“Open-System” electronic cigarettes cannot be regulated effectively.

Introduction:
This text discusses the challenges of regulating open-system electronic cigarettes (ECIGs), which allow users to modify various components and liquids. The authors argue that due to this customizability, it is difficult to enforce regulations on flavor availability, nicotine content, and nicotine emissions. They provide evidence on how users can circumvent regulations, leading to unregulated and potentially harmful products.

Key Points:

* Open-system ECIGs consist of component parts that users can modify and fill with any liquid, making them a nearly infinite number of products.
* Every aspect of ECIGs, such as device power, heating element, and liquid constituents, influence toxicant delivery to the user.
* Flavor regulations cannot be successful in the open-system context because users can mix unflavored nicotine liquid with flavored non-nicotine liquids or create their own flavors.
* Limiting liquid nicotine content might not achieve its intended goal, as open-systems with modifiable power settings can produce higher nicotine yields.
* Regulating nicotine flux (rate of nicotine emission) as a performance standard is more effective than focusing on product characteristics, but it still fails in an open-system context.
* Open-system ECIGs have too many user-accessible, policy-defeating features, making effective regulation difficult.
* Regulations on closed-system ECIGs, like JUUL, can be effective as they have fewer user-accessible features.

Main Message:
The main message of this text is that open-system ECIGs, due to their highly customizable nature, are challenging to regulate effectively, especially in regards to flavor availability, nicotine content, and nicotine emissions. Policymakers should focus on regulating closed-system ECIGs, as they are easier to control and can be designed with safety features that limit user modifications. The text emphasizes the importance of addressing the regulatory challenges posed by open-system ECIGs to protect public health.

Eissenberg T, Soule E, Shihadeh A, CSTP Nicotine Flux Work Group. “Open-System” electronic cigarettes cannot be regulated effectively. Tobacco control. 2021;30(2):234-235. doi:10.1136/tobaccocontrol-2019-055499