Response      to    

Consultations  on  the  Future  of  Tobacco  Control  in  Canada    

prepared  for    

Health  Canada        

April  12,  2017  

 

 April  12,  2017      Consultations  on  the  Future  of    Tobacco  Control  in  Canada  Room  1605  -­‐626  Mail  Stop  0301A  150  Tunney’s  Pasture  Driveway  Ottawa,  ON  K1A  0K9    To  Whom  it  May  Concern,    The  Canadian  Vaping  Association  (CVA)    is  a  membership  driven  organization  and  the  official  voice  for  the  vaping  industry  in  Canada.    We  advocate  on  behalf  of  the  hundreds  of  manufacturers,  the  thousands  of  employees  in  over  eight  hundred  vape  product  shops  and  for  the  hundreds  of  thousands  of  vapers  throughout  Canada.  We  have  been  working  closely  with  Health  Canada,  the  federal  government  and  provincial  governments  on  issues  related  to  harm  reduction  through  the  use  of  electronic  cigarettes.    We  advocate  vaping  as  an  alternative  to  combustible  cigarettes.    Our  Association  boasts  membership  from  coast  to  coast  to  coast  with  every  Province  and  Territory  represented  by  our    governance  structure.    We  are  participants  in  legislative  initiatives  that  have  been  introduced  across  Canada  at  the  provincial  level  and  nationally  in  the  Senate  round  of  the  recently  introduced  legislative  amendments  to  the  Tobacco  Act.    We  believe  we  are  fair  and  reasonable  in  our  approach  with  government  and  the  amendments  we  seek,  at  all  levels  of  government  ,  only  serve  to  strengthen  all  regulation  for  vaping  as  an  alternative  to  smoking  now  and  into  the  future.    Furthermore,  our  stake  in  the  future  of  the  industry  is  incumbent  on  our  demonstrated  integrity  and  credibility,  which  we  believe  will    lead  to  confidence  in  CVA  by  Regulator(s).    Integrity  is  critical.  To  that  end,  CVA  wishes  to  advise  Health  Canada  that  our  organization,  its  members  and  those  on  the  Board  of  CVA  have  no  conflicts  of  interest  either  actual  or  perceived  by  virtue  of  us  having  no  relationship  with  the  tobacco  industry  or  the  pharmaceutical  industry-­‐  whatsoever!      Furthermore,  CVA  makes  no  claims  that  vaping  is  a  smoking  cessation  tool  nor  do  we  claim  that  vaping  has  health  benefits.    We  advocate  for  vaping  as  an  alternative  to  those  wishing  to  stop  smoking  cigarettes  and  seek  an  alternative  to  inhale  nicotine.    Indeed  we  are  well  aware  and  appreciate  that  promoting  products  and  services  for  cessation  or  quitting  smoking  are  the  sole  purview  of  skilled  and  highly  trained  health  professionals.    What  we  as  vape  advocates  and  vape  shop  owners  and  

 

operators    do  is  ensure  that  those  who  seek  an  alternative  to  combustible  cigarettes  and  who  consider    purchasing  vape  products  are  detailed  by  qualified  individuals,  at  the  point  of  purchase,    trained  to  deliver  information  to  patrons  seeking  to  understand  how  to  use  the  vape  product  and  the  quality  liquid(s)    used  with  vape  technology.    We  are  grateful  for  the  opportunity  to  provide  Health  Canada  with  our  thoughts,  views  and  considered  opinions  on  its  call  to  action  on  Tobacco  Control.    Our  efforts  herein  comprise  the  input  from  CVA  public  policy  expertise,  our  professional  legal  advisory  and  our  clinical  partners  –  who  are  physicians  in  pain  management  and  addiction  counselling.    We  look  forward  to  reviewing  the  final  report.    In  the  meantime,  should  you  have  any  questions  or  comments  please  do  not  hesitate  to  contact  the  undersigned.    Respectfully  Submitted  by:  Canadian  Vaping  Association    Lead  Contacts            Marc  Kealey,    CVA  Member  and       Darryl    Tempest  Public  Policy  Counsel       Executive  Director  marc@kealeyandassociates.com                            dtempest@canadianvapingassociation.org      c:   CVA  Board  of  Directors     Christopher  Macleod  Esq.,    Cambridge  LLP     Rajeev  Sharma  Esq.,  Sharma  Lawyers  LLP     Anthony  Chris  MD,  FRCSC  

 

Discussion  Issues      A.    Less  than  5%  by  2035  and  Other  Targets    Health  Canada  seeks  input  into  realistic  balances  for  reducing  the  overall  use  of  tobacco  to  less  than  5%  by  its  target  date.    In  this  section  of  the  discussion  paper,  Health  Canada  asks  if  a  target  for  vaping  product  use  among  youth  who  do  not  use  tobacco  be  included  in  its  overall  strategy.    CVA  categorically  disagrees  that  any  such  target  ought  to  be  considered.  Here’s    why.    There  have  been  myriad  research  showing  no  decline  in  tobacco  use  among  high  school  students.    The  basis  of  the  findings  in  the  aggregate  seems  to  rely  on  the  misidentification  of  nicotine  as  tobacco.    It  is  this  fundamental  error  in  definition  that  seems  to  fan  the  flames  of  anti-­‐vaping  legislation  globally.      CVA  believes  that  characterization  of  vaping  products  as  ‘tobacco’  is  an  abuse  of  the  definition  of  tobacco  and  we  believe  the  attempt  to  introduce  this  in  the  Tobacco  strategy  may  be  designed  to  link  the  two,  which  is  patently  incorrect.    Tobacco  is  NOT  nicotine  much  like  Smoking  is  not  vaping.    In  fact,  in  a  recent  study  in  the  USA    “Monitoring  the  Future”i,  researchers  conducted  a  survey  and  found  that  only  20%  of  what  had  been  characterized  as  experimental  use  of  vaping  products  among  vape  product  users  who  were  identified  as  youth  reported  vaping  nicotine.    In  fact,  the  Monitoring  the  Future  Study  which  suggested  the  “gateway  theory”  to  smoking  as  a  result  of  vaping  was  soundly  refuted  and  criticized  by  public  health  experts  in  Europe  who  noted:   “There  are  many  questions  that  need  to  be  asked  about  these  conclusions.  The  first  is  that  the  measures  of  both  vaping  and  smoking  are  weak  and  could  include  simple  experimentation  –  there  is  no  measure  of  either  regular  vaping  or  smoking,  and  in  fact  the  smoking  measure  at  follow  up  included  those  who  had  tried  a  cigarette  even  once.  There  is  nothing  to  suggest  that  these  young  people  have  become  regular  smokers  and  therefore  could  suffer  the  health  harms  that  smoking  causes.      The  second  is  that  many  things  not  measured  in  the  survey  could  have  influenced  the  change  in  risk  perception  between  baseline  and  follow  up.      The  third,  which  the  authors  acknowledge,  is  that  there  are  lots  of  factors,  which  influence  whether  someone  starts  smoking.  Some  of  the  most  important  (susceptibility  to  smoking,  and  whether  friends  and  family  smoke)  were  simply  not  assessed  in  this  study.    

 

“Yet  arguably  the  most  significant  problem  with  this  article  is  that  it  is  completely  silent  about  the  context  in  which  the  study  took  place.  In  short,  there  is  key  information  from  Monitoring  the  Future  that  appears  nowhere  in  the  text.    “The  missing  information  is  that  cigarette  smoking  amongst  teenagers  in  the  USA  has  steadily  declined  since  the  late  1990s.  As  measured  in  the  MTF  survey,  past  30  day  smoking  peaked  at  28.3%  in  1996  and  fell  to  5.9%  by  2016.  In  fact  since  2011  when  e-­‐cigarette  use  began  to  rapidly  rise  in  the  USA,  there  has  been  a  particularly  marked  decline  in  teen  cigarette  smoking,  from  11.7%  to  5.9%.  Declines  have  also  been  observed  in  all  other  forms  of  tobacco  use  from  when  the  MTF  survey  started  measuring  them  (i.e.  smokeless  tobacco,  cigars)  to  20161.  The  real  headline  is  that  teen  smoking  in  the  USA  is  at  an  all-­‐time  low,  including  during  the  period  when  e-­‐cigarette  experimentation  was  rising.  If  e-­‐cigarettes  were  causing  tobacco  smoking,  these  trends  would  be  reversed”  ii      In  our  own  aggregated  review  of  research  and  literature  on  vaping,  we,  at  CVA,  uncovered  that  since  vaping  technology  has  increased  in  public  acceptance  as  an  alternative  to  smoking  sales  of  alternative  methods  like  nicotine  gums  and  patches  are  dwindling.        We  know  that  tobacco  companies  are  trying  to  introduce  products  to  the  market  to  capture  users  on  the  vaping  trend  by  manufacturing  and  marketing  their  own  electronic  cigarette  brands,  but  this  is  being  stonewalled  by  the  vape  community  (manufacturers  and  vape  product  shop  owners  and  operators)  who  are  not  interested  in  buying    (or  selling)  vaping  products  from  the  very  industry  that  got  them  hooked  on  cigarettes  in  the  first  place.          Health  Canada  is  well  advised  and  we  recommend  that  Health  Canada  reach  out  to  the  vaping  community  through  CVA  to  seek  advice  and  input  on  what’s  really  going  on  rather  than  confusing  the  public  through  suggestions  and  comments  by  public  policy  makers,  politicians  and  other  stakeholder  groups  that  nicotine  is  tobacco.          Furthermore,  at  a  time  when  the  government  is  legalizing  marijuana,  Health  Canada  appears  to  be  focusing  negative  attention  on  vaping  and  vaping  devices  that  are  proven  to  be  a  less  harmful  alternative  to  smoking  by  magnitudes.      

 

B.    Protecting  Youth    CVA  is  on  record  stating  that  Regulation  of  the  industry  must  ensure  that  access  to  vaping  and  vape  products  must  be  restricted  to  individuals  over  the  age  of  majority.    We  as  an  industry  and  the  lead  voice  for  vapers  in  Canada  would  never  endorse  access  to  vaping  or  vape  products  to  youth.    That  noted  and  yet  again,  it  appears  that  Health  Canada  through  its  Tobacco  Control  Strategy  wants  the public  to  infer  that  cigarette  smoke  and  vapour  from  vape  products  are  similar  and  therefore  vape  products  and  vaping  ought  to  have  broadened  restrictions  in  the  same  way  as  cigarettes. Here’s  why  we  disagree  with  the  assertion  that  vaping  be  banned  like  cigarettes:    Internationally  acclaimed  studies  have  proven  that  cigarettes  are  not  only  highly  addictive,  but  very  dangerous.  

 It  is  widely  known  that  there  are  over  4000  chemical  compounds  created  through  the  combustion  of  a  single  cigarette.    The  most  hazardous  chemicals  are  carbon  monoxide,  

nitrogen  oxides  hydrogen  cyanides  and  ammonia.    It’s  also  widely  known,  too,  that  about  70  of  those  chemicals  are  known  to  cause  cancer  –  including  polonium.  

 

 

 

Compare  that  with  chemicals  and  compounds  in  e-­‐cigarettes  and  the  vapour  from  them:  

• Nicotine    (optional)  • Propylene  glycol  (not  

Ethylene  glycol  -­‐  which  is  toxic).  This  chemical  compound  is  approved  for  use  in  asthma  inhalers  and  nebulizers.    In  fact,  the  USA  FDA  classified  propylene  glycol  as    "generally  recognized  as  safe".  

• Vegetable  glycerol  –  which  has  low  toxicity  and  is  generally  used  in  medications,  cosmetic  and  food  items  

• Flavours  –  which  are  food  grade  and  generally  recognized  as  safe.    The  flavour  makes  up  a  small  percentage  of  the  e-­‐liquid,  but  because  they  are  digested  the  long-­‐term  affect  has  yet  to  be  determined.  

 It  is  widely  believed,  and  CVA  agrees,  that  more  study  needs  to  be  done  on  this,  but  the  ingredients  in  vape  products  are  not  identified  as  cancer  causing  and  are  recognized  as  being  magnitudes  safer  than  tobacco.iii   This  noted,  we  recommend  that  inferences  to  vaping  vapour  as  similar  to  tobacco  exhalant  NOT  be  part  of  the  Tobacco  Control  Strategy.    Further,  CVA    recommends  that  addition  of  an  advisory  council  to  provide  input  to  Health  Canada  on  the  effects  (if  any)  on  vapour  from  vape  products.    In  the  interim,  CVA  and  its  sister  organization  ECTA  (E-­‐cigarette  Trade  Association)  will  continue  its  work  to    create  an  accreditation  program  and  certification  program  to  provide  Regulators  and  the  public  with  accurate  and  responsible  information  about  the  effects  (if  any)  of  vaping  and  vape  products.    Furthermore,  CVA  agrees  that  access  to  vape  products  for  youth  under  the  age  of  majority  ought  to  be  prohibited  (or  banned)  .  CVA  has  already  begun  a  process  to  include  signage  in  vape  products  shops  that  clearly  defines  who  is  allowed  access  to  the  vape  product  shop  AND  employees  are  trained  to  demand  identification  from  any  persons  deemed  to  look  or  be  under  the  age  of  majority.    Employees  are  then  required  not  to  serve  or  restrict  the  access  to  those  persons.    There  should  be  a  clear  distinction  between  the  products  sold  at  vape  product  shops  and    endorsed  by  CVA  and  accredited  through  ECTA    versus  cig-­‐a-­‐likes  that  look  like  analog  cigarettes  and  that  can  be  purchased  today  at  most  convenience  stores  

 

 

anywhere  in  Canada.      For  example,  the  products    known  as  Blu™  or  Vuze™.    CVA  accredited  vape  product  shops  do  NOT  sell  these  products  nor  do  we  endorse  their  use.      Health  Canada  and,  frankly  most  lawmakers  and  the  media  do  not  understand  nor  do  they  know  the  difference  between  these  products  manufactured  by  tobacco  companies  and  the  products  sold  at  qualified  vape  product  shops.        In  fact,  vapers  use  the  latter  product    (known  as  Electronic  Nicotine  Delivery  Systems  or  ENDS)  to  titrate  down  the  level  of  nicotine  that  they  may  have  inhaled  in  combustible  cigarettes  while  they  smoked.        ECTA  research  conducted  at  vape  product  shops  in  communities  in  Ontario  in  2016  points  to  safe  levels  of  aerosol  that  is  proven  to  be  safe  to  by-­‐standersiv.    For  these  reasons  we  caution  against  the  linkage  to  vaping  and  vape  products  in  the  same  way  that  Health  Canada  treats  smoking  cigarettes.        C.    Helping  Canadians  who  use  Tobacco    We  are  pleased  that  Health  Canada’s    Tobacco  Control  Strategy  includes  options  for  those  who  have  an  addiction  to  nicotine  and  that  there  is  recognition  that  options  other  than  cessation  products  and  nicotine  replacement  therapies  could  and  should  be  considered.      To  that  end,    we  provide  our  comments  to  the  possible  options  and  questions  in  this  section.    CVA  agrees  with  Health  Canada  and  believes,  too,  that  quitting  smoking  is  the  most  optimal  approach  for  improving  one’s  health.    But    we  also  know  that  many  smokers  are  addicted  to  nicotine  and,  as  such,  want  to  enjoy  the  sensory  delights  that  vaping  provides  as  an  alternative  to  cigarette  smoking.    Health  Canada’s  plan  to  reduce  smoking  prevalence  to  less  that  5%  is  ambitious.  In  our  view,  it  will  be  exceedingly  challenging  if  the  only  strategies  that  Health  Canada  considers  would  be  cessation  and  prevention.      We  are,  however,  encouraged  that  Health  Canada  through  its  Tobacco  Control  Strategy  encourages  harm  reduction.    Consider  that  current  smoking  rates  are  declining.  The  rates  Health  Canada  suggests  to  less  than  5%,  however,  may  be  tough  to  reach  and  therefore  would  render  the  program  a  failure  –  unless,  of  course,  there  was  another  strategy  available.    To  that  end,  we  recommend  a  program  under  the  Tobacco  Control  Strategy  whereby  Health  Canada  would  encourage  smokers  to  switch  to  vape  products.    Do  not  mis-­‐understand,  CVA  wholeheartedly  endorses  the  promotion  of  other  nicotine  products  like  NRTs  and  such,  but  we  do  not  endorse  nor  recommend  approaches  that  use  combustible  cigarettes.        We  know  from  the  aggregated  and  global  literature  review  that  we  have  amassed  at  CVA  that  many  smokers  find  it  much  easier  to  vape  as  an  alternative  to  cigarettes  

 

rather  than  smoking  cessation  or  nicotine  replacement.    A  simple  and  random  survey  of  our  members  would  provide  that  to  Health  Canada.    Seeking  vaping  as  an  alternative  to  smoking  provides  an  individual  with  the  opportunity  to  continue  his/her  use  of  nicotine  and  maintain  the  sensory  delight(s)  they  have  grown  accustomed  to  through  cigarette  smoking.    What  we  have  come  to  know  anecdotally  at  CVA  is  that  smokers  who  have  considered  vape  products  as  an  alternative  tend  to  titrate  down  the  level  of  nicotine  they  use  in  their  ENDS  –  thereby  creating  the  additional  benefit  of  creating  less  harm.      We  were  struck  by  the  definitive  study  in  the  UK  released  by  the  Royal  College  of  Physicians  who  noted;    “e-­‐cigarettes  are  consumer  products,  and  that  their  success  in  part  derives  from  their  appeal  to  those  who  would  never  even  try  to  quit  smoking  via  conventional  methods  or  are  unwilling  or  unable  to  quit.  E-­‐cigarettes  are  not  medical  aids  to  reduce  craving  and  withdrawal  during  a  quit  attempt,  but  an  alternative  way  of  taking  the  recreational  drug  nicotine.  It  important,  therefore,  not  to  treat  e-­‐cigarettes  as  medicines,  to  misapply  concepts  like  ‘efficacy’  or  to  rely  on  randomised  controlled  trials  that  are  suited  to  singular  interventions,  such  as  administering  a  drug.    The  ‘efficacy’  of  e-­‐cigarettes  is  not  a  property  of  the  device  and  liquid,  but  the  outcome  of  a  complex  ecology  of  behavioural  influences,  including  properties  of  the  product,  but  also  peer  support,  marketing,  beliefs  about  risk  and  scare  stories  in  newspapers,  local  availability,  the  attitude  to  smoking/vaping  in  the  social  and  work  environment,  and  the  policy  framework  –  packaging,  warnings,  restrictions,  diversity,  marketing,  taxation  etc.      Users  tend  to  progress  over  time,  acquire  vaping  skills  and  switch  products  to  more  complex  configurations,  lower  nicotine  liquids  and  more  diverse  flavours  as  they  migrate  away  from  tobacco.    A  period  of  dual  use  may  be  part  of  a  transition  that  lasts  longer  than  any  RCT  ever  would,  but  ends  in  permanent  smoking  cessation.  Because  of  their  poor  efficacy,  conventional  smoking  cessation  techniques  also  involve  prolonged  “dual  use”,  but  this  occurs  serially  with  successive  quit  attempts  and  relapses  back  to  smoking  then  the  next  quit  attempt  and  so  on  until  success  or  through  an  indefinite  cycle  of  cessation  and  relapse.”    v      We  encourage  Health  Canada  to  continue  to  liaise  with  CVA  and  its  sister  organization  ECTA  as  we  embark  on  a  campaign  in  public  on  harm  reduction.    To  that  end,  we  will  propose  several  Harm  Reduction  symposia  to  be  held  across  Canada  with  panelists  who  span  the  continuum  on  harm  reduction  and  options  for  reducing  Tobacco  use.    Of  course,  this  program  would  require  objective  financial  support  from  governments  across  Canada  –  at  both  provincial  and  federal  levels  –  and  we  have  begun  to  explore  that  process.      Our  first  endeavour  is  through  the  Economic  Club  of  Canada  who  will  host  an  event  in  the  Greater  Toronto  Area  in  spring  of  2017  with  a  blue  ribbon  panel  of  experts  and  lawmakers  who  will  offer  considered  opinion  on  the  very  issue  of  vaping  in  the  context  of  harm  reduction.    

 

As  another  possible  option  we  would  encourage  Health  Canada  to  consider  is  the  adoption  of  an  Industry  Advisory  Committee.    This  Committee  would  be  chaired  by  Health  Canada  and  be  populated  with  notable  advisors  from  the  vaping  industry.    The  terms  of  reference  for  the  Committee  would  be  adopted  when  the  Committee  is  established,  but,  for  the  most  part,  would  ensure  the  involvement  of  the  industry  in  the  development  of  the  promotion  of  vaping  as  an  alternative  to  smoking  and  could  also  include  but  not  be  limited  to:  

• The  provision  of  expert  advice  on  vaping  and  the  evidence  related  to  harm  reduction.    NOTE:    there  are  Canadian  and  international  experts  that  we  could  deploy  for  this  option,  

• Assisting  in  the  definition  and  implementation  of  industry  related  programs  and  services  aimed  at  the  vape  industry  –  to  encourage  compliance  to  harm  reduction  strategies  consistent  with  what  CVA  has  described  herein.  

   F.    Building  Capacity  and  Conclusion    While  we  understand  and  support  the  work  being  done  by  Health  Canada,  we  recognize  too,  that  we  have  a  vested  interest  in  the  business  of  vaping.    We  acknowledge  that  Regulation  must  be  a  part  of  our  business  strategy  and  the  CVA  is  committed  to  being  the  partner  with  Health  Canada  to  ensure  our  compliance  to  that  end.    We  know,  too,  that  research  cannot  and  must  not  be  done  in  isolation  from  industry  partners.    That  is  why  we  have  encouraged  Health  Canada  and,  in  fact,  the  Government  of  Canada,  to  work  closely  with  CVA  to  ensure  that  the  vaping  industry  is  transparent  in  its  operations  and  above  all  compliant  to  and  with  Regulations.    In  return  we  can  provide  valuable  and  immediate  information  on  what  is  happening  on  the  ground  in  communities  across  Canada  and  partner  with  Health  Canada  when  using  its  heft  at  the  WHO  and  other  global  forums  where  Government  policy  is  being  considered.    We  are  delighted  to  be  asked  to  participate  in  this  feedback  mechanism  and  look  forward  to  seeing  the  final  report.                                                                                                                    REFERENCES  i  Monitoring  the  Future  -­‐  Johnston,  L.  D.,  O'Malley,  P.  M.,  Bachman,  J.  G.,  Schulenberg,  J.  E.,  &  Miech,  R.  A.  (2015).  Monitoring  the  Future  national  survey  results  on  drug  use,  1975-­‐2014:  Volume  II,  college  students  and  adults  ages  19-­‐55.  Ann  Arbor:  Institute  for  Social  Research,  The  University  of  Michigan,  416  pp.  ii    SMC  –  Expert  Reaction  to  Study  on  Teen  Vaping  and  Future  Smoking.    Professors  P.  Hajek,  Queen  Mary  University  and  Linda  Bauld,  University  of  Stirling  Feb.  2017  iii  Medical  research:  

 

                                                                                                                                                                                                                                                                                                                                         • E-­‐cigarettes:  harmless  inhaled  or  exhaled    • Society  for  Research  on  Nicotine  and  Tobacco  (PDF)  

Dr  Joel  Nitzkin,  Chair  of  the  Tobacco  Control  Task  Force  for  the  American  Association  of  Public  Health  Physicians,  believes  the  hazards  posed  by  e-­‐cigarettes  would  be  much  lower  than  one  percent  of  that  posed  by  smoking  tobacco  cigarettes.  iv  ECTA  –  Air  Quality  Testing  results  from  commissioned  work  of  ECTA  as  a  result  of  Bill  45,  Ontario  2015  .    Author  Daniel  David  DANIEL@EVAPE.CA    v  Royal  College  of  Physicians  -­‐    Nicotine  Without  Smoke  -­‐    www.RCPLondon.ac.uk  2016