Diksha Mohanty, M.D., Steven Lippmann, M.D.

Smoking tobacco is bad for health and causes millions of people to die prematurely. Conventional cigarettes reportedly cause more deaths than car accidents, murder, and drugs.

Electronic cigarettes (e-cigarettes) are one alternative product that can heat a nicotine-containing solution and might be less dangerous than smoking; however, that contention is not fully proven. E-cigarettes, with relatively low temperatures provide thermal decomposition rather than combustion; that may make them less toxic than tobacco cigarettes.

During 2018, tobacco companies in the U.S.A. plan to gain approval to begin selling so called heat-not-burn (HNB) cigarettes; they are already popular in some other countries. These heat-not-burn versions contain tobacco and are thus similar to conventional cigarettes; however, they heat rather than burn the tobacco, employing a battery-powered heating device.

The companies report HNB products as being less toxic than conventional smokes and even to gradually replace them. The lower HNB temperatures of thermal decomposition instead of combustion appear to diminish some harmful effects of smoking. Nevertheless, their aerosols still contain some, but less, nicotine and reportedly have lower concentrations of tar, carbon monoxide, ash, and other substances; however, volatile organic compounds are detected in their inhaled gases.

Claimed to offer harm reduction, HNB might be safer than smoking. Harm reduction with HNB products is a great idea. Yet, these HNB versions, like           e-cigarettes, are not fully researched, nor documented to be safe – particularly not after prolonged exposure or during a pregnancy. HNB cigarettes provide nicotine at addictive quantities, even if they are safer than smoking. Indoor air quality for others remains unknown. Once marketed, existing legal and policy regulations may need updating.

Physicians should continue advocating everyone to be tobacco and nicotine free especially so during a gestation and for young people. HNB products remain addictive and safety, especially after long exposure, is yet to be corroborated by independent investigations. Only further research and clinical experience will determine the safety profile of these new nicotine-delivery devices.

Suggested Readings

1. Auer R, Concha-Lozano N, Jacot-Sadowski I, et al. Heat-Not-Burn Tobacco Cigarettes: Smoke by Any Other Name. J Am Med Asso Int Med.2017;177(7): 1050-1052
2. Bekki K, Inaba Y, Uchiyama S, Kunugita N. Comparison of Chemicals in Mainstream Smoke in Heat-not-burn Tobacco and Combustion Cigarettes. J Univ Occu Env Health.2017;39(3):201-207
3. Levy D, Cummings K, Villanti A, et al. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction.2016;112(1):8-17
4. Caputi T. Industry watch: heat-not-burn tobacco products are about to reach their boiling point. Tobacco Control.2016;26(5):609-610