E-cigarettes: Are we renormalizing public smoking? Reversing five decades of tobacco control and revitalizing nicotine dependency in children and youth in Canada

Question 1

What is an e-cigarette?

Answer 1

A battery attached to a chamber containing a liquid which is heated and turned into vapour which is smoked

Question 2

What is contained in the E-liquid solution?

Answer 2

Propylene glycol, glycerol, flavouring agents

0-2.4% nicotine

Question 3

What is the evidence re: e-cigarette use as a smoking cessation tool or harm reduction?

Answer 3

Unproven

May renormalize nicotine dependency

Question 4

What are some concerns medically with e-cigarettes?

Answer 4

1. No standard nicotine amount
2. Potential for acute cardiac events –> thrombosis risk
3. Fine particulates in aerosol may worsen asthma and other breathing issues
4. Aerosolized propylene glycol and glycerol –> mouth and throat irritation, dry cough
5. Potential heavy metal ingestion
6. nicotine poisoning from discarded cartridges
7. Tank-type or dripping can result in formaldehyde and other toxin production

Question 5

What legislation does the CPS recommend the federal government enact re: e-cigarettes?

Answer 5

1. Expand regulations governing the bilingual marketing, packaging and labelling of conventional tobacco products to include all e-cigarette devices and e-liquids. New regulations must include:
   - Maximum dosage of nicotine in e-liquids, to be strictly enforced.
   - Package warnings on potential and known harmful effects which are equivalent to messaging on cigarette packaging.
   - Complete, accurate labelling for e-liquids, including a full list of ingredients and an exact measure of nicotine concentration.
   - Packaging e-liquids in containers that are child-resistant and carry explicit and appropriate cautionary warnings regarding toxicity.
   - A ban on e-cigarette-related advertising and sponsorship of events and activities intended for young audiences.
   - A ban on marketing e-cigarette-related products using strategies or in venues that attract children and youth in particular, such as ‘giveaways’ and promotion through social media.
2. Strictly prohibit manufacturers or sellers of e-devices or e-liquids from making any positive health claims until industry evidence on product safety and efficacy has been reviewed, evaluated and accepted under Health Canada’s Food and Drug Act.
3. Restrict Internet sales of e-cigarettes and related products to direct mail only to individuals, and only to individuals identifiable as adults. Such limits would curb development of a ‘black’ or ‘grey’ market and facilitate taxation.
4. Make it illegal for anyone under the current federally established legal age to purchase conventional tobacco products to buy, possess or use any form of e-cigarette or other ‘vaping’ device.
5. Federal and provincial/territorial governments should tax all e-liquids containing nicotine at levels approaching current levies on other legal, recreational psychoactive substances such as cigarettes and alcohol.

Question 6

What legislation does the CPS recommend the provincial/territorial or municipal government enact re: e-cigarettes?

Answer 6

1. Making it illegal for anyone under the current provincially established legal age to purchase conventional tobacco products to buy, possess or use any form of e-cigarette or other ‘vaping’ device.
2. Requiring e-devices and e-liquids to be sold only in venues where tobacco is sold legally.
   - Vending machine sales of e-cigarettes should be banned.
   - Retail outlets selling these products to the public would need a license, as they do for conventional cigarettes.
   - Establishments licensed to carry e-devices and e-liquids would not be allowed to create so-called ‘power wall’ displays for these products: the same restrictions governing behind-the-counter sales of conventional cigarettes would apply to all e-cigarette-related products.
3. Expanding all current restrictions on smoking in public spaces or workplaces to apply equally to any form of e-cigarette device.
4. Provincial/territorial governments must also foster local programs that address the litter generated by e-device use through levies on the purchase price. Such programs should be developed, implemented and maintained like other environmental stewardship programs.

Question 7

What does the CPS recommend health care providers do re: e-cigarettes?

Answer 7

1. Educate young patients and their families on the risks and hazards of e-cigarette use and exposure.
2. Make counselling on e-devices a segue into broader discussion of tobacco use and smoking cessation.

Question 8

What does the CPS recommend the school boards and ministries of education do re: e-cigarettes?

Answer 8

1. Adhere to all existing restrictions on smoking in places of learning
2. A teaching component on the dangers of exposure to and use of e-cigarettes should be included in an age-appropriate health curriculum