E-cigarettes, or “vapes”, are marketed as a healthier alternative to smoking tobacco. But a string of deaths suggests they may carry their own risks. 

Nathan Harris, 21, is holding a full cream piccolo with one sugar in one hand and a Juul vaping device in the other.

If  he had been told six months ago that his tobacco substitute was more harmful than the caffeine in his coffee, he wouldn’t have believed it.

However, with the death toll mounting from lung injuries that have been linked to vaping, the likes of Harris are now being warned to give up the habit.

As of this week (Nov 20), the US’s health protection agency, the Centers for Disease and Control Prevention, had recorded 47 deaths of e-cigarette smokers. Nearly 2,300 people had been diagnosed with lung injuries.

While there are no equivalent figures for Australia, vaping – where a flavoured liquid, sometimes containing nicotine, is vaporised to be inhaled – is increasingly popular here, and health authorities are on the alert for adverse effects.

When e-cigarettes first appeared, they seemed to be a magic bullet for tobacco smokers keen to give up. They contained no harmful tar or carbon monoxide, but still delivered a “buzz”.

Numerous studies have demonstrated that vaping does help people to stop smoking – but the spate of lung injuries has raised the question of whether e-cigarettes have created a whole new set of health problems.

There is also concern that vaping is encouraging young people to take up smoking – particularly because of the appeal of flavoured liquids such as berry and bubblegum – and then move on to conventional cigarettes.

In Australia, the sale and possession of vape products containing nicotine are banned, while others can legally be bought and consumed. However, the US studies suggest that the latter, too, may carry health risks. Most states and territories have outlawed vaping in smoke-free areas of pubs and other public spaces.

Increasing numbers of countries are banning vape products, although they remain legal in the UK and much of Europe. The US recently announced plans to ban flavoured liquids.

Emeritus Professor Simon Chapman, from the University of Sydney’s School of Public Health, believes that Australia’s “precautionary approach” to e-cigarettes is prudent.

He told the Australian science media website, Scimex: “The average daily vaper inhales a cocktail of vaporised nicotine, propylene glycol and chemical flavouring agents deep into their lungs 200 times a day, or 73,000 times a year. We have no idea what the long-term consequences of this are.”

Chapman added: “Evil genies are very, very hard to get back in their bottles …

“Vapers are being treated like human lab rats by the vaping and tobacco industries which have all now bought into e-cigs.”

A study published by the New England Journal of Medicine in September described the most common symptoms of the vaping-related lung injuries as shortness of breath, coughs, chest pain, nausea, vomiting, diarrhoea and abdominal pain.

The study said that while the specific causes of the illnesses had not been precisely ascertained, use of products containing tetrahydrocannibol – or THC, the active ingredient found in cannabis – was most commonly reported by patients.

The Centers for Disease Control reported earlier this month that it had identified vitamin E acetate as a “chemical of concern”, after analysing fluid samples from the lungs of patients. The chemical is used as a thickening agent in vaping products containing THC.

The vaping industry and its proponents insist that e-cigarettes are, on balance, beneficial. Brian Marlow, campaign director of Legalise Vaping Australia, says: “The reality is that 50 million people around the world currently vape every day without incident, and nicotine vaping has now been proven to be the most popular and most effective quit smoking tool globally.

“That is why, in nations like New Zealand and the United Kingdom, health authorities are promoting vaping as a healthier alternative to tobacco and encouraging smokers to make the switch to help them quit smoking permanently.”

The health risks of tobacco have been known for decades, and Australia prides itself on some of the world’s strictest anti-smoking laws and measures. These include steep costs and plain cigarette packaging.

After smoking tobacco for four years, Harris began vaping in March in an effort to reduce – and, he hoped, eventually give up – his cigarette consumption.

“After doing my own research online, I couldn’t see any evidence to prove that replacing cigarettes with vaping wasn’t a healthier option,” he said.

“Although I initially began smoking [cigarettes] in social settings, I started smoking a lot more frequently when I began working in hospitality. It’s something I’ve had to hide from my family for four years and I found myself enjoying it less and less with each cigarette I smoked.”

Earlier this month, the Federal Minister for Health, Greg Hunt, said there was “deep concern that these (e-cigarettes) are both an on-ramp for young people to smoking and that they are also potentially dangerous to young people directly”.

But Dr Colin Mendelsohn, from UNSW’s School of Public Health and Community Medicine, told Scimex that he did not advise vapers to stop using their devices.

“Vapers in Australia who are using nicotine from a reputable source to quit smoking should not panic,” he said.

“It is important not to stop vaping if you might relapse to smoking.”

However, he added: “Non-smokers and young people should not vape.”

According to the 2016 Australian National Drug Strategy Household Survey, most vapers are current and ex-smokers aged between 18 and 24.

In September, the BBC reported that the vaping industry globally was worth almost £15.5 billion ($30 billion), nearly three times its estimated value five years ago.

In the streets of Sydney’s CBD, Australia’s vaping culture is clearly visible. Amber Knight, 32, a receptionist at a law firm, leaves her desk two to three times a day to get her (nicotine-free) “vape hit”.

“I don’t know what to believe in the media in today’s day and age,” says Knight, who quit smoking cigarettes as her New Year’s resolution this year and took up vaping.

“Almost every day, the news will come out saying there is something new that will kill you or make you sick.”

According to the National Health Survey, 13.8 per cent of Australians smoked daily in 2017-18, slightly down on 14.5 per cent in 2014-15.

“I can honestly say that since quitting the darts (cigarettes) and taking up vaping, I have felt noticeably better,” says Knight.

“I am less frequently out of breath, I’m waking up without a gross feeling in my throat, and on a social aspect, I’m feeling less embarrassed when I exhale vapour instead of cigarette smoke.”