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Canada’s proposed vape flavour ban

Dr John's Blog Posted on by

This is the full text of my submission to Health Canada in response to Order Amending Schedules 2 and 3 to the Tobacco and Vaping Products Act (Flavours) Canada Gazette Part I, Vol. 155, No. 25 on June 19th, 2021

Dr. John Oyston, MB BS, BMedSci, FRCA, FRCP(C). August 9th, 2021

INTRODUCTION

I am an anesthesiologist who has seen the disease, disability and death caused by tobacco smoking. I have watched surgeons remove smokers’ cancerous lungs and ischemic legs, I have seen patients struggle to breathe with only one lung, or walk on one leg, and then push their wheelchairs into the hospital parking lot for a smoke, such is the power of nicotine addiction.

I am opposed to the proposed vape flavour ban. It will make vaping less attractive to all ages and lead to an increase in tobacco smoking. Teens will choose cigarettes rather than vape, and adult vapers will be pushed back to tobacco use. Dual users will be converted back into smokers, and Canada’s 4.6 million smokers will be discouraged from trying to quit by vaping.

SUMMARY

The Regulatory Impact Analysis Statement (RIAS) is full of flaws, errors, misconceptions and lies which is unfortunate when a goal of the Tobacco and Vaping Products Act is to “prevent the public from being deceived and misled with respect to the health hazards of using vaping products”.

The argument put forward by Health Canada is:

  1. There has been a rapid increase in youth vaping.
  2. Young people are being exposed to vaping product-related harms.
  3. Vaping creates an increased risk of tobacco use.
  4. Unsweetened tobacco mint and menthol flavours are adequate for adult vapers.
  5. There is no benefit to dual use of vape and cigarettes, so there is no downside to dual users switching back to 100% tobacco use.
  6. Existing smoking cessation methods work. Vaping is an unproven way to quit smoking.
  7. For businesses who sell both tobacco and vape products, an increase in tobacco sales will mitigate their losses from reduced vape sales.

Only the last statement is true, the rest are all exaggerations or falsehoods. Nevertheless, Health Canada uses them to support the world’s most extreme ban on sugars, sweeteners and flavours in vape juice, even though they admit that they do not know what effect this will have on adult vapers. The experts they chose to consult are divided as to whether this ban is advisable or not. Health Canada has not studied the effect of similar bans in San Francisco, Massachusetts, New York, New Jersey and in Nova Scotia, nor have they examined alternative options to protect youth, such as those being used in New Zealand, British Columbia and Ontario. Although they acknowledge there is strong public demand for better enforcement of existing regulations, they do not provide support or funding for this.

ANALYSIS

  1. “There has been a rapid increase in youth vaping.” The RIAS shows alarming graphs with teen vaping shooting up to 29.4% in 2019, but it has not been updated. The 2020 CTNS data shows that 15-19 yr-old vaping has declined slightly from 15.1% to 14.4%. However, this includes everyone who has vaped even once at a party in the previous month. Only 2% of teens are vaping daily, and one of those is a smoker using vape as a safer alternative to smoking. Regulations should reflect reality, not alarmist projections.
  • Young people are being exposed to vaping product-related harms. The RIAS exaggerates the harm done by vaping. Health Canada says it does not know the long-term risks of vaping. They could look to England, where over a million people have been vaping for over three years, with few reported problems. Public Health England and the Royal College of Physicians both stand by their statements that the risk of vaping is unlikely to exceed 5% of the risk of smoking. Health Canada does not even reference this figure, and instead chose to ask five academics with PhDs in psychology, who put the estimated risk four times higher, at 20%. They did not provide a written report or any data to explain this four-fold increase in risk.
  • Vaping creates an increased risk of tobacco use. Teens who experiment with one form of nicotine inhalation (vaping) are definitely more likely to try another form (smoking), just as teens who try alcohol in fruit coolers are likely to also try wine, beer and spirits. No-one is suggesting we ban all flavours of alcohol to protect teens. If vaping was a gateway to smoking, then teen smoking rates should be rising but in fact they are falling more rapidly that usual, both in Canada and the USA. The 2020 CTNS data shows a current smoking rate of 3.1% for 15 -19-year-olds, lower than Health Canada’s “End Game” target of 5% by 2035. Vape is safer, cheaper, cleaner, more convenient and more discreet than smoking. Vaping is protecting teens from smoking, because if a teen owns a vape, why would he or she choose to buy cigarettes?
  • Unsweetened tobacco mint and menthol flavours are adequate for adult vapers. Both adults and teens prefer sweet vape juice. In the survey Health Canada presented, only 12% of adults preferred tobacco flavour and 17% mint or menthol. 71% preferred fruit and other flavours. Of the 23,000 vapers who sent postcards to Health Canada, 85% preferred non-tobacco flavours. After the implementation of this ban, over 80% of the remaining flavours will be reformulated to make them even less palatable.  A recent study showed that 33% of young adult vapers would switch to tobacco smoking if flavours were banned. Health Canada knows that there is scientific evidence that smokers who use non-tobacco flavoured vape are more than twice as likely to quit as those who stick with tobacco. So why force adults to switch back to tobacco flavours?
  • There is no benefit to dual use of vape and cigarettes. Health Canada repeatedly claims that there is no health benefit to vaping unless you switch to 100% vaping. This defies both logic and science. If someone switches from smoking 20 cigarettes a day to 10 cigarettes and half a pod of vape, there will obviously be less second-hand smoke. (Second hand vape is almost harmless). Reducing exposure to tobacco smoke will decrease smokers’ COPD and cancer risk. (The cancer risk from vaping is 1% of that from smoking.) If the regulations result in dual users switching back to 100% smoking, as Health Canada anticipates, this will cause harm.
  • Existing smoking cessation methods work. Vaping is an unproven way to quit smoking. While it is true that Health Canada has not yet approved that vaping is as a way to quit smoking, scientific research shows that smokers are 82% more likely to quit if they use vape than if they use conventional nicotine replacement therapy. Impartial bodies such as the Cochrane Collaboration endorse vaping as a way to quit smoking. Conventional smoking cessation therapy has barely changed in the last 20 years, and has left 4.6 million Canadians, 15% of the population, still smoking. Vaping with flavours offers them an enjoyable way to continue to self-medicate with nicotine while greatly reducing harm. Health Canada should be encouraging this, not making vape less palatable.
  • “An increase in tobacco sales will mitigate their losses from reduced vape sales.” Here Health Canada is correctly assessing the result of the proposed ban. Adults and teens will turn away from vaping and back to cigarette smoking, with disastrous consequences for public health.

ALTERNATIVE OPTIONS

How else could Health Canada protect teens without causing harm to the half million adults who vape as a treatment for their cigarette-induced nicotine addiction, and help adult smokers switch to vaping?

As the RAIS stated, there is strong support for enforcing the existing regulations that ban advertising aimed at teens and the sale of vaping products to minors. High-profile prosecutions of some repeat offenders would have significant impact.

Actively promoting the use of vaping by adult smokers, with images and videos of old adults dressed unfashionably going into Rexall or Shoppers Drug Mart to buy vapes would dramatically erode the cool image of vaping. In the UK, adults see vaping as a treatment for their nicotine addictions, and few teens vape for fun.

New Zealand, British Columbia and Ontario have banned the sale of flavoured vapes in convenience stores and gas stations, which are notorious for selling to minors and are not trained to help smokers quit. They can still be sold in adult-only specialty vape shops, which could lose their licenses if they sell to teens.

Flavour bans in the USA have increased tobacco use (by over 100% in San Francisco youth), and created a substantial blackmarket.

OTHER SUGGESTIONS

Health Canada should work with the vaping industry to develop vaping devices and liquids which meet medical standards, so that they can be sold in pharmacies, prescribed by physicians and covered by health insurance plans. This is an area where Canada could be a world leader.

In France and Belgium, vape store staff are trained and certified in providing smoking cessation advice. Health Canada should support a similar program in Canada.

Health Canada should recognize that the Canadians who are still smoking are different from those who have already quit. The standard smoking cessation methods which worked for healthy, educated, employed, straight, cis-gendered white people do not seem to be working for them. It is time to move from nicotine prohibition to harm reduction.

CONCLUSION

Health Canada needs to do much more research before it moves ahead with this flavour ban. It needs to know how dangerous vaping is, if teen vaping causes or prevents teen smoking, to what extent banning flavours would result in vapers of all ages switching to tobacco smoking, and how many adult smokers would be discouraged from switching to vaping.

I strongly support Option 1, no changes to the existing law pending further research.

If flavour bans are considered desirable, adult-only specialty vape stores should be exempted.

Yours sincerely,

Dr. John Oyston MBBS, BMedSci, FRCA, FRCP(C)

Assistant Professor, University of Toronto

(Name and telephone number redacted)

Ties with the vaping industry

I have been an advocate for tobacco control for many years. For example, I founded “Stop Smoking for Safer Surgery” in 2011. I have been funded by the University if Catania for research into the health effects of vaping, and Serna paid me as a consultant on curriculum development related to vaping. I run a smoking cessation program called “Quit by Vaping”.

For details on how to make a submission to Health Canda please see: How to make a submission about the proposed vaping flavour ban

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