Twenty-nine cases of nicotine poisoning specifically from electronic cigarettes were reported this year in Sweden, nearly a tenfold increase from last year's three incidents. A third of the reported cases were children, the Swedish Poison Information Centre (SPIC) stated.
"We are extremely worried about this product, which is spreading like wildfire," said Barbro Holm Ivarsson, spokesperson from Pscyhologists Against Tobacco, to news agency TT. "And if such strong liquids are going to exist then it is a very serious problem that they are not regulated yet."
E-cigarettes, or e-cigs, are made to look like real cigarettes but instead contain a battery, small heater, and liquid known as smoke juice. The liquid is heated into a vapour which the user then inhales. The liquid usually contains nicotine, but not always.
The sale of smoke juice containing nicotine is banned in Sweden, but it can still be ordered online and has a growing street market. Since it is the vapour that users inhale, the liquid inside of the e-cig is extremely concentrated - and quickly becomes lethal.
"The concentration of nicotine in a 10 milliletre bottle (of smoke juice) is so strong it can kill a small child," Ivarsson said, confirming a statement by the World Health Organisation.
In May, a two-year-old girl in Israel died after drinking the liquid, and cases of liquid nicotine poisoning are becoming increasingly common worldwide. Poisoning usually occurs through drinking liquid nicotine refills for the e-cigs.
"I don't think we have had any cases (in Sweden) where a child inhaled it," Eva Olsson, pharmacist at SPIC, told The Local. "Usually kids find the little bottle and drink it. And it's essentially the same thing as a child smoking a cigarette. They are not used to the nicotine and their bodies can't handle it."
Pharmacists at SPIC have seen serious cases involving symptoms of vomiting, shock, seizures, and heart palpitations, but no deaths yet.
E-cigarettes have been a hot-topic in the EU for the past few months, with a town in northern France banning their public use in November, and a national ban likely to follow. Spain followed suit in mid-December.
The European parliament voted in October against classifying the products as medicinal, a move which would have made e-cigs available only from pharmacies. But in Sweden, as well as Denmark and Finland, e-cigs containing nicotine are still classified as medicine. All medicines must be investigated and regulated before they can be sold, resulting in a de facto ban of e-cigarettes, which are still somewhat novel.
"It's very unclear," Olsson said. "Nicotine is classified as medicine, but the laws regarding (the liquid) are not finished. People can still order it online and some stores sell it over the counter. Selling it is not really allowed, but it's not really forbidden either. "
The Swedish Medical Products Agency (Läkermedelsverket) forbid a distributor in Skåne County from selling e-cigs in October, and the agency continues to watch online retailers and kiosks who break the rules. Essentially the agency is waiting for the EU to decide once and for all if e-cigarettes are medicinal or simply tobacco.
"Straight nicotine is classified as medicine by Swedish law, so Swedish actors are not allowed to sell it," agency spokesperson Mårten Forrest told The Local. "But this is not an approved and studied medicine yet, so you shouldn't be able to import it, either."
If they are classified and sold as medicine, distributors must prove that they help rehabilitate tobacco addiction and that they are safe. A randomised trial study by The Lancet concluded that e-cigarettes are at least as effective as methods such as cutting down or using nicotine patches when it comes to quitting smoking - even when using non-nicotine e-cigs.
Earlier this month, a leaked European Commission document revealed plans to regulate and heavily restrict e-cigarettes by 2017, with such measures that would ban all currently available e-cigs. The leak was met with an outcry by many who have helped stop smoking thanks to e-cigs. Many supporters, users and health professionals alike, claim they are a less dangerous alternative to normal cigarettes, which were the substance involved in over 1,000 of the calls SPIC received during the year.
However, the World Health Organisation has "strongly advised" against e-cigs, citing potential health problems and claiming the risks of e-cig usage "remain undetermined".
British newspaper The Daily Telegraph reported that the EU wants the tobacco-free e-cigs to be covered in a "tobacco products directive", claiming that e-cigs "normalize the act of smoking" and "can develop into a gateway to normal cigarettes".
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