The growing national debate over the definition and safety of electronic cigarettes has crashed upon the shore of Lake Superior in the last week.

The growing national debate over the definition and safety of electronic cigarettes has crashed upon the shore of Lake Superior in the last week.

On Monday, ordinances that mirror those being enacted across the country were introduced to the Duluth City Council regarding the sale of the smokeless devices and where they can be used.

Initial negative reaction to the measures was largely based on the thought that the city was trying to ban the e-cigarette outright. It isn’t.

That comes as some relief to the users in Duluth who have weaned themselves off tobacco products by using the e-cigarette.

Council members have now heard overwhelmingly from area health experts and residents that it should stay on course and regulate the devices despite little study on whether they are safe for users or those around them.

Duluth wouldn’t be setting a precedent. More than a dozen cities across the state have passed rules that equate e-cigarettes with tobacco when it comes to sales and licensing as well as where they can be used.

Under the proposed Duluth ordinances, the devices would generally be regarded as cigarettes when it comes to use in indoor spaces and certain outdoor public areas such as parks. Sales would fall under tobacco license regulations.

Electronic cigarettes are devices that superheat liquid, most often infused with nicotine, with the breath intake of the user. That creates a mist with the nicotine or flavor desired that is delivered into the mouth. To distinguish the use of electronic cigarettes from tobacco products, advocates favor the term “vaping” to smoking.

No one is saying that the vapor inhaled or dispersed around the user is as dangerous as traditional tobacco smoking. Studies have varied on what exactly is being emitted and, as of now, there is no federal regulation of the apparatus or the liquid that goes into them. Until more is known, some policy-makers would rather err on the side of caution.

“We just don’t know yet,” City Councilor Jennifer Julsrud said of the health risks surrounding vaping. “If it’s determined it’s safe, we can change.”

Hookah dust-up

Talk of regulation in Duluth started with word from a downtown commercial property owner that a potential renter was planning a hookah lounge. The property owner spoke with Jill Doberstein, program manager for tobacco prevention and control at the local branch of the American Lung Association. He wanted to know what he was potentially dealing with.

Hookahs are a type of group smoking from a shared cache of tobacco in the style of customs in the Mideast. Lounges have sprouted up in the Twin Cities area and are allowed under a loophole in the state Freedom to Breathe Act from 2007 that prohibited smoking in public places like bars and restaurants. It did allow an exemption for “sampling,” something often done in cigar shops to allow customers to try a product before buying it.

Dealing with the hookah issue got Councilors Julsrud, Linda Krug and Patrick Boyle thinking about shoring up tobacco regulations overall, especially after tinkering with definitions earlier this year to deal with the ingestion of synthetic drugs. Julsrud said more new products are coming every day and the city needs to be proactive. She said the explosion of synthetics and the problems now in dealing with them show that a reactive approach is much more difficult.

“Let’s get ahead of this stuff,” she said.

Enter the E-Cig

The hookah discussion was soon injected with news that an electronic cigarette store was set to open this month in the area of the Miller Hill Mall. The business model for those stores is to allow customers to try different flavors for the devices in the store.

Brian Annis of Duluth is such an advocate of e-cigarettes that he made plans to open the store and was seen on TV news talking about it. He said he was set to open shop today, but the ordinances have things on hold right now. He’s not happy with the latest developments at City Hall.

“They’re saying ‘no’ on little to no information or flawed information,” he said. “That’s the whole guilty until proven innocent thing.”

City Attorney Gunnar Johnson said council members were given model language from other cities and through advisory agencies like the League of Minnesota Cities.

“It’s just a question of wrapping those rules in,” he said of language covering hookahs and e-cigarettes.

“I’m an entrepreneurial spirit,” Annis said of the reason he wants to open shop. He’s a former smoker who has seen the benefits of the e-cigarette for himself and those around him.

He has visited shops in the Twin Cities area and is convinced a store will do well in Duluth.

Another group, called E-Cig Crib, has also shown an interest in the Duluth market. It has three stores in the Twin Cities area. Doberstein said E-Cig Crib contacted the same commercial space owner who eventually denied the hookah operators. A manager at the Coon Rapids store said the company has looked at a couple of sites in Duluth.

A key component to “vapor lounges,” as they are called, is the ability for customers to test flavors on site. The new city rule on sampling would quash that.

“I could open without tasting,” Annis said, but it wouldn’t be ideal. He said he could also just cross over into Hermantown or another nearby city to avoid the restriction.

“That is a big part of it,” Annis said. “It’s about taste. People can pick what works for them.”

How we got here

The first-generation e-cigarettes, introduced in the U.S. in 2007, are much like you see in convenience stores. They are as small as a cigarette, often looking like one. Its components are cheap, often made in China, as is the liquid nicotine or flavorings that are placed inside them. They are designed for a few uses and are thrown away.

Many of these brands of e-cigarettes are being purchased by Big Tobacco companies — like Blu Ecigs from Lorillard — or introduced, like Vuse for R.J. Reynolds.

Later iterations are larger with interchangeable parts. The one Annis uses is “custom” made, he said. They look more like some space-age inoculation device than a conventional cigarette. These are the types typically seen in a “vapor lounge.”

The latest models offer larger liquid cartridges and longer-life batteries. Some can even be recharged by plugging them into an electrical outlet.

Annis said he got tired of ordering e-cigarettes online only to get broken parts or “bad-quality” liquids.

He called the type of e-cigarette found in Duluth convenience stores “cheesy” in their quality and chemistry. And he admits there is a chill about Big Tobacco getting involved in those products.

“You’re still feeding that machine,” he said.

It is estimated that the e-cigarette business will generate $1.7 billion in U.S. sales by the end of this year. Advertising for the products is also ballooning.

Annis said the hardware for vaping costs $40 to $60. He said users will spend about $40 a month on the liquid and for parts that wear out. He called it a bargain compared to a pack-a-day smoker who spends $180 a month or more.

Strong support, backlash

Former smokers are often the biggest advocates for the devices. They have let their experiences be known to City Council members in a barrage of emails the past week. Their stories usually start with describing their smoking habit in the past and move on to how e-cigarettes saved them from tobacco’s grip.

Andrew Roseth of Duluth was one of those begging the council not to lump the devices in with tobacco.

“I believe that if you treat it just like cigarettes then you are taking away from people’s options to quit smoking,” he wrote. He, like Annis, said smokers who see e-cigarettes in public will learn of the option and try to get off tobacco.

“I believe that being able to smoke my e-cig in places where I can’t smoke cigarettes is a main factor contributing to the increase in people looking at other options to quit,” Roseth said.

But health experts want further study on the safety of the products.

In 2010, the U.S. Food and Drug Administration lost a battle with e-cigarette manufacturers to have the products listed as drug delivery devices and subject to scrutiny like that of other FDA-approved products such as nicotine inhalers.

The FDA has since vowed that it will find a way to regulate the liquids sold.

“There are no consumer protections,” Doberstein said. “It’s really sort of backwards.”

Duluth family physician Addie Licari urged the City Council in an email last week to do what it can to regulate e-cigarettes now.

“The use of these devices in our parks, public buildings, and city property promotes the idea that smoking, regardless of cigarettes vs. nicotine vapor, is healthy, highly acceptable and harmless,” she wrote. “This is not the case, given the many details still to be worked out about nicotine vapor and the known risk to health with standard cigarettes.”

Online confusion

There is much debate online between e-cigarette advocates and skeptics when it comes to the safety of vaping. Each side highlights studies that support their view and generally leave a blur of confusion.

City Council members are likely feeling the same as e-mail campaigns have been waged by no-smoking advocates and groups supporting e-cigarettes.

An example of where people fall on the issue came late last month in the New York Times “Room for Debate” online discussion that featured experts on both sides of the issue. Links to the debate exploded on social media for both sides.

One essay was from Dr. Anne Joseph, a professor of medicine at the University of Minnesota.

Electronic cigarettes “may help smokers quit, but we do not know enough yet to endorse them as a cessation aid,” she wrote. “We could learn more if rigorous clinical trials compared e-cigarettes to other FDA-approved stop-smoking medications like nicotine patches, gum, and lozenges, bupropion, and varenicline, but these trials have yet to be performed. Until then, medicines with a proven track record should be a first choice for those who want to quit.”

A counterpoint came from Michael Siegel, a professor of health sciences at Boston University, who said that if the products are helping people quit, as numbers show, they should be embraced.

“Many anti-smoking groups oppose these products because they are blinded by ideology: they find it difficult, if not impossible, to endorse a behavior that looks like smoking, even though it is literally saving people’s lives,” he wrote.

The image

For those who have fought for years to protect the public from secondhand smoke, the e-cigarette again “normalizes” what looks like smoking in public.

Doberstein is worried about what message that sends to young people.

“They want to normalize the behavior,” she said. “It undermines the efforts we’ve made with the youth.”

She said no-smoking advocates are also leery about e-cigarette brands being bought up by the large tobacco companies they’ve long fought against.

Annis said he has a much different mantra.

“Electronic cigarettes don’t glamorize smoking,” he said. “They glamorize not smoking.”

Doberstein said she and the American Lung Association have nothing against e-cigarette users who are free from tobacco today.

“We’re not discounting those stories,” she said. “We just want them to use FDA-approved devices.”

Julsrud wants to make it clear to residents that the measures being voted on Sept. 9 do not restrict the use of e-cigarettes; they only regulate sales and where vaping can be done. “You will still have the freedom to use them,” Julsrud said.

Annis said passage of the ordinances would be a blow to his business plan but won’t deter him.
“I’m full-speed ahead with this,” he said. “The only question is whether it’s in Duluth or not.”