Simrat Kaur Sarai, M.D., Steven Lippmann, M.D.

E-cigarettes emerged on to the American market about one decade ago. Their consumption by children has evidenced a dramatic rise in popularity. Health issues about electronic cigarette safety are of concern particularly after long-term use by young people. They might be less toxic than tobacco smoking, but that does not confer safety. The inhaled aerosol vapors sometimes contain a number of potentially dangerous chemicals (e.g., formaldehyde) and metals (e.g., lead), especially when in prolonged exposures. New regulations last year now restrict youth purchase to those over age 18.

Risks are heightened by e-cigarette use in non-standard practice. Increasingly many people, including teenagers, utilize a technique called “dripping”. This method of vaping e-cigarette liquids is particularly dangerous; dripped inhalations contain higher concentrations of aerosolized nicotine and other products. They are thus more addictive, yield higher nicotine blood levels, and might be of greater toxicity health concerns.

Dripping is accomplished by “dripping” e-cigarette refill liquids directly on to the heating element and/or providing higher coil temperatures through greater voltage output from the battery to the atomizer. Elevated temperatures provide more toxic emissions. Some electronic devices facilitate such use and other conventional versions can be modified to allow dripping. Users indicate that dripping confers a tastier, stronger effect, delivered in an impressively atomized cloud.

While they may avoid inhalation of combustion products, e-cigarettes also might be a gateway to tobacco or other drug use and surely can initiate or sustain nicotine addiction. Dripping affords more exposure to toxic agents than conventional e-cigarette vapors. Lack of acute health risk does not assure safety in prolonged applications. Physicians already counsel against tobacco smoking. They should now heighten their efforts to advocate for abstinence from e-cigarette vaping, especially to children, pregnant or lactating women, and usage in versions that allow dripping. Public health measures to counter electronic cigarette use are indicated. Education about the potential dangers of e-cigarettes and dripping is an urgent issue.

Reference:

Krishnan-Sarin S, Morean M, Kong G, et al. E-Cigarettes and “Dripping” Among High-School Youth.
Pediatrics. February, 2017. http://pediatrics.aappublications.org/content/early/2017/02/02/peds.2016-3224