Liquid-nicotine child poisoning seen on the rise

Vials come in many flavors; packaging isn’t childproof

WASHINGTON - Calls to Arkansas’ poison-control center about liquid-nicotine poisoning have spiked in the past 16 months, the center’s managing director said Thursday.

Half of the 26 poisoning cases involving children reported since 2011 have occurred in the past three months, said Howell Foster, managing director of the Arkansas Poison and Drug Information Center. The bulk of the calls, 21 of 26, are about poisoning in children 5 years old and younger, he said.

An electronic cigarette simulates a normal cigarette. It uses a battery-powered heating element that creates a nicotine vapor. The user can choose how much nicotine is vaporized. Non-nicotine options are also available.

The devices, also called e-cigarettes or vaporizers, and accessories can be bought online or can be found in tobacco shops, convenience stores and mall kiosks.

Vials of liquid nicotine are sold in a variety of flavors ranging from mentholto chocolate to bubblegum.

Nationally, also, the number of child liquid-nicotine-related calls to poison centers has jumped, Foster said, from 201 cases in 2012 to 1,296 in 2013.

Results of a Centers for Disease Control and Prevention study released Thursday show that the number of calls to poison centers involving liquid nicotine rose from one per month in September 2010 to 215 per month in February this year.

The study also found that 51.1 percent of the calls involved children 5 years old and younger.

CDC Director Tom Frieden said in a statement that the poisonings will continue as use of electronic cigarettes continues to increase.

“E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children,” he said.

The Arkansas cases include poisoning either from vials used to refill electronic cigarettes or from using electronic cigarettes, Foster said.

Poison control received its first call about a child sick from liquid nicotine in 2011, Foster said. The next year, there were two calls. In 2013, Arkansas had 10 calls, he said. So far this year, there have been 13 reports.

“We’re only three months into the year,” Foster said. “We’ve seen a large increase in the number of calls.”

Foster said he wants to see the FDA require childproof containers for the vials of liquid nicotine.

Many containers aren’t labeled with the amount of nicotine inside, he said. Foster said just a 10 milligram vial containing 10 percent nicotine can be dangerous.

“There’s enough in there to kill a child,” he said. “I’m not crusading against people who use e-cigarettes, but the liquid refills that you can buy online are fairly concentrated.”

Most of the 26 calls have involved minor symptoms such as nausea, throwing up and sweating, Foster said.

“Only one has been deemed what I would consider serious,” Foster said.

That child was hospitalized overnight because of a slowed heart rate. He said the child recovered.

In a meeting Thursday of the Senate Appropriation’s subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies, U.S. Sen.Mark Pryor, D-Ark., held up a vial of “moon pie” flavored liquid nicotine and asked FDA Commissioner Margaret Hamburg what the agency is doing to protect children from the drug.

Liquid nicotine, like electronic cigarettes, is not regulated by the federal government. The U.S. Food and Drug Administration submitted proposed rules giving it authority to regulate the devices to the White House Office of Management and Budget in October.

This week, seven health groups wrote to President Barack Obama asking him to direct the office to release the proposal for public comment.

Hamburg said the FDA has authority to regulate only tobacco, not imitation cigarettes unless they are used for therapeutic reasons. She said the agency can’t move forward until the White House releases the proposed rule.

“We do need to have authority over these products in order to regulate them and take certain action,” she said. “This is an area that requires greater attention, action and concern.”

Pryor said after the meeting that he intends to continue pushing the FDA to get authority to regulate liquid nicotine and electronic cigarettes, as well as encouraging the industry to voluntarily begin using childproof packaging.

“In many places, it’s completely unregulated. This has happened so fast that lawmakers just haven’t been prepared,” he said. “This is just kind of the Wild West right now in terms of the laws.”

Calls to the Smoke Free Alternatives Trade Association, which represents the interests of companies that manufacture and sell electronic cigarettes and similar products, were not returned Thursday.

Pryor said he may propose legislation, depending on how long it takes the FDA to get authority over the industry.

Northwest Arkansas, Pages 9 on 04/04/2014

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