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This article was published 29/11/2013 (1100 days ago), so information in it may no longer be current.
Hacking in the middle of the night did it for Ed Ryabinov.
Coughing up mucus from 20 years of heavy cigarette smoking, gunk that just wanted to crawl out of that deep place inside his lungs -- he couldn't wait for that first smoke of the day to calm it down.
That was about four years ago. At the time a close family member was also suffering from lung cancer. By chance someone introduced him to an electronic cigarette, a novelty item then.
The simplicity of it caught Ryabinov's imagination. There, in his hands, as he saw it, was his salvation from the onset of lung disease. And the end of forking over a small fortune to buy cigarettes each week.
Most importantly, it gave him the power to control his nicotine habit instead of being a slave to cigarettes.
Little did he know he'd be on the cusp of what's now a global phenomenon. The surge in popularity of e-cigarettes has created a no-man's land of dueling government regulations and conflicting opinions among medical professionals around the world.
In Canada, the United States and throughout Europe, the jury is out -- some would say deadlocked -- on whether the e-cigarette is a tobacco product or medicine. And like a complicated court case, the jury also has to decide: Do e-cigarettes help people quit smoking? Are they just a fad? Should they be regulated by government? Taxed like tobacco? Or banned? There's also the question of whether puffing on an e-cigarette or "vaping" as it is called, poses a health risk.
Ryabinov doesn't care about any of that. His swears his e-cigarette has done what no smoking cessation product ever could -- it's given him his health back.
"I'm enjoying this more than I would a cigarette," he says. "The funny thing about an electronic cigarette is once you develop a taste for it, you can't smoke cigarettes. I can't inhale tobacco anymore. My brain hates it. I hate the taste. I hate the smell. Anything with inhaling smoke, today my body does not tolerate it. I'm disgusted by it."
He's not alone. Vaping is slowing coming out of the shadows and losing its cult-like status. More and more Winnipeggers are doing it, many openly. The first two vape gatherings were held this fall at the Elmwood Legion. Both were organized by the Winnipeg Vape Club via an e-cigarette Internet chat room at Wacked Out Canada and Facebook.
Kathy Martin, spokeswoman for the club, said she started vaping in October 2010 in a bid to kick her 33-year smoking habit.
"I breathe better. I sleep better. I can smell better and taste better," says Martin, who, in the Winnipeg e-cigarette Internet forum, is better known as Katmandu. "Until I started vaping, I didn't really understand when people went, 'Oh, smokers stink.' I really didn't get it until I stopped smoking and the all of sudden you can smell a smoker 10 feet away."
She started the gatherings -- the next one is planned for January -- to spread the word about vaping and to allow the curious to have their questions answered by veteran vapers instead of relying on the Internet and YouTube videos.
"It's very gratifying when someone walks into a meet and says, 'I want to stop smoking. I want to start vaping. What do I do? Can somebody help me out?'"
As to how many people vape in Manitoba, no one knows, Martin says. It's not so much vaping is hidden in the underground; it's more because it's in its infancy compared to bigger cities like Vancouver, Toronto and Montreal.
"We're small, but the numbers are growing, and that's great to see," Martin says.
Ex-smoker Ron Thiessen started vaping about a year ago after he saw someone using an e-cigarette in a Winnipeg restaurant.
The 20-year smoker entirely quit cigarettes as a result.
"I feel as if I have my lungs back. I can now jog to the bus stop if I need to," he says.
Thiessen, Martin and Ryabinov have no hesitation advocating the benefits of e-cigarettes. They and others also have no qualms about advocating a product that hovers in a regulatory grey zone. The villain in all this is the liquid nicotine or nicotine extract in the e-cigarettes.
Health Canada says e-cigarettes containing nicotine are not legal in this country and cannot be sold or imported via Internet mail order. Specifically, the federal agency says the importation, advertisement and sale of these products as smoking cessation devices is illegal in Canada. However, it says nothing about personal possession of nicotine "juice" and vaping equipment.
Martin says Health Canada's 2009 advisory on using e-cigarettes is just that--advice and nothing more.
"It basically says we advise you not to use them because there isn't enough known about them," she says. "That doesn't mean that it's a law. It doesn't mean that it's banned. It doesn't mean that it's illegal. They're simply saying we advise you not to use them. There is no law and they are not illegal in Canada."
Martin and other users buy their e-cigarette kits and nicotine liquid directly from retailers online in Canada and the United States or from manufacturers in Hong Kong and South Korea. Local suppliers -- a handful advertise on e-cigarette Internet chat rooms, Facebook or on Kijiji--sell to eager customers.
The vials of nicotine liquid they sell contain common food additives, vegetable glycerine and propylene glycol. And if desired, flavouring. Examples available via the Internet include peanut butter, cherry crush, gummy bear and maple rum.
The idea is no one really smokes cigarettes for the taste of tobacco -- they smoke to get their fix of nicotine.
"It's harm reduction," Martin says. "Smoking kills you. We all know that. If we can get people using something safer, like, what's wrong with that?"
A local e-cigarette and nicotine liquid seller, who did not want his name published, says he got into the business to help people like him quit smoking.
"I'm so grateful that this thing is out there because, man, I've tried everything," the 39-year-old seller says. "I faced the doom of being a cigarette smoker every day of the rest of my life and the whole stigma that goes with it. Do you know how people look at you when you're a cigarette smoker? We're like circus freaks. It's an addiction and it's a horrible addiction and we're caught in the trap."
South of the border, liquid nicotine and e-cigarettes are easily available over-the-counter as there is no law prohibiting their sale. What the U.S. Food and Drug Administration has frowned on is claims by some distributors that e-cigarettes can help you quit smoking. The scientific research just isn't there to support it. The FDA has also said it is looking at regulating the industry, perhaps extending its authority to treat e-cigarettes as tobacco products.
A similar scenario is playing out in Great Britain and Europe, such as prohibiting sale to people under 18 and forcing e-cigarettes to be subject to the same advertising restrictions as tobacco products.
Where e-cigarettes do get some respect, such as from the British Medical Association, is that they are regarded as a lower health risk than tobacco smoking.
"In light of the lack of scientific evidence about the efficacy and safety of e-cigarettes, coupled with the absence of a robust regulatory framework in the UK, health professionals should encourage their patients to use a regulated and licensed nicotine replacement therapy to help quit smoking," the BMA says in a 2012 bulletin. "Where a patient is unable or unwilling to use or continue to use an approved and tested nicotine replacement therapy, health professionals may advise patients that while e-cigarettes are unregulated and their safety cannot be assured, they are likely to be a lower risk option than continuing to smoke."
Yet data from Great Britain suggests the impact of e-cigarettes falls into a grey area, much like the industry itself.
A 2012 Action on Smoking and Health online survey of 10,000 adults (aged 18+) in England found that:
-- one fifth of smokers had tried e-cigarettes, but only a third of those who had tried them were still using them;
-- one out of five users of e-cigarettes have quit smoking altogether;
-- four out of five e-cigarette users continue smoking, and use e-cigarettes primarily as a substitute where smoking is not allowed, and to help them quit and to cut down;
-- less than one per cent of non-smokers had tried them.
While governments and public health agencies have been slow to respond to e-cigarettes, the big tobacco companies have been quick like bunnies.
Philip Morris USA, Reynolds American and the Lorillard Tobacco Company have each acquired or launched their own e-cigarette lines.
One reason is the market for e-cigarettes will approach $2 billion in sales by the end of 2013 and may surpass $10 billion by 2017. Bonnie Herzog, an analyst at Wells Fargo & Co., also told Bloomberg News that demand for the smokeless devices may surpass that of traditional cigarettes in the next decade.
The U.S. Federal Trade Commission has also reported that the amount spent on cigarette advertising and promotion by the largest cigarette companies in the U.S. declined from $9.94 billion in 2008 to $8.53 billion in 2009, and again to $8.05 billion in 2010. The declines correspond with fewer cigarettes being sold as cigarette prices increase and with more restrictions on where people can smoke and wider acceptance of the health damages of smoking.
For smokers, there's also the cost savings to switching to e-cigarettes.
Ryabinov pays about $7 a week to "smoke" his e-cigarette. Compare than with the average cost of a pack of cigarettes in Manitoba, about $14.
"I have smoked it everywhere," he says. "I can do it in such a way that you can stand next to me and you wouldn't even know. I smoked it on the plane. I smoked an e-cigarette on the plane, not once but twice. I never had an issue. When I exhale it's a tiny little vapour just the same as you drinking tea.
"I like my habit of smoking," Ryabinov adds. "The habit by itself I enjoy and love even today when I'm thinking, when I'm enjoying the company of friends or playing cards."
Martin estimates she's saved more than $10,000 in the past three years because she's not buying cigarettes.
E-cigarettes are also cheaper than other stop-smoking products such as nicotine gum and patches--a pack of gum costs about the same as a pack of cigarettes.
For the local seller, he says his best customers are younger people and smokers in their 30s and 40s who want to quit. Smokers 50 and older are more hesitant to take it up.
"Winnipeg is one of these traditionalist places. People don't want to change here. It's really weird, because it's gangbusters in Victoria and Vancouver. Shops out there cannot keep supply. They cannot keep up with demand. Montreal is the same."
He says ultimately he would like to become a licenced vendor of vaping equipment without worrying about Health Canada.
"Nobody knows the future of this," he says. "The thing is, if this stuff does get regulated they'll tax the s out of it and then it will right back to square one. I think the underground market in this will stay."
Ryabinov says vaping also eliminate the foul smell of tobacco smoke on clothes and inside cars, plus the danger of second-hand smoke.
"I truly believe that of the people who have converted have most likely added a few years to their lives or slowed down progression of COPD (chronic obstructive pulmonary disease). All their alveoli (tiny air sacs in the lungs) are not being plugged with nicotine-content tar," Ryabinov says.
Where vaping earned the reputation of being a safer alternative to tobacco smoking was with Chinese pharmacist Hon Lik, who patented the first nicotine based electronic cigarette in 2003. He was also as the first person to manufacture and sell such a product, first in the Chinese market and then internationally. The idea is a smoker can wind down their nicotine addiction by slowly vaping smaller doses of nicotine liquid over time
Martin says when she started vaping, the nicotine juice she used contained 24 mg of nicotine. She went down to 18 mg and is currently at 12 mg with a plan to step down to nine mg when she feels ready.
"When I went from 18 to 12 it was a fairly large step," she says. "I'd rather go gradually. I eventually want to get down to a lower level and whether I get down to zero or not, I'm not putting that pressure on myself to do so as long as I continue to need my nicotine. If I stop vaping it, I know I'll be smoking."
Again, there is no science to back vaping up as a way to quit smoking. There is no science to show that vaping is as effective as other, recognized smoking cessation devices. Or that it's even safe.
"This is not a health device," Ryabinov adds. "What it does do is not harm you further. It gives your body a chance to recover. It allows your lungs to clear themselves. People should not think vaping is good for them. If you've never smoked I say never start vaping. But if you smoke, I'd say by far it's a healthier alternative, no doubt."