Accidental poisonings from e-cigarettes have risen significantly in Australia in the past five years, with many severe cases affecting children.
The number of calls to the country’s four Poison Information centres went from two to 54 between 2009 and 2013.
It comes as the World Health Organisation calls for regulations to stop the makers of e-cigarettes promoting their products as a way to quit smoking.
Accidental poisoning calls included a toddler who ingested an entire nicotine capsule from the electronic device, and a nursing home patient found sucking on a flavoured cartridge.
Health authorities around the country have expressed concerns about issues relating to the devices. They range from pure nicotine sold online to marketing to young people.
Queensland Poisons Information Centre manager Carol Wylie has been researching the trend.
“It was becoming more clear to us, particularly last year, that we were getting more calls about the electronic cigarettes,” she said.
“Presumably that reflects that more people are using electronic cigarettes.”
Ms Wylie said poisons experts were worried by calls about toddlers ingesting the nicotine cartridges from the devices. The cartridges come in colours and flavours ranging from apple to bubblegum.
A moderate dose of nicotine is toxic to a 13-kilogram toddler.
“Children are quite sensitive to nicotine,” Ms Wylie said.
“It is possible for a toddler to get a reasonably large dose of nicotine from one exposure.”
Ms Wylie said there had been children hospitalised with significant symptoms and she was concerned the cartridges were easily accessible to infants.
“There’s no safety cap, for example. Most of the calls that we’ve had have been children biting into the cartridges or accessing the liquid from them.
“With any toxin there’s a potential for fatality, but we’ve not had any in our cases that we’ve reviewed.”
The Western Australia Poisons Information Centre said it was worried about pure (99 per cent) e-liquid refills available on the internet with containers ranging from six millilitres to one litre.
“One lick would be a toxic dose for a toddler,” a spokesman for the centre said.
Queensland Health said it was concerned the devices were aimed at young people.
“[E-cigarettes] could encourage smoking among children and adolescents with the use of fruit and confectionary flavours, brightly coloured packaging and targeted advertising,” a department spokesman said.
Adults also at risk of poisoning
Accidental e-cigarette poisonings are low compared to cigarettes, however the devices have got health officials concerned, even for adults.
Cartridges bought online have been found with undisclosed ingredients and dangerous levels of nicotine – a scheduled poison.
“We have also noted that we have been getting calls about people that use them intentionally that might have side effects that they’re ringing us and asking about – headache, tremor, they’re not feeling very well,” Ms Wylie said.
“People have got some of the vaping fume in their eyes or sometimes direct exposure to their eyes; some of the children have had symptoms from the smoke as well as actually ingesting it.
“We’ve had a couple of patients who have had the products spilt direct onto their skin and sometimes that’s caused a bit of irritation to the skin.”
While the devices do not have the carcinogens of tobacco cigarettes, the jury is still out on whether they are healthy in the long term.
There is also debate about whether they help people quit smoking or reinforce smoking behaviours.
In Australia, the Therapeutic Goods Administration has not approved them to use as a quit-smoking device.
While Ms Wylie said there had been no calls regarding e-cigarettes without nicotine, there was no evidence they were safe.
A Queensland Health spokesman said electronic cigarettes available in Australia had not been tested for safety or quality.
“[They] could deliver reliable doses, leak and contain unknown toxic chemicals as they are often labelled incorrectly and may not be packaged safely,” the spokesman said.
Different laws for different states
Lawmakers are also grappling with the status of e-cigarettes. Legislation varies from state to state on the sale of cigarette-like objects without nicotine.
Nationally, it is illegal to sell nicotine e-cigarettes but legal to import three months’ supply if it is not therapeutic.
The industry says the law needs to catch up so the devices can be properly regulated.
Dr Stephen Jenkins from Nicoventures, a company established by British American Tobacco which is working to get regulatory approval for e-cigarettes in Australia in order to sell them, said the laws had not kept pace with technology.
“These laws were written at a time when electronic cigarettes were not on the marketplace,” Dr Jenkins said.
“It’s a strange situation when cigarettes are allowed legally in the country when products that are considered by many to be significantly less harmful … are currently illegal here.”
The company said it wanted to work with regulators in Australia.
“People are buying these products over the internet, the markets, from many sources and we don’t know the quality controls that these products are being made under,” Dr Jenkins said.
“It’s very important we get standards in place and standards in place soon.”
For Ms Wylie the answer was clear: “If we do have them around, we do need them to be safe.”
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