Statement from the Council of Chief Medical Officers of Health on Nicotine Vaping in Canada – CVA Response

Hamilton, Ontario, Jan. 24, 2020 (GLOBE NEWSWIRE) -- Review of the statement from the Council of Chief Medical Officers of Health (CCMOH), has caused the Canadian Vaping Association (CVA) grave concern. Youth uptake has been a shared concern for the CVA, medical community and regulators alike. The CVA has been working with Government in good faith to provide solutions to combat this problem. Some of the recommendations made by the CCMOH would paralyze an industry with the potential to save millions of lives.

The following are the CCMOH recommendations, followed by the CVA’s response to each recommendation:

“Ban all flavoured vaping products and then provide regulatory exemptions or market authorizations for a minimum set of flavours to support smokers who choose to use vaping to end or reduce their use of nicotine-containing products.”

In following this recommendation, age restricted specialty vape shops would immediately close, thus putting tobacco owned vape brands (typically sold in gas stations and convenience stores) at a huge advantage. These tobacco owned vape brands provide very high nicotine concentration products, with concentration levels as high as 59 mg/ml. Adult vape stores have historically sold products with nicotine concentrations at or below 24mg/ml with the most popular strengths sold being 3 or 6 mg/ml, a strength almost impossible to find at gas stations and convenience stores. As such, this CCMOH recommendation would unintentionally encourage vapers to increase their nicotine consumption.

Additionally, all evidence shows that flavours are not a primary reason for youth use. Only 22.3 percent of young people indicated that they vape because e-cigarettes “are available in flavors, such as mint, candy, fruit or chocolate,” according to the CDC report Tobacco Product use and Associated Factors Among Middle and Highschool Students. The most common reason for use among youth was, “I was curious about them.”  Additionally, youth uptake was not an issue until 2018 when high nicotine big tobacco vape products entered the market through the non-age restricted convenience store and gas station sales channel. Flavours had been available for almost a decade prior with little to no interest in these products from youth.  All of this data reinforces the need to better educate youth vaping and to prohibit the sale of vape products in non-age restricted environments, rather than implementing changes that will cause adult only specialty vape shops to close.

We also whole heartedly disagree with the recommendation to eliminate flavours since they are a crucial component of what makes vaping such an effective harm reduction method.  When considering the importance of flavours, it is necessary to understand that the sense of smell and taste are directly connected to the limbic system. The limbic system is a set of structures in the brain that deal with emotions and memory. It regulates autonomic and endocrine function in response to emotional stimuli and also is involved in reinforcing behaviours. This explains the fundamental reason that vaping flavoured e-liquids has allowed so many smokers to have a successful transition to this much less harmful alternative to combustible tobacco.  In fact, The New England Medical Journal cites vaping as nearly twice as effective as any other cessation method. To suggest eliminating or limiting such a significant factor in a smoker’s successful path to quitting is a disservice to public health.

“Limit the nicotine content in vaping products, including pods, to a maximum of 20mg/ml (levels lower than this may further decrease the addictive potential for youth) and adopt other appropriate standards regarding nicotine delivery.”

The CVA is in complete agreement with this statement, and we have been consistently calling on regulators to limit nicotine e-liquid to 20mg/ml.  The nicotine level in the United Kingdom has been capped at 20mg/ml and, while almost 2 million adults there have quit smoking through a transition to vaping as a much less harmful alternative, there has been little to no issue surrounding youth uptake.  Note that in the UK there are no restrictions whatsoever on flavours. This is direct evidence that the high nicotine levels, not flavours, are responsible for attracting youth. We are certain that reducing the nicotine cap, thus eliminating the “nicotine buzz”, will make vaping much less attractive to youth.

“Regulate all constituents of e-liquids based on potential to cause harm when inhaled rather than oral ingestion”

Regulating vaping products based on potential harm is a misguided view. Regulation needs to look at total harm reduction. The Royal College of Physicians has reported vaping products to be at least 95% safer than combustible tobacco. The best available research indicates that vaping is between 18% and 54% effective in getting smokers to quit completely, which means of the 5 million smokers in Canada we have the potential to reduce smoking rates by 900,000 to 2,700,000 Canadians.  As we know that smoking kills one in two long term users, vape products have the potential to save 450,000 to 1,350,000 Canadian lives. Vaping research will continue to emerge over time, but there is an obligation to public health to make evidenced-based decisions using the data currently available.

“Tax vaping products in a manner consistent with maximizing youth protection while providing some degree of preferential pricing as compared to tobacco products.”

This statement clearly indicates that CCMOH understands that vaping is a less harmful alternative to traditional tobacco, thus their recommendation to provide some degree of preferential pricing as compared to tobacco products. To add additional tax to products that smokers wish to use in their path to quitting is unethical and will primarily hurt individuals looking to better their health by reducing their chances of dying at the hands of a smoking related illness. We truly believe that taxing vaping products will have little effect on youth uptake since there is a significant amount of evidence that underage vapers are not price sensitive, having purchased these products at highly inflated prices on the black market.

“Consider making the age of 21 the minimum sales age for both tobacco and vaping products, knowing that establishing the legal minimum sales age requires balancing policy objectives to minimize an illegal market while delaying the onset of youth use through limiting access through social sources.”

The age of majority should be consistent across all age restricted industries. The level of harm in vaping products is not more than alcohol, tobacco or cannabis and, in some cases, is significantly less. 

“Create requirements for dual age-verification of internet purchases of vaping products that are the same as those required for cannabis.”

The CVA is in complete agreement with this recommendation. We have developed proprietary software which can be implemented across the board to perform dual age verification. We welcome the opportunity to present this system to regulators and Government.

“Enhance surveillance and reporting of vaping product use and population health impacts.”

We welcome further studies into vaping. It is only with research that balanced regulations can be made. Our current pain point, however, is that there are 10 years of studies into vaping, and to date much of the data has been completely disregarded by the medical community and policy makers.

While we agree with some of the recommendations made, we must reiterate that the recommendation to limit flavour options would only serve to benefit big tobacco and their high nicotine vape brands. This would not reduce youth access and would have only a minimal impact on youth vaping rates.  The unintended consequence would be pushing reformed smokers towards either high nicotine vape products, sold in non-age restricted environments by organizations not equipped to educate them, or to flavoured black market products made and sold from people’s homes as occurred during the early days of the industry. The CVA can not state strongly enough what a mistake this would be.

About the Canadian Vaping Association

The Canadian Vaping Association (canadianvapingassociation.org) is a registered national, not-for-profit organization, established as the voice for the burgeoning Canadian vaping industry. Founded in 2014, the CVA represents over 300 manufacturing, retail and online vaping businesses in Canada and has no tobacco companies, nor their affiliates, as part of their membership. The association is the primary liaison with the federal and provincial governments on all legislative and regulatory issues related to the industry. The primary goal of the CVA is to ensure that government regulation is reasonable and practical, through the strategy of professional proactive communication and education supplied bilingually to health officers, media, and elected officials.

Darryl Tempest
The Canadian Vaping Association 
6472741867
[email protected]