Do e-cigarettes belong in sober homes?

Are electronic cigarettes contributing to nicotine addiction, or are they harm-reduction products that can help people avoid the medical illnesses and other noxious effects associated with tobacco, and maybe help some smokers quit? In fact, not much is known yet about the health effects of e-cigarettes, but according to electronic cigarette company GreenSmartLiving, sober homes are ideal locations for use of the product. The company is now donating starter kits to sober homes in California.

“We’re taking a very responsible approach as a company,” says Joe Brown, director of GreenSmartLiving sales in central California, where the Salt Lake City-based company says it already has made inroads in sober homes. “We just launched an initiative for sober homes,” Brown told Addiction Professional last month. “We talk about the benefits of the electronic cigarette—a product without the carcinogen.”

Brown says talking to people about the benefits of the e-cigarette is rewarding. He was approached by the executive director of one recovery program who told him “’our folks are chain smokers because nicotine helps them get through the day,’” he says. “‘We know this isn’t good.’” So he donated some starter kits, and what started as a “grassroots” initiative has now become a targeted marketing effort to recovery residences.

“Whoever is interested, we will go to their sober living home and donate as many as 10 to 20 [kits],” says Brown. “We’ll keep going from home to home.”

GreenSmartLiving was an exhibitor last month at the National Conference on Addiction Disorders (NCAD) in Anaheim, Calif., an event hosted by the publisher of Addiction Professional. Brown calls that appearance the “coming-out party” for the product.

The company has presented to five sober homes so far, and is about to work with Oxford House in the Oregon and Washington areas, representing nearly 400 homes in that region, says Brown.

“We’ll be at their house manager conference in late November to schedule the donation presentations,” he says. “We’re very excited about this connection, since Oxford House represents over 1,200 homes in 46 states. This union will truly make our movement a national initiative.”

Asked if e-cigarettes can be used to help people stop smoking, Brown says, “We’re not allowed to tell the world that we’re a cessation device.” But he adds that a “paradigm shift” is taking place in terms of smoking.

“We’re the only electronic cigarette that is not owned by big tobacco,” says Celeste Chaney, director of marketing for GreenSmartLiving. “We’re number four in the convenience channel in terms of sales numbers, but we aren’t owned by tobacco and we don’t source the nicotine from tobacco. Instead, GreenSmartLiving gets the nicotine from eggplants, tomatoes and other non-tobacco products. Whether this will help it steer clear of looming regulation from the Food and Drug Administration (FDA) remains uncertain.

How it works

GreenSmartLiving’s e-cigarette consists of a battery that can be recharged, a cartridge that is screwed in, and a solution that is heated, Chaney explains. The vapor that is created is what is inhaled and exhaled.

The cartridges come in a high-nicotine version, which is comparable to a regular cigarette, and a low-nicotine option, both in menthol and regular. There are also flavorings, such as blueberry acai. There is also a no-nicotine cartridge that does not come with any special flavors.

Starter kits retail for $19.99 and include the battery, the charge adapter and two cartridges. Each cartridge offers the equivalent of one pack of cigarettes. Cartridge refills come in a pack of five and cost $12.99.

Asked about the addictive potential of nicotine, Chaney says “nicotine itself is just like caffeine—caffeine isn’t really good for you either, and caffeine is highly addictive.” She adds that the target demographic for the product is made up of people who are looking for an alternative to tobacco, not non-smokers. “A lot of people are looking for something else, but they don’t want to quit,” she says.

For smokers, says Chaney, the reason they don’t want to quit isn’t necessarily that they are addicted—it’s a social experience as well. “It’s stepping outside, it’s a habit,” she says. Although Chaney doesn’t smoke, she says she does enjoy her morning cup of coffee, adding, “It’s a habit; part of it is just holding the warm mug.”

Asked how GreenSmartLiving would prevent someone who had never smoked before from using its electronic cigarette, Chaney replies, “That’s a good question.” Brown says “we are not selling it in homes—it’s not our intention to create a whole new society of smokers.”

Many people who are recovering from drug addiction “probably have addictive personalities,” says Chaney. “Unfortunately, many replace their other addictions with cigarettes.”

Weighing the ethics

For safety reasons, recovery residences maintain a standard to ban smoking, says Beth Fisher, past president of the National Alliance for Recovery Residences (NARR). There is no national NARR standard regarding e-cigarettes. Asked whether it is ethical for sober homes to take donations of electronic cigarettes, Fisher says that the homes are allowed to accept donations if they have a policy so stating, and if they are not-for-profit entities.

But Fisher, who is executive director of Hope Homes, which operates sober homes in Alabama, Georgia, North Carolina and South Carolina, personally doesn’t like the idea of e-cigarettes for people in recovery.

“It’s catering to an addictive behavior, so as a professional I would have concerns about promoting the use of e-cigarettes in any recovery community,” she says, stressing that she is stating her opinion and not necessarily one that reflects NARR’s as a whole.

Fisher adds that she would be “really surprised” if a certified recovery residence would allow e-cigarettes inside the house.

“You’re not technically burning anything, and no noxious chemical is being released, but nevertheless the behavior is an addictive behavior and potentially triggering to others in the community,” she says. “At the very least, it would be necessary to create a policy about it. It’s not NARR’s place to dictate what that policy would be, but we do promote recovery-oriented activity.”

FDA’s role

Meanwhile, there have been calls from Capitol Hill to regulate e-cigarettes, partly because manufacturers are targeting children, according to a group of House Democrats. On Sept. 16, this group asked the Obama administration to issue rules regarding these “kid-friendly” products, some of which have flavors such as “Cherry Crush” and “Cookies & Cream Milkshake.”

In a letter signed by Reps. Henry Waxman (D-Calif.), Diana DeGette (D-Colo.), Frank Pallone Jr. (D-N.J.) and John Dingell (D-Mich.), lawmakers asked the FDA to act quickly.

In response to an inquiry from Addiction Professional for this article, the FDA stated in an e-mail that the “safety and efficacy of e-cigarettes have not been fully studied,” so “consumers of e-cigarette products currently have no way of knowing whether e-cigarettes are safe for their intended use, how much nicotine or other potentially harmful chemicals are being inhaled during use, or if there are any benefits associated with using these products.”

The FDA intends to issue a proposed rule that would extend its tobacco regulation to e-cigarettes (there are currently no FDA- approved e-cigarettes). Three years ago it sent warning letters to e-cigarette distributors for violating the Federal Food, Drug, and Cosmetic Act, including “violations of good manufacturing practices, making unsubstantiated drug claims, and using the devices as delivery mechanisms for active pharmaceutical ingredients.”

Tobacco or not, FDA spokeswoman Jennifer Haliski says in no uncertain terms that nicotine is addictive.

“Electronic cigarettes are battery-operated products that turn nicotine, which is highly addictive, and/or other chemicals into a vapor that is inhaled by the user,” Haliski says. “The FDA regulates electronic cigarettes that are marketed for therapeutic purposes as drugs or devices. The FDA intends to propose a regulation that would extend the agency's tobacco product authorities—which currently only apply to cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco—to other categories of tobacco products that meet the statutory definition of tobacco product. Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products.”