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E-liquid is the mixture used in ] such as ]s.<ref name=Kacker2014/> The main ingredients in the e-liquid usually are ], ], water, ], and ].<ref name=Caponnetto2013/> However, there are e-liquids sold without propylene glycol, nicotine, or flavors.<ref name=Kacker2014/><ref name=Brandon2015/><ref name=Cochrane2014/> The liquid typically contains 95% propylene glycol and glycerin.<ref name=Ruiz2014/> The flavorings may be natural or artificial.<ref name=Bertholon2013/> About 8,000 flavors exist as of 2014.<ref name=WHO2014/> There are many e-liquids manufacturers in the USA and worldwide.<ref name=Blackwell2015/> While there are currently no ] (FDA) manufacturing standards for e-liquid, the FDA has proposed regulations that are expected to be finalized in late 2015. <ref name=FDA2015/> Industry standards have been created and published by the American E-liquid Manufacturing Standards Association (AEMSA)<ref name=AEMSA2015/> | |||
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== Contents == | |||
E-liquid,<ref name=Weaver2014>{{cite journal|last1=Weaver|first1=Michael|last2=Breland|first2=Alison|last3=Spindle|first3=Tory|last4=Eissenberg|first4=Thomas|title=Electronic cigarettes: a review of safety and clinical issues|journal=Journal of Addiction Medicine|volume=8|issue=4|year=2014|pages=234–240|issn=1932-0620|doi=10.1097/ADM.0000000000000043|pmid=25089953}}</ref> e-fluid, or e-juice<ref name=EbbertAgunwamba2015>{{cite journal|last1=Ebbert|first1=Jon O.|last2=Agunwamba|first2=Amenah A.|last3=Rutten|first3=Lila J.|title=Counseling Patients on the Use of Electronic Cigarettes|journal=Mayo Clinic Proceedings|volume=90|issue=1|year=2015|pages=128–134|issn=00256196|doi=10.1016/j.mayocp.2014.11.004|pmid=25572196}}</ref> is the solution used in vapor products including e-cigarettes.<ref name=Kacker2014/> E-Liquids come in many variations, including different nicotine strengths and many different flavors.<ref name=Bekki2014>{{cite journal|last1=Bekki|first1=Kanae|last2=Uchiyama|first2=Shigehisa|last3=Ohta|first3=Kazushi|last4=Inaba|first4=Yohei|last5=Nakagome|first5=Hideki|last6=Kunugita|first6=Naoki|title=Carbonyl Compounds Generated from Electronic Cigarettes|journal=International Journal of Environmental Research and Public Health|volume=11|issue=11|year=2014|pages=11192–11200|issn=1660-4601|doi=10.3390/ijerph111111192|pmid=25353061}}</ref> The main ingredients are ], ], and ]; and most often, ] in liquid form.<ref name=Caponnetto2013>{{cite journal|title=Electronic cigarette: a possible substitute for cigarette dependence.|journal=Monaldi archives for chest disease|date=Mar 2013|author1=Caponnetto P|author2=Russo C|author3=Bruno CM|author4=Alamo A|author5=Amaradio MD|author6=Polosa R.|volume=79|issue=1|pages=12–19|pmid=23741941}}</ref> The liquid typically contains 95% propylene glycol and glycerin, and the remaining 5% being flavorings and nicotine.<ref name=Ruiz2014>{{cite journal|last1=Jimenez Ruiz|first1=CA|last2=Solano Reina|first2=S|last3=de Granda Orive|first3=JI|last4=Signes-Costa Minaya|first4=J|last5=de Higes Martinez|first5=E|last6=Riesco Miranda|first6=JA|last7=Altet Gómez|first7=N|last8=Lorza Blasco|first8=JJ|last9=Barrueco Ferrero|first9=M|last10=de Lucas Ramos|first10=P|title=The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes.|journal=Archivos de bronconeumologia|date=August 2014|volume=50|issue=8|pages=362–7|pmid=24684764|doi=10.1016/j.arbr.2014.06.007}}</ref> The most regularly used base carrier chemical is propylene glycol with or without glycerin.<ref name=Grana2014>{{cite journal|last=Grana|first=R|author2=Benowitz, N |author3=Glantz, SA |title=E-cigarettes: a scientific review.|journal=Circulation|date=13 May 2014|volume=129|issue=19|pages=1972–86|doi=10.1161/circulationaha.114.007667|pmc=4018182|pmid=24821826}}</ref> E-liquid containing glycerin and water made without propylene glycol are also sold.<ref name=Kacker2014>{{cite journal|last1=Oh|first1=Anne Y.|last2=Kacker|first2=Ashutosh|title=Do electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes?: Review on e-cigarette vapor versus tobacco smoke|journal=The Laryngoscope|date=December 2014|volume=124|issue=12|pages=2702–2706|doi=10.1002/lary.24750|pmid=25302452}}</ref> It is uncertain whether the nicotine used in e-liquid is manufactured using a ] (USP) grade nicotine, a tobacco plant extract, tobacco dust or a synthetic nicotine.<ref name=Chang2014>{{cite journal|last1=Chang|first1=H.|title=Research gaps related to the environmental impacts of electronic cigarettes|journal=Tobacco Control|volume=23|issue=Supplement 2|year=2014|pages=ii54–ii58|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051480|pmc=3995274|pmid=24732165}}</ref> Most e-cigarette liquids contain nicotine, but the level of nicotine varies depending on user-preference and manufacturers.<ref name=Bur2014/> E-liquid without nicotine is also available.<ref name=Bur2014>{{cite journal|last1=Burstyn|first1=I|title=Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks.|journal=BMC Public Health|date=9 January 2014|volume=14|pages=18|doi=10.1186/1471-2458-14-18|pmc=3937158|pmid=24406205}}</ref> Although some e-juice is nicotine-free, surveys demonstrate that 97% of e-cigarette users use products that contain nicotine.<ref name=Brandon2015>{{cite journal|last1=Brandon|first1=T. H.|last2=Goniewicz|first2=M. L.|last3=Hanna|first3=N. H.|last4=Hatsukami|first4=D. K.|last5=Herbst|first5=R. S.|last6=Hobin|first6=J. A.|last7=Ostroff|first7=J. S.|last8=Shields|first8=P. G.|last9=Toll|first9=B. A.|last10=Tyne|first10=C. A.|last11=Viswanath|first11=K.|last12=Warren|first12=G. W.|title=Electronic Nicotine Delivery Systems: A Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology|journal=Clinical Cancer Research|url=http://clincancerres.aacrjournals.org/content/early/2015/01/08/1078-0432.CCR-14-2544.full.pdf+html|year=2015|volume=21|pages=514–525|issn=1078-0432|doi=10.1158/1078-0432.CCR-14-2544|pmid=25557889}}</ref> A 2015 review suggests that 1% of users use liquid without nicotine.<ref name=Born2015>{{cite journal|last1=Born|first1=H.|last2=Persky|first2=M.|last3=Kraus|first3=D. H.|last4=Peng|first4=R.|last5=Amin|first5=M. R.|last6=Branski|first6=R. C.|title=Electronic Cigarettes: A Primer for Clinicians|journal=Otolaryngology -- Head and Neck Surgery|year=2015|issn=0194-5998|doi=10.1177/0194599815585752|pmid=26002957}}</ref> | |||
The e-liquid is sold in bottles or pre-filled disposable cartridges, or as a kit for consumers to make their own e-juices.<ref name=DiyLiquid2>{{cite web|url = http://www.ecigarettemag.com/e-liquid-mixing/|publisher = Ecigarette Mag|title = E-liquid Mixing Guide – a Guide to DIY Mixing|accessdate = 10 November 2014}}</ref> E-liquids made at home are common.<ref name=USFA2014>{{cite web |title=Electronic Cigarette Fires and Explosions |publisher=U.S. Fire Administration |year=2014|pages=1–11|url=https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf}}</ref> Some vendors of e-liquids, offer options to change the amounts of flavorings or nicotine strengths, and build each bottle customized for the purchaser.<ref name=DiyLiquid>{{cite web|url=http://www.ecigarettemag.com/e-liquid-mixing/|publisher=Ecigarette Mag|title=E-liquid Mixing Guide – a Guide to DIY Mixing|accessdate=10 November 2014}}</ref> E-liquids are made with various tobacco, fruit, and other flavors,<ref name=Grana2014/> as well as variable nicotine concentrations (including nicotine-free versions).<ref name=Caponnetto2013/> The standard notation "mg/ml" is often used on labels to denote nicotine concentration, and is sometimes shortened to "mg".<ref name=Laugesen2007>{{cite web|url=http://www.healthnz.co.nz/Ruyan_ecigarette.htm |author=Murray Laugesen|title=The Ruyan e-cigarette; Technical Information Sheet|publisher=Health New Zealand|date=17 October 2007|accessdate=31 March 2008}}</ref> In surveys of regular e-cigarette users, the most popular e-liquids have a nicotine content of 18 mg/ml, and the preferred flavors were largely tobacco, mint and fruit.<ref name=Hajek2014>{{cite journal|last1=Hajek|first1=P|last2=Etter|first2=JF|last3=Benowitz|first3=N|last4=Eissenberg|first4=T|last5=McRobbie|first5=H|title=Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit.|url=http://tobonline.com/Media/Default/Article/Addiction-%20Hajek%2014.pdf|journal=Addiction (Abingdon, England)|date=31 July 2014|volume=109|issue=11|pages=1801–10|doi=10.1111/add.12659|pmid=25078252}}</ref> A cartridge may contain 0 to 20 mg of nicotine.<ref name=Cervellin2013/> EU regulations cap the concentration of nicotine in e-liquid at a maximum of 20 mg/mL.<ref name=EbbertAgunwamba2015/> A refill bottle can contain up to 1 g of nicotine.<ref name=Cervellin2013>{{cite journal|last1=Cervellin|first1=Gianfranco|last2=Borghi|first2=Loris|last3=Mattiuzzi|first3=Camilla|last4=Meschi|first4=Tiziana|last5=Favaloro|first5=Emmanuel|last6=Lippi|first6=Giuseppe|title=E-Cigarettes and Cardiovascular Risk: Beyond Science and Mysticism|journal=Seminars in Thrombosis and Hemostasis|volume=40|issue=01|year=2013|pages=060–065|issn=0094-6176|doi=10.1055/s-0033-1363468|pmid=24343348}}</ref> Refill liquids are often sold in the size range from 15 to 30 mL.<ref name=Hildick-SmithPesko2015>{{cite journal|last1=Hildick-Smith|first1=Gordon J.|last2=Pesko|first2=Michael F.|last3=Shearer|first3=Lee|last4=Hughes|first4=Jenna M.|last5=Chang|first5=Jane|last6=Loughlin|first6=Gerald M.|last7=Ipp|first7=Lisa S.|title=A Practitioner's Guide to Electronic Cigarettes in the Adolescent Population|journal=Journal of Adolescent Health|year=2015|issn=1054139X|doi=10.1016/j.jadohealth.2015.07.020|pmid=26422289}}</ref> One cartridge may typically last as long as one pack of cigarettes.<ref name=Odum2012>{{cite journal|last1=Odum|first1=L. E.|last2=O'Dell|first2=K. A.|last3=Schepers|first3=J. S.|title=Electronic Cigarettes: Do They Have a Role in Smoking Cessation?|journal=Journal of Pharmacy Practice|volume=25|issue=6|year=2012|pages=611–614|issn=0897-1900|doi=10.1177/0897190012451909|pmid=22797832}}</ref> Some liquids without flavoring is also sold.<ref name=Cochrane2014>{{cite journal|last1=McRobbie|first1=Hayden|last2=Bullen|first2=Chris|last3=Hartmann-Boyce|first3=Jamie|last4=Hajek|first4=Peter|last5=McRobbie|first5=Hayden|title=Electronic cigarettes for smoking cessation and reduction|journal=The Cochrane Library|year=2014|volume=12|pages=CD010216|doi=10.1002/14651858.CD010216.pub2|pmid=25515689}}</ref> The flavorings may be natural or artificial.<ref name=Bertholon2013>{{cite journal|last1=Bertholon|first1=J.F.|last2=Becquemin|first2=M.H.|last3=Annesi-Maesano|first3=I.|last4=Dautzenberg|first4=B.|title=Electronic Cigarettes: A Short Review|journal=Respiration|year=2013|issn=1423-0356|volume=86|pages=433–8|doi=10.1159/000353253|pmid=24080743}}</ref> About 8,000 flavors exist as of 2014.<ref name=WHO2014>{{cite web|title=Backgrounder on WHO report on regulation of e-cigarettes and similar products|url=http://www.who.int/nmh/events/2014/backgrounder-e-cigarettes/en/|accessdate=2 June 2015|date=26 August 2014}}</ref> A user does not normally consume a whole cartridge in a single session.<ref name=Pepper2013>{{cite journal|last1=Pepper|first1=J. K.|last2=Brewer|first2=N. T.|title=Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review|journal=Tobacco Control|volume=23|issue=5|year=2013|pages=375–384|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051122|pmid=24259045}}</ref> Most e-liquids are produced by a few manufacturers in China, the US and Europe.<ref name=Hajek2014/> An e-cigarette user will usually obtain 300 to 500 puffs per mL of liquid.<ref name=Hildick-SmithPesko2015/> | |||
== Manufacturing == | |||
E-liquids are manufactured by many producers, both in the US and across the world.<ref name=Blackwell2015/> First tier manufacturers use lab suits, gloves, hair covers, inside of certified clean rooms with air filtration similar to pharmaceutical-grade production areas.<ref name=Blackwell2015>{{Cite web|title=Avail Vapor offers glimpse into the 'art and science' of e-liquids|url=http://www.richmond.com/business/local/article_9f65201a-94c0-51b1-9663-f9fbb5c522af.html|author=John Reid Blackwell|website=Richmond Times-Dispatch|accessdate=2015-11-23}}</ref> | |||
=== Standards === | |||
Standards for e-liquid manufacturing have been created by American E-liquid Manufacturing Standards Association (AEMSA), which is trade association dedicated to creating responsible and sustainable standards for the safe manufacturing of e-liquids used in vapor products.<ref>{{Cite web|title = About AEMSA|url = http://www.aemsa.org/welcome-to-the-aemsa/|website = AEMSA|accessdate = 2015-11-23}}</ref> AEMSA has published a comprehensive list standards and best known methods, which are openly available for use by any manufacturer of e-Liquids. The AEMSA standards cover nicotine, ingredients, sanitary manufacturing rooms, safety packaging, age restrictions, and labeling.<ref name=AEMSA2015>{{Cite book|title=E-Liquid Manufacturing Standards|url=http://www.aemsa.org/wp-content/uploads/2015/09/AEMSA-Standards-v2.3.pdf |publisher=AMERICAN E-LIQUID MANUFACTURING STANDARDS ASSOCIATION (AEMSA)|year=2015|location=US |pages=1-13}}</ref> | |||
== Regulation == | |||
There are no current governmental or US ] (FDA) manufacturing standards for e-liquid.<ref name=FDA2015/> The FDA has sought to regulate e-liquid through use of the ], passed into law in 2009.<ref name=FDA2015/> In April of 2014, the FDA issued it's "Deeming" proposals for public comment, which would cover e-liquids manufacturing. The Final Rule, (in final form) giving the FDA authority to regulate e-liquids is anticipated to be released in late 2015, or early 2016.<ref name=FDA2015>{{Cite web|title = Products, Guidance & Regulations - Deeming – Extending Authorities to Additional Tobacco Products|url = http://www.fda.gov/TobaccoProducts/Labeling/ucm388395.htm|website = www.fda.gov|accessdate = 2015-11-23|language = en|first = Center for Tobacco|last = Products}}</ref> | |||
==References== | |||
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