Scitech | The regulation complication

Public health challenges in the growing e-cigarette market

A recent report published by the Propel Centre for Population Health Impact at Waterloo University on smoking patterns and trends in Canada indicates an increase in smoking, especially among young adults above 20 years old. The increase marks a slowdown in the overall decline in smoking observed over the past decade. Although smoking tobacco has been strongly linked to coronary artery disease, several forms of cancer, and chronic obstructive pulmonary disease (COPD), it remains for many people a tough habit to kick, with only 13 per cent of those who planned to abstain last year succeeding.

Enter e-cigarettes, also known as electronic cigarettes; battery-powered, reusable devices that mimic the use, and often appearance and taste, of conventional cigarettes. They do not contain tobacco, and only emit a nicotine vapour, often flavoured, instead of the smoke from tobacco combustion. Therefore, theoretically, they supply the user with nicotine while avoiding the toxic chemicals associated with conventional cigarettes.

E-cigarette companies have capitalized on the negativity surrounding conventional smoking, marketing themselves as a clean delivery device that satisfies nicotine cravings. Packages are covered with labels that say “Vapour–not smoke,” or “Less tar & more taste.” And it has worked. ‘Vaping’ has been featured on pop-culture sensations like House of Cards. Vaping cafes are popping up across Canada and the globe. Given the current growth, Wells Fargo predicts that the retail sales value for e-cigarettes worldwide will surpass $10 billion by 2017. Bloomberg Industries has projected that e-cigarette sales will exceed those of traditional cigarettes by 2047.

This growth has largely been attributed to the growing popularity of e-cigarettes in a younger generation of users. Groups such as the World Health Organization (WHO) and Center for Disease Control and Prevention in the US (CDC) have expressed concern that these products will lead to more nicotine addiction in youth and serve as a gateway for non-smokers to smoking tobacco. The problem of youth nicotine addiction has thus been central to the regulation debate surrounding e-cigarettes. Other major concerns include the fact that no long-term studies have been conducted to corroborate the claims that e-cigarettes have helped people quit smoking, and that the health risks of inhaling propylene glycol – a liquid in the cartridge of most e-cigarettes –remain unclear.

People are also concerned that these products will undermine hard-won progress in tobacco control such as workplace smoking bans. As big tobacco companies such as Lorillard and Altria enter the e-cigarette market, some express suspicion at what their long-term strategic goals may be. Are they recognizing that e-cigarettes are their future, or encouraging their use as a gateway product to cigarettes?

On August 26, the WHO called for strict regulation of e-cigarettes, and called on governments to implement a ban on selling Electronic nicotine delivery systems (ENDS) to minors, and a ban on use indoors. The report says, “The fact that ENDS exhaled aerosol contains on average lower levels of toxicants than the emissions from combusted tobacco does not mean that these levels are acceptable to involuntarily exposed bystanders.” The WHO also called for the restriction of e-cigarette advertising. Many worry that current campaigns romanticize smoking and make it appear as a normative and even desirable behaviour, paving the way for a new generation of smokers.

The sale of e-cigarettes is currently prohibited in Australia, Brazil, Mexico, Panama, Singapore, and Switzerland, and allowed in most others. Health Canada last issued guidelines for e-cigarette use in 2009, stating that the products had not yet been fully evaluated for “safety, quality and efficacy,” and that consumers should hold off on buying them until more information becomes available. Currently, e-cigarettes that claim health benefits and are intended for nicotine delivery are regulated under the Food and Drugs Act. Those that do not make such claims are neither approved nor banned in Canada. 

From a regulatory standpoint, it seems that the greatest difficulty lies in deciding how to classify e-cigarettes. Should they be treated as tobacco products (even though they contain no tobacco), or medicines? The Electronic Cigarette Trade Association of Canada does not think they can be classified as either, and should be treated separately. The group supports further study into the safety and regulation of these products, and the regulation of contaminants in the e-cigarette liquid.

Groups like the Canadian Lung Association (CLA) and Canadian Cancer Society (CCS) want to see much tougher federal policies on e-cigarettes in line with WHO and CDC recommendations. The CLA would like to see an all-out ban on e-cigarette sales until their safety is properly researched. The CCS has called for national bans on sale to minors and controls on e-cigarette advertising.

Where the federal government has been dragging its feet, provinces and municipalities look poised to make changes soon. Nova Scotia plans to pass legislation to regulate e-cigarettes like tobacco. Similarly, in Quebec, Lucie Charlebois, the minister for Rehabilitation, Youth Protection and Public Health, wants to put e-cigarettes under Quebec’s Tobacco Act, and wants the same rules to apply to both e-cigarettes and real cigarettes. It is likely that if they move ahead with regulations, other provinces will follow suit. Montreal Public Health has also called for more regulations, releasing five different recommendations for lawmakers; Toronto City Council is banning their use in city workplaces.

Given the lack of long-term scientific research on e-cigarettes, and their growing popularity, some legislative guidance on their production and consumption seems reasonable. It remains to be seen how the federal government will react, if it reacts at all, and who it will consult in developing its policy. In the meantime Canadians will have to decide for themselves whether e-cigarettes are a solution or a key to Pandora’s box.