April 5, 2019

Do e-cigarettes cause seizures? FDA wants to find out.

Daily Briefing

    FDA on Wednesday announced it is examining whether there is a direct connection between e-cigarette use and seizures after receiving about three dozen reports of e-cigarette users experiencing seizures, CNBC reports.

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    E-cigarettes have been sold in the United States for at least a decade and have become popular among both adults looking to quit smoking and teens who have not previously smoked. But despite the surging popularity of e-cigarettes, public health experts say little is known about the health effects of long-term use, particularly among nonsmokers.

    The National Academies of Sciences, Engineering, and Medicine (NASEM) in a January report found that e-cigarettes contain numerous potentially toxic chemicals, but that they contain fewer toxic chemicals than conventional cigarettes, and those chemicals are present in lower levels. But the researchers noted the long-term health benefit "is substantially less and is even negative under some scenarios." They continued, "If the products do not increase combustible tobacco cessation in adults, then with the range of assumptions the committee used, the model projects that there would be net public health harm in the short and long term."

    FDA is investigating the link between e-cigarette use and seizures

    Outgoing FDA Commissioner Scott Gottlieb and Amy Abernethy, FDA's principal deputy commissioner, in a statement said poison control centers and the agency received 35 reports between 2010 and 2019 of e-cigarette users—particularly children and young adults—experiencing seizures. According to Gottlieb and Abernethy, the cases involved both frequent and first-time e-cigarette users and occurred after both limited and prolonged use of an e-cigarette. They said some cases involved individuals who had taken other substances, such as marijuana or amphetamines, or individuals with a history of seizures.

    Gottlieb and Abernethy said nicotine poisoning is known to cause seizures, and researchers have documented cases of seizures resulting from the accidental or intentional consumption of e-cigarette liquids, which have a high concentration of nicotine. They noted there are a number of reasons why an e-cigarette user might experience a seizure. For example, a user might be using an e-cigarette designed to allow them to rapidly consume large amounts of nicotine, or they might intentionally inhale a large amount of nicotine. Underlying medical conditions and other substances can trigger seizures as well, they said.

    Gottlieb and Abernethy acknowledged "35 cases may not seem like much compared to the total number of people using e-cigarettes," but they noted a number of adverse reactions go unreported, and they suggested this action could encourage e-cigarette users to better report cases of seizures.

    Gottlieb and Abernethy said the evidence FDA has reviewed up to this point has not established a direct relationship between e-cigarette use and seizures. Gottlieb and Abernethy said, "We want to be clear that we don't yet know if there's a direct relationship between the use of e-cigarettes and a risk of seizure." However, they said FDA believes the number of cases "warrant [a] scientific investigation into whether there is in fact a connection" between e-cigarettes and the risk of seizures.

    E-cigarette makers' comments

    An Altria spokesperson declined to comment on FDA's investigation, Bloomberg reports.

    Juul spokesperson Joshua Raffel said the company has "robust safety monitoring systems in place and will vigilantly monitor for any evidence of safety issues" (LaVito, CNBC, 4/3; Edney, Bloomberg, 4/3; FDA release, 4/3).

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