By Steven Reinberg
HealthDay Reporter

THURSDAY, April 3, 2014 (HealthDay News) The number of calls to poison control centers for nicotine poisoning from e cigarettes has risen dramatically in recent years, U.S. health officials reported Thursday.

Calls related to poisoning from the liquid nicotine used in these devices were running at a rate of roughly one a month in 2010, but jumped to 215 in February of this year, according to the U.S. Centers for Disease Control and Prevention.

Even more troubling, more than half (51 percent) of the poison calls involved children aged 5 and younger, while 42 percent involved people aged 20 and older.

“The time has come to start thinking about what we can do to keep this from turning into an even worse public health problem,” said Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health.

He added that many people are not aware that liquid nicotine is toxic. “We need to make sure we can avert the possibility of an unintended death from nicotine poisoning,” he said.

“We have not had an unintentional poisoning death from e cigarettes yet in the United States that we know of, but the potential is there given the amount of concentrated nicotine in these solutions it would not take a lot for a child death to occur,” McAfee noted.

CDC director Dr. Tom Frieden noted in a news release that e cigarettes are particularly attractive to kids because they come in candy and fruit flavors.

Dr. Vincenzo Maniaci, an emergency medicine specialist at Miami Children’s Hospital, agreed that the danger to children is real.

“The concentration of nicotine in these solutions is significant and they need to be made childproof and regulated,” Maniaci said. “Especially for kids under the age of 5, this amount of nicotine can be fatal.”

McAfee noted that the U.S. Food and Drug Administration is planning to propose regulations for e cigarettes. He added that he hopes these regulations will include how the product is packaged, including childproof caps and warning labels.

“These things can be hardwired into these products, rather than being left to the whim of the manufacturer,” he said.

In the meantime, McAfee advised keeping these devices, and their refills, out of the reach of children.

“These should be treated with the same caution one would use for bleach. In some ways, this is more toxic than bleach,” he said.

Poisoning from the liquid nicotine in e cigarettes can happen in one of three ways by swallowing it inhaling it or absorbing it through the skin or membranes in the mouth and lips or eyes, McAfee said. Once it is in a person’s system, nicotine can cause nausea, vomiting or seizures.

If those symptoms are occurring, the patient will typically be told to go straight to the emergency room, said Amy Hanoian Fontana, from the Connecticut Poison Control Center.

If there are no symptoms, then the patient will be told to stay home and the center will call again in a few hours to see how the patient is doing. If liquid nicotine was spilled on the skin, the person should wash his or her skin in lukewarm water for about 20 minutes, Hanoian Fontana added.

“We want to know what happened, when it happened and if the person is having any effects from the liquid nicotine,” she explained. “Then we are going to make a determination whether this is something we can keep at home, or if they are having severe symptoms we may recommend that they go into the emergency department. It’s very case based, depending on the situation.”

McAfee noted that the nicotine poisoning problem may be even bigger than the CDC report indicates.

“All we are reporting is calls to poison control centers. There are many people who had an episode, but didn’t call a poison control center. This report also doesn’t include people who had such severe symptoms that they called 911 or went to an emergency room,” he said.

The report is published in the April 4 issue of the CDC’s Morbidity and Mortality Weekly Report.

As part of the study, the researchers compared the monthly volume of calls to poison centers involving e cigarettes and regular cigarettes. They found the proportion of e cigarette related calls jumped from 0.3 percent in September 2010 to 41.7 percent in February 2014.

“The remarkable thing about this is that e cigarettes account for less than 2 percent of tobacco product sales,” McAfee said.

The number of calls per month about regular cigarettes did not increase during the same period. The most common way regular cigarettes cause a problem is when a child eats one, the researchers said.

That more than half the calls were about children is very concerning, said Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City.

“That’s a warning for parents who use these products. They need to keep them locked in a secure place, and it argues for tamperproof caps on these liquid nicotine products to prevent kids from getting into them,” he said. “These can be deadly the risks are real.”

More information

Visit the U.S. Food and Drug Administration for more on e cigarettes.

Cvs vows to quit selling tobacco products – nytimes.com

Why buy electronic cigarettes online? – ghetto e cigs

On Wednesday, Walgreens said it had been assessing its sales of tobacco products for some time. We will continue to evaluate the choice of products our customers want, while also helping to educate them and providing smoking cessation products and alternatives that help to reduce the demand for tobacco products, according to a statement released by the company. Although CVS ranks first in overall sales and pharmacy sales among the nation s drugstores, according to analysts, Walgreens is the largest in the number of stores.

Rite Aid, another large chain, said in a statement it continually reviewed product mix to make sure it suits the needs and desires of customers.

As for driving away customers to competitors, Troyen A. Brennan, the executive vice president and chief medical officer for CVS, said It s obvious that the average person will just find somewhere else to buy cigarettes. What we re thinking about is if others want to emulate this business decision we ve made, then over time that will make cigarettes less available and scientific literature does suggest that a reduction in the availability of cigarettes reduces smoking.

Dr. Brennan, together with Steven A. Schroeder of the Smoking Cessation Leadership Center at the University of California, San Francisco, wrote an op ed article making the case for eliminating tobacco products from drugstores in The Journal of the American Medical Association published online on Wednesday.

Some 18 percent of American adults smoke, down from 42 percent in 1965. In places like New York City, which has used a combination of steep taxes on cigarettes and bans on smoking in most places to discourage smokers, the decline is even greater, down to 14 percent.

But health experts remain concerned because the rate of decline has stagnated over the last decade, and some 480,000 deaths each year are linked to smoking. From 1999 to 2003, for example, the smoking prevalence among high school girls dropped 37 percent, according to the Centers for Disease Control, but from 2003 to 2007, the decline was only 2.3 percent.

This month, a group of seven advocacy organizations including the American Heart Association and the Campaign for Tobacco Free Kids called on governments to take steps to reduce smoking rates to less than 10 percent over the next decade and ensure no American is exposed to secondhand smoke within five years.

We have seen the decrease in initiation of smoking plateau, particularly among some populations of young people, and we ve been working very hard on those populations that have been stubbornly hard to reduce but we need to redouble our efforts, said Risa Lavizzo Mourey, the chief executive of the Robert Wood Johnson Foundation. Decreasing the availability of tobacco products as CVS is doing is an important and bold step toward making it harder for people to get access to these harmful products.

Coincidentally, the F.D.A. announced on Tuesday the start of a national education program aimed at preventing smoking among youth. The ads, which will be distributed across social media platforms, try to show teenagers the toll that smoking takes on the body in memorable ways, such as a young man who uses a pair of pliers to pull a stained tooth from his mouth to buy a pack of cigarettes.

A shortage of primary care doctors and expanding access to health care coverage under the Affordable Care Act is turning drugstore chains into big players in the nation s health care system. Consumers routinely get flu shots in drugstores, for instance, and clinics staffed by nurse practitioners or physician assistants and offering basic care for common ailments like strep throat or pink eye are popping up everywhere from Walgreens to Walmart.

A report last year by Accenture predicted such so called retail clinics were poised to grow at a rate of 25 to 30 percent over the next few years, which would swell the number to 2,800 in 2015, from 1,400 in 2012.

CVS s 800 MinuteClinics already account for most of such outlets, and Mr. Merlo said the company hoped to add another 700 for a total of 1,500 by 2017. For that reason, he said, the decision to stop selling tobacco products was really more of a discussion about how to position the company for future growth.

The company estimated that the decision would erase 17 cents in earnings per share of stock annually, but that it had identified ways of offsetting the impact on profits. (The earnings hit this year will only be 6 cents to 9 cents a share while the company works through its remaining inventory of tobacco products.)

The company hopes to make up some of the lost revenue and income with a smoking cessation program that it is starting this spring with the goal of getting half a million Americans to stop smoking. Helena Foulkes, executive vice president for CVS, said This is the kind of offering we can bring to clients like insurance plans and companies, many of which will pay for such a program.