FARGO-A new study for tobacco control advocates in North Dakota suggests buying e-cigarette liquid can be like playing Russian Roulette in terms of nicotine levels that can deviate greatly from concentrations on product labels.

The study, commissioned by the North Dakota Center for Tobacco Prevention and Control Policy, found that half of tested labels-51 percent-didn't accurately reflect the contents of the e-cigarette liquid. The actual nicotine levels in some products were 172 percent higher than labeled, according to the study published in the Journal of Pediatric Nursing.

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Jeanne Prom, executive director of the North Dakota Center for Tobacco Prevention and Control Policy, called the study results "alarming" and underscores the need for regulating e-cigarette liquids.


"Nicotine is a very dangerous and addictive drug and it needs to be regulated as such," she said. "One or two teaspoons can be fatal, depending on the size of the child."

E-cigarette advocates tout them as safer alternatives to cigarettes, a claim Prom argues has not been demonstrated.

"There's no scientific evidence that's proven that to be true," she said. "We just don't have enough evidence to support that claim."

Also, she said, e-cigarette flavoring ingredients, even if deemed safe as food additives, have not been proven to be safe when vaporized and inhaled.

"We're also concerned because we're seeing an epidemic of e-cigarette use by kids.

The study, which was conducted by researchers at North Dakota State University and published in the Journal of Pediatric Nursing, was prompted by reports that children were showing up at health care facilities with nicotine toxicity from e-cigarette liquids, which often are marketed and packaged to appeal to children, Prom said.

She said the Poison Control Center also received calls from North Dakota for cases of nicotine toxicity in children caused by e-cigarette liquids.

E-cigarette liquids were purchased from 16 North Dakota retailers in June 2015. The contents were analyzed by a laboratory at North Dakota State University.

The lab analyzed 93 liquid containers, and found that 34 percent had less nicotine than claimed on the label, while 17 percent had more. Actual concentrations ranged from 66 percent below the level claimed on the label to 172 percent greater than disclosed on the label, according to study figures.

"It's the Wild West as far as who manufactures and how they manufacture," Prom said. "A lot of these products come from China, so it's definitely a situation of buyer beware."

The Food and Drug Administration last month issued new regulations for e-cigarettes and any product "made or derived from tobacco that is intended for human consumption, but does not apply to products that contain neither tobacco nor nicotine.

Starting in August, the FDA will ban the sale of e-cigarette and tobacco products to those up to the age of 18-already banned in North Dakota, which also requires child-resistant containers for e-liquids. Also starting in August, the FDA will prohibit free samples, as well as false or misleading advertising and regulate adulterated products.

The FDA will require warning labels for e-cigarette products in 2018, and that year will begin requiring premarket reviews of tobacco products-a process the vaping industry and its supporters argue will be prohibitively expensive.

Marcus Wax, a spokesman for United Vapers of North Dakota, an advocacy group for e-cigarette sellers, makers and customers, said he welcomes reasonable regulations, including a ban on selling to children, labeling disclosure requirements, and requiring child-resistant containers.

Disreputable e-cigarette product manufacturers and sellers give the entire industry a bad reputation, he said.

" 'Bathtub juice,' as it's called around the shops, has been known to be a problem for some time," he said, adding that reputable makers and sellers welcome standards and regulations that are not overly burdensome. "We're all eager for the bathtub juice era to end."