What should Health Canada tell Canadians about the risks and benefits of vaping?

Clearly, they need to tell non-smokers of any age that vaping is not harmless and that people who would not benefit from vaping should not do so.

But what should they tell Canada’s 4.2 million smokers who are dying at the rate of about 4,000 per month because they are continuing to smoke despite all the information and conventional treatment that has been available for many decades?

And what should they tell people who find that nicotine helps with their anxiety, calms down their ADHD, improves their mood and allows them to concentrate?

On February 14th, 2022, Physicians for a Smoke-Free Canada (PSFC) published a report entitled “Science has marched on“. They state that:

Vaping products reversed the downward trend in youth nicotine use

E-cigarettes cause damage to respiratory and circulatory systems.

Health Canada should say that: “smoking kills, and vaping almost certainly kills too.“

Smokers trying to quit should be told that: “using e-cigarettes will likely decrease the chances of success but will increase health risks in comparison with approved smoking cessation aids.“

Science has marched on: it’s time to update the advice to Canadians

ALL THESE STATEMENTS ARE FALSE.

I have written a rebuttal report entitled “Communicating about Vaping” in cooperation with another physician (Dr. Mark Tyndall) and a professor of psychology (Dr. Chris Lalonde). We feel that the PSFC report is incomplete, inaccurate and contains outdated information. PSFC has a bias against any form of nicotine use. They do not seem to understand that it is the tar produced by burning tobacco leaves that kill smokers; nicotine by itself is fairly harmless.

In our report, we argue that:

Measuring “nicotine use” is non-sensical. There is nothing to be gained by adding up the number of people who use conventional nicotine replacement therapy (NRT), oral nicotine products like snus, heat-not-burn products like iQOS, vape and combustible cigarettes. Although all these people may use nicotine they have almost nothing else in common and the risk profiles of these products are vastly different.

However, “nicotine use” is actually going way down. In both the USA and Canada, the youth smoking rates and the youth vaping rates are decreasing! In the USA, vaping rates have decreased from 22.4% in 2019 to 11.2% in 2021. Smoking rates also went down from 5.8% to a record low of only 1.9%. The combined “nicotine use” decreased from 28.2% to 11.7%. In Canada, youth smoking rates have declined from 5% in 2019 to 3% in 2020 and vaping has declined from 15% to 14% for a combined decrease in “nicotine use” from 20% to 17%. PSFC gives New Zealand as an example of a country where both smoking and vaping rates are increasing, but the latest data shows that youth smoking rates in NZ are continuing to fall and have now reached 1.3%.

While we agree that there are minor health issues when non-smokers start vaping, when e-cigarettes are used as they are intended to be used, as a substitute for combustible cigarettes, they have significant health benefits. A five-year study of people with chronic bronchitis (COPD) who switched from smoking to vaping showed that they had fewer acute episodes, better lung function and could even walk further than a control group who continued to smoke.

PSFC says that “vaping almost certainly kills”. Health Canada says that there have been zero deaths from vaping-related illnesses in Canada.

PSFC does not think that e-cigarettes or vaping are an effective way to quit smoking. Martin Dockrell, the Tobacco Control Lead for Public Health England, disagrees:

The data that shows that vaping is an effective way to quit was reviewed in “Vaping in England: an evidence update including vaping for smoking cessation, February 2021.” “Three systematic reviews consistently found vaping products containing nicotine were significantly more effective for helping people stop smoking than NRT. This finding was supported by two non-randomized studies that reported higher quit rates of people using a vaping product who attended a stop smoking service, compared with those who used NRT.”

We agree with PSFC that Health Canada needs to improve its communication with Canadians about vaping. At present, only 4% of Canadians know that vaping is much safer than cigarette smoking.

Canada should follow the lead of countries such as New Zealand and promote the role of vaping as a legitimate way to quit smoking and a way to help reach our “Tobacco Endgame” target of a smoking rate of 5% by 2035.

For more details, download the full text of the “Communicating about Vaping” report.