Brazilian medical societies expect the National Health Surveillance Agency (Anvisa) to decide later this year to keep the importation and sale of electronic cigarettes in Brazil prohibited. In 2009, the agency published a resolution banning the so-called Electronic Smoking Devices (DEFs), which are now undergoing a process of discussion and updating of technical information.
Anvisa is in the phase of Public Procurement of Subsidies, open to receiving technical information about electronic cigarettes. “We hope that by the end of the year we will have that decision. But our role now is to deliver to Anvisa all the scientific evidence proving the harmful effects of electronic cigarettes”, said Ricardo Meirelles, from the Brazilian Medical Association (AMB).
The AMB, the Federal Council of Medicine (CFM) and medical entities, such as the Brazilian Society of Pulmonology and Tisiology (SBPT), have united around the ban on the sale of electronic cigarettes. These entities alerted Anvisa about the damages of this device and have fought against false information from manufacturers, who claim that electronic cigarettes are a healthier alternative to conventional cigarettes.
“Several studies prove that Electronic Smoking Devices (DEFs) cause damage to health. They can cause bronchial irritation, inflammation in those who have chronic obstructive pulmonary disease (COPD). These people cannot use electronic cigarettes under any circumstances,” said Meirelles.
Aristotle Alencar, from the Brazilian Society of Cardiology, explained that these devices produce ultrafine particles. These particles are able to cross the barrier of the lung alveoli and fall into the bloodstream, causing inflammation. “When this inflammation occurs in the endothelium, which is the layer that lines the vessel internally, it can trigger acute cardiovascular events, such as infarction and the acute coronary syndrome, angina pectoris.”
This type of cigarette, called vapers by manufacturers, with the intention of dissociating from the figure of the cigarette, it contains a series of harmful and carcinogenic substances. They contain substances such as nicotine, propylene glycol and glycerol, both chronic irritants; acetone, ethylene glycol, formaldehyde, among other carcinogenic products and heavy metals (nickel, lead, cadmium, iron, sodium and aluminum). To attract consumers, additives and flavorings such as tobacco, menthol, chocolate, coffee and alcohol are included.
“The protective effect attributed to electronic cigarettes does not exist. In countries that have released these products, there is a growing increase in cardiovascular diseases in the population under 50 years of age”, said Alencar. “Unlike conventional cigarettes, which sometimes take 20 or 30 years to manifest illness in the user, electronic cigarettes have shown this aggressiveness in less time,” he added.
Another dangerous substance found in many of these cigarettes is tetrahydrocarbinol, or THC. “It is the substance that leads to the dependence of the marijuana user”, explained Meirelles. According to him, DEFs can also contain hash oil and other illicit drugs.
Youth and propaganda
Teenagers are targeted by e-cigarette manufacturers. THE design of the devices and the essences offered are clues that, despite indicating the product only to adults, they seek to attract the attention of young people. The adoption of more childlike flavors, the application of colors in the smoke and even the design of some models are not attractive to the adult audience.
“The flavor strategy, for example. As much as they say it’s not a product for children, I don’t know an adult who uses the cotton candy flavor. He is well characterized with this idea of youth”, said Sabrina Presman, from the Brazilian Association for the Study of Alcohol and Other Drugs (Abead).
She also cites the similarity of the device to everyday items of a student, such as pens or flash drives. “The very format of the electronic cigarette is confused with the things of young people. It is more modern and many parents cannot identify what is a pen, what is a pencil and what is a cigarette”.
Paulo César Corrêa, coordinator of the smoking commission of the Brazilian Society of Pulmonology and Tisiology (SBPT), highlighted that these products are presented with slogans that treat conventional cigarettes as outdated and harmful. The idea is to keep this bad publicity away from e-cigarettes. According to him, there is evidence that people who have never smoked are three times more likely to regularly smoke conventional cigarettes after using these devices.
Corrêa also warned about the strategy of the electronic cigarette industry in selling information that this type of product is less harmful than conventional cigarettes and that, therefore, switching to electronic cigarettes would be a healthier alternative. However, he warns: e-cigarettes are not just made of steam and water.
“Although we do not have a complete description of the epidemiological risks, the existing evidence allows us to say that the product is extremely dangerous and harmful to individual and public health”.
Electronic cigarettes are devices powered by a lithium battery and a cartridge or refill, which stores the liquid. This device has an atomizer, which heats and vaporizes the nicotine. The device also has a sensor, which is activated when taking a drag and activates the battery and the led. But not all e-cigarettes come with a light. led.
The vaporization temperature of the resistor is 350°C. In conventional cigarettes, this temperature reaches 850°C. When heated, DEFs release a liquid vapor similar to a conventional cigarette.
Electronic cigarettes are in their fourth generation, where a higher concentration of toxic substances is found. There are even heated tobacco cigarettes. They are electronic devices to heat a stick or a capsule of compressed tobacco to a temperature of 330°C. In this way, they produce an inhalable aerosol.
“These devices expose the user to toxic emissions, many of which cause cancer”, explained Cláudio Maierovitch, from the Brazilian Association of Collective Health.
Another type of DEF looks like a pen drive. These are nicotine salts (nicotine + benzoic acid). This type of cigarette causes less irritation in the user, facilitating the inhalation of nicotine. And thus causes greater dependence. Users of this device have little response to conventional treatment of nicotine addiction. “Using such a device with 3% to 5% nicotine is equivalent to smoking 10 to 15 cigarettes a day. Devices with 7% nicotine are equivalent to more than 20 cigarettes a day, about a pack of cigarettes,” said Meirelles.