Require Childproof Packaging for E-cigarettes

TMA Testimony by Robert Sanders, MD

Senate Health and Human Services Committee
Senate Bill 706 – Childproof Packaging for E-cigarettes

April 6, 2015

Good afternoon Chairman Schwertner and Committee Members,

My name is Dr. Robert Sanders and I am a practicing urgent care pediatrician in San Antonio. I serve on the Injury Prevention Committee of the Texas Pediatric Society. I appreciate the opportunity to testify for the committee substitute of Senate Bill 706. The Texas Pediatric Society and the Texas Medical Association have made it a priority to advocate for limiting youth access to e-cigarettes and protecting children from e-cigarette poisonings.

Texas pediatricians are concerned about the known and unknown health risks associated with smoking or “vaping” e-cigarettes. Scientific conclusions on the effects of e-cigarettes are only now beginning to emerge and vary widely due to variability across devices, e-juices and product brands. However, we feel there is enough evidence associated with the health risks of ingesting e-cigarette liquids that substantial protections need to be put in place in order to protect our smallest children from poisonings.

E-cigarette juices contain a wide variety of materials some of which can be toxic to an individual either through ingestion, inhalation or absorption through the skin or eyes. This is especially true for children who are more susceptible to the ill effects of toxins due to their small bodies and weaker immune systems. The most common materials in e-cigarettes are liquid nicotine, propylene glycol, vegetable glycerin, flavorings (such as bubblegum, Sponge Bob and sweet tart), various oils and whole tobacco or herbs. Liquid nicotine is the most dangerous out of all these components and a child who only ingests 0.8mg/kg can develop mild symptoms. A child who ingests 1.4-1.9mg/kg will likely experience severe poisoning. To put this in perspective, a small child weighing 25 lbs. would only need to ingest 15 mg of nicotine to be at risk of a severe and potentially fatal poisoning.  Furthermore, a one ounce bottle of refill juice can contain up to 1000mg of nicotine (in the most concentrated solutions) thus making only a few drops of the solution fatal to a toddler or infant who inadvertently tried to drink the fruity smelling liquid at the end table.

Unfortunately, the risk of child poisoning is not hypothetical. Reports of e-juice poisonings are on the rise nationally. While not all poisonings are captured in these numbers due to a lack of reporting, between September of 2010 and February of 2014, nearly 2500 e-cigarette related exposure calls have been made to poison control. That translates to one report a month in 2010 and 215 reports a month in 2014. Furthermore, 51% of all these calls involved children younger than five years of age.  Without protections in place, it was only a matter of time before there was a fatal child poisoning. Just 4 months ago, a toddler in upstate New York died from liquid nicotine poisoning. 

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