IQOS: What you need to know

Sales of a new heat-not-burn alternative to cigarettes are now allowed in the United States. The Food and Drug Administration will permit the product IQOS (pronounced EYE-kose) to be sold as a “modified risk” tobacco product to people over the age of 18.

The FDA has launched a crackdown on the use of e-cigarettes among young people and says marketing of this new product will be heavily restricted to adult smokers only.

This is because so many kids started using e-cigarettes like JUUL.  

The FDA says IQOS sales to adults will be allowed because “the products produce fewer or lower levels of some toxins than combustible cigarettes.” However, the FDA is very specific that they do not endorse the product as “safe” or "FDA approved."

According to the FDA statement: "All tobacco products are potentially harmful and addictive and those who do not use tobacco products should continue not to do so."

We talked to Maher Karam-Hage, M.D., professor of Behavioral Science and medical director of the Tobacco Treatment Program at MD Anderson, about this new product. He says IQOS may be just as harmful as regular cigarettes and so-called ‘light’ cigarettes. Here's what he had to say.

What is IQOS?

IQOS is a tobacco heating system that uses tobacco that is wrapped in a special paper to deliver nicotine to users.

These so-called "heatsticks" are heated up inside the IQOS and nicotine is released with other tobacco components and flavors for users to inhale.

This is different from regular cigarettes, which burn tobacco. The key thing, though, is that the aerosol released by the heated tobacco in IQOS contains cancer-causing chemicals.

Is IQOS safer than smoking cigarettes?

Because it is tobacco, the chemicals released in the aerosol from an IQOS device are the same cancer-causing substances found in cigarettes and e-cigarettes. Some were found in IQOS at even higher levels, while others were lower.

Heating the tobacco instead of burning may produce fewer cancer-causing substances. And the ones that are released are in lower amounts. But that doesn't mean IQOS is safe, says Karam-Hage.

"We do not know if IQOS is less harmful or if it will cause less disease than smoking in the long run," he says.

The bottom line: "Quitting smoking is the best way to reduce your disease risk from tobacco. And the best way to do that is to use medications, nicotine patches, lozenges and gum."

How does IQOS differ from JUUL and other e-cigarettes?

E-cigarettes currently on the market are nicotine delivery devices that have a battery, a heating element and a container for liquid. When the liquid is heated, users inhale the aerosol as a vapor.

IQOS devices do not use heated liquids, like e-cigarettes, to deliver nicotine into the body. IQOS devices heat real tobacco leaves that contain many naturally occurring toxins and cancer-producing substances.

Another way e-cigarettes and IQOS devices vary: E-cigarette liquids come in a variety of flavors. IQOS only come in regular tobacco flavor or menthol.

"The only way IQOS and e-cigarettes are similar is that they both have a battery and they are not burning the tobacco," says Karam-Hage.

What should smokers know about IQOS?

The FDA has not endorsed IQOS as a safe product. It also has not said it is an effective tool to help users quit smoking regular cigarettes.

Karam-Hage compared this new product to the "supposedly healthier" low-tar cigarettes introduced decades ago. Low-tar and "light" cigarettes did not prove to be safer in the long run and in some cases cause new forms of disease.

If you don't smoke, don't start. If you do smoke, the best thing you can do for your health is quit all tobacco products.

Karam-Hage says the best way to quit is with a program that includes a combination of medications or medicinal nicotine replacement that uses purified nicotine, along with psychological support.

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