarettes is a dependable way to quit smoking, or become a safer alternative.

Choosing your e cigarette liquid, ejuice

Even though it was invented in the early 1960, the e cigarette was not fully appreciated and used until the year 2000. A recent study shows that close to 4 million Americans now consume this product and the number is expected to grow with the advantages and the safety that the product has come with. With the e cigarette general population that are irritated by the smell of tobacco has been drastically reduced. A lot of development has also been done on the product and now, one can appreciate the e cigarette liquid that come in different flavors.


When choosing the type of e cigarette liquid to buy, you need to consider a lot of factors.

  • One of the factors that you need to always comprehend on before buying is your smoking habits. There are those that are heavy smokers and those that are not. If you are a light smoker, you will need to smoke the one which has a lower amount of nicotine; thus, you will choose one that has small dosage. If you are a heavy smoker, you will need one that has a slightly higher amount of nicotine dosage as compared to the light smokers.

Another factor that you need to consider when choosing e cigarette liquid to vape is the flavor that comes with it. Therefore, you need to understand what taste you mostly prefer especially if the one flavour you love is unavailable for you. This goes without saying that, for the new consumers of the product, you will need to try all the varieties for you to find one that mostly suits you. From the variety of the flavours in the market, you are assured of getting one that

  • matches your taste completely. One that falls from the coffee flavour to the tobacco flavour itself.
  • The final factor that you need to factor in when buying the e cigarette liquid is the cost of the cigar in comparison to the quality. There are a lot of e cigarette in the market, and it depends on you to get one that suits your financial ability. In addition to this, it is your responsibility to get one that is of high quality. You do not want to get one that is of low quality because it is cheap as this will be exposing you to more risks which may finally be expensive though in a different way.


The design of the e cigarette is made in such a way that reduces the amount harmful ingredients in the smoke. As the e cigarette liquid burns, the vapor it releases is not only less harmful but it also has fewer odours. This is what makes it advantageous to use if you are in a group of people who are irritated by the smell of plainly burning cigarette. Coupling this with the different flavors that have now been designed and manufactured, the smoking of cigarette is about to change for the better.


Check our store as we offer a variety of e cigarette liquid flavors.


Our juices do not contain any nicotine whatsoever. The supply/distribution of liquid nicotine is against the law in Australia but it is legal to import up to 3 months supply from overseas vendors. Send us an email to and we’d be happy to recommend some vendors to you.