Vaping

In response to an “epidemic” of vaping amongst youth, the province of British Columbia has released a new set of regulations designed to reverse this trend. It aims to position the government as a progressive champion for the health and well-being of young people and has been widely applauded by anti-smoking groups. As other provinces tackle the same issues, it is likely that similar legislation will be enacted across Canada. While vaping has been increasing amongst youth since 2015, the impetus to act now has been driven by the recent outbreak of over 2,000 cases of vaping related lung diseases in the United States, including 42 deaths. While there have been no reported deaths in Canada, there have been 6 reported cases of vaping associated illnesses, the details of which have not been released.

Public health officials at the Centers for Disease Control in the US have been extremely cautious in reporting out the cause of these acute lung injuries and for several months would only say that vaping should be avoided until investigations were complete. It is now clear that these illnesses had nothing to do with vaping commercially available nicotine-containing e-cigarettes.

At the outset, over 90% of the patients self-reported vaping THC and it was recently shown that 29 of 29 lung fluid specimens collected showed vitamin E acetate which has been an additive in THC vaping pods. Vitamin E acetate or other oils are not found in standard nicotine-containing vaping liquids. This tragic outbreak is a problem of illegal, boot-leg THC vaping pods that is driven by lax regulation, misinformation and uneven cannabis legislation across the US. Since these illnesses are unrelated to youth vaping in general, the regulations introduced in BC will not directly prevent any new cases of acute lung injury. In fact, prohibition invites alternative supply sources as seen in the US and the unintended consequences could actually be an upswing of cases.

What is even more problematic however, is that the announcement from the BC government did not even mention the potential of vaping as a harm reduction strategy to reduce the suffering and death caused by cigarettes. Even before the outbreak of lung disease in August of 2019, the voice and interests of smokers were largely ignored. Public health officials clung to the thinnest of arguments against the benefits of vaping over smoking cigarettes and essentially gave people the green light to continue smoking. How can a technology that allows people to use nicotine while essentially eliminating exposure to all of the known toxins and carcinogens be met with so much scepticism and opposition?

Ironically, many of the institutions and individuals speaking out the loudest against vaping do support other harm reduction measures like seatbelts and airbags to reduce traffic fatalities, designated driver programs to reduce impaired driving, bicycle helmets to reduce head injuries, condoms to prevent the transmission of sexually transmitted infections, and even needle exchange programs to reduce the transmission of HIV among people injecting drugs. These are pragmatic and common-sense approaches that reduce the risk of harm when engaging in activities that carry some degree of inherent risk. However, this standard public health approach has not been applied to vaping even though the direct health and societal impacts of cigarette smoking are far greater than all these other issues combined.

At the core of the opposition to vaping is the belief that we are actually doing a good job at helping people to quit smoking cigarettes. This is so far from the truth. The overall slow reduction in smoking prevalence seen in Canada is directly related to the relentless and predictable death of current smokers along with a reduction in smoking initiation by young people. Current smokers, most of whom have tried and failed to quit with the available interventions, have been left to either quit on their own or die prematurely. The impact of smoking related illness has fallen disproportionately on people living in poverty, people with mental illness, and those dealing with other substance use challenges, where the rates of smoking are high and the chance of quitting is extremely low.

Today alone, 100 Canadians will die directly and prematurely from smoking cigarettes. This is the public health emergency, not vaping. Any new legislation that restricts vaping without addressing cigarettes only serves to benefit tobacco sales and the companies that profit from it. Transitioning people from cigarettes to vaping should be the centre piece of our tobacco-free aspirations in Canada. Many people will be able to quit vaping nicotine overtime, but getting off cigarettes, the most dangerous nicotine delivery method known, should be the priority. In order to encourage this transition, vaping products must be incentivised for current smokers. This includes accurate information, lower cost, choice of flavors, and adequate nicotine dosing. This all can be done while discouraging the uptake of vaping among young non-smokers through education, youth-oriented promotional restrictions, and other measures to reduce youth access.