The Emerging Phenomenon of Electronic Cigarettes

Pasquale Caponnetto; Davide Campagna; Gabriella Papale; Cristina Russo; Riccardo Polosa


Expert Rev Resp Med. 2012;6(1):63-74. 

In This Article

Electronic Cigarettes: Regulatory Issues

Obviously, these products need to be adequately regulated. Internet marketing of the electronic cigarette and the inadequacy and misapplication of import product codes, however, impede systematic regulation. Thus far, there have been heterogeneous regulatory responses ranging from no regulation to complete bans. In Italy, Categoria electronic cigarettes (including those with nicotine) are the only ones approved by the Italian Institute of Health. The WHO's Study Group on Tobacco Product Regulation advised a precautionary approach to electronic cigarettes[1] and, with few exceptions, most national regulatory agencies have also adopted a similar stance. The basis for these regulatory decisions is uncertain, and more research on electronic cigarettes must be conducted in order to ensure that the decisions of regulators, healthcare providers and consumers are based on science.

However, whether this should occur before allowing the products on to the market or accepting that they might continue to be allowed is debated. According to those who argue that research data should be available before allowing the electronic cigarette on to the market, the first priority is to characterize the safety profile of these products, including in long-term users.[45] Nevertheless, it is not in the best interests of public health to halt the marketing of electronic cigarettes until these long-term studies are completed. All research to date shows much higher rates of smoking abstinence among users when compared with other methods. Furthermore, the complete absence of any serious adverse events reported during the 7 years the products have been in use worldwide should be compared with the severe health hazards of continued smoking.

In the absence of specific recommendations for regulation, it is important that electronic cigarette manufacturers and distributors must comply with the best possible quality standards. For example, future regulations should ensure that the liquid in the electronic cigarette is manufactured under sanitary conditions and uses pharmaceutical-grade or US Pharmacopoeia-grade ingredients, and that a listing of all ingredients, additives, any potentially harmful constituents and information on the percentage of nicotine present, if any, should be explicitly stated. Also, labels should not be required to display misleading messages such as, 'this product is not a safe alternative to cigarettes'. A more accurate message would be, 'this product may be less hazardous than cigarette smoking.' In the authors' opinion, the electronic cigarette industry should welcome regulation as a way to legitimize their business, and recognize that regulation may ultimately help to prove the electronic cigarettes to be a safer alternative to traditional tobacco products.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.