Baptist Health Experts: Plan to Limit Nicotine in Tobacco Products Falls Short. Here’s Why

The U.S. Food and Drug Administration (FDA) said it plans to establish “a maximum nicotine level” to reduce the addictiveness of cigarettes and other combusted tobacco products. “The goal of the potential rule would be to reduce youth use, addiction and death,” the FDA states.

Nicotine is not one of the carcinogens that makes smoking cigarettes so toxic, but it’s the ingredient that makes smoking very addictive and a difficult habit to quit. The proposed action, however, does not address nicotine in e-cigarettes, or vaping products, which have exploded in popularity among teens and young adults over the past several years.

Separately, the FDA has issued “marketing denial orders” to JUUL Labs Inc. for all of their e-cigarette devices currently marketed in the U.S., effectively banning their products. As a result, JUUL must stop selling and distributing these products, and those currently on the U.S. market must be removed, the FDA stated.

In taking this action, the FDA cited some of the company’s study findings that raised concerns “including regarding genotoxicity and potentially harmful chemicals leaching from the company’s proprietary e-liquid pods.”

There is also no way to know “the potential harms from using other authorized or unauthorized third-party e-liquid pods with the JUUL device or using JUUL pods with a non-JUUL device,” the agency stated.

While JUUL products represent about 40 percent of the e-cigarette U.S. market, other vaping devices remain on the market containing nicotine and other chemicals.

Mark Dylewski, M.D., chief of general thoracic surgery at Miami Cancer Institute.

Cancer and cardiovascular experts with Baptist Health agree that the FDA’s proposal to reduce nicotine levels in traditional tobacco products, including cigarettes, is a good first step — but it fails to address the addictiveness of e-cigarettes, where the amount of nicotine is greater and even adjustable in some vaping devices. 

“It’s a positive step, but you can’t regulate nicotine in cigarettes and not regulate nicotine in e-cigarettes,” said Mark Dylewski, M.D., chief of general thoracic surgery at Miami Cancer Institute, part of Baptist Health. “It makes no sense whatsoever. So, it’s important for the community to understand the difference and the risks associated with both combustible tobacco products and e-cigarettes. E-cigarettes have a high level of nicotine that is highly addictive.”

Each year, 480,000 people die prematurely from a smoking-associated disease, making tobacco use the leading cause of preventable disease and death in the U.S. Smoking is the cause of the majority of lung cancer cases, and lung cancer remains the deadliest cancer.

Vaping products, or e-cigs, entered the market a few years ago with the initial intent of helping current smokers of traditional tobacco products quit the habit with a less potent product as a “bridge” to a healthier lifestyle. But the big problem with vaping devices is their intensity of the nicotine delivery. And since these products are marketed heavily toward young adults, they become their first nicotine product, says Christina Michael, M.D., a cardiologist with Bethesda Hospital East, part of Baptist Health.

Christina Michael, M.D., a cardiologist with Bethesda Hospital East, part of Baptist Health.

“There are certainly people who use e-cigarettes as their first introduction to nicotine, and there’s certainly people who use e-cigarettes to try to get off traditional cigarettes,” explains Dr. Michael. “The problem regulators have is that e-cigarettes put youth and non-nicotine users at risk because they are introduced to nicotine products through e-cigarettes. So, these companies were marketing to the youth who are non-nicotine users and introducing them to the nicotine world and nicotine dependence.”

The possible long-term link between vaping products and cancer has yet to be established because e-cigarettes have been on the market for just a few years. In 2019, reports surfaced nationwide of patients, mostly otherwise teens and young adults, showing up at ERs with severe shortness of breath, often after suffering for several days with vomiting, fever and fatigue. They all had one thing in common: They had used vaping devices that may have been altered or obtained from questionable, off-market sources.

“It’s important that we try to educate people that e-cigarettes can be very harmful — in the sense that people use e-cigs not knowing that they can potentially deliver more nicotine to them,” explains Dr. Dylewski. “They become more addictive. And then they go back to using combustibles, and fulfill that addiction by using combustible cigarettes more frequently. And then the risks of cancer and coronary artery disease and peripheral vascular disease go up because they’re using more combustible cigarettes.”

Dr. Michael: “The reason cardiologists care is that there’s a clear association. Youth who use e-cigarettes are much more likely to become cigarette smokers. They pick up the smoking habit and they pick up nicotine dependence from e-cigarette use. And that’s a gateway to combustible tobacco products, which are linked to very harmful cardiovascular effects.”