As plumes of cotton candy and strawberry ice cream-scented clouds fill the air, the heated debate over vaping regulation in Canada wages on.
The popularity of nicotine vapes, or e-cigarettes, continues to rise, but so too do questions of whether vape uptake is a positive sign of changing times or a new public health concern hooking a younger generation to nicotine.
One Health Canada survey found that youth smoking rates have decreased from 5 to 3 per cent from 2019 to 2020. However, Canada has some of the highest rates of teen vape use in the world, with one 2023 survey showing that nearly a third of teens Grade 7 to 12 had tried vaping.
Since vaping became legal in Canada in 2018, markets have been flooded with new products. Several studies have concluded that vaping does appear to be less harmful than smoking tobacco, but that it is still not without its own health risks.
Vaping certain fruit-flavoured e-cigarette fluids has previously been shown to produce dangerous compounds called volatile carbonyls from the heating process. These compounds are known to have health implications for chronic obstructive pulmonary disease (COPD), cardiovascular disease and cancers.
A recent study co-authored by Donal O’Shea, professor at the RCSI University of Medicine and Health Science in Dublin, used AI to analyze the chemical compounds of 180 different vape flavours when heated. It found that vapes produce 127 “acutely toxic” chemicals, 153 “health hazards” and 225 “irritants.”
Further, many experts have warned of the still unknown long-term effects of e-cigarette use.
In June 2021, the federal government released draft regulations that would ban most flavours of e-cigarette fluids except tobacco, mint and menthol. However, these flavour bans have yet to be put into effect.
Provincially, Quebec, New Brunswick, P.E.I., Nova Scotia, Nunavut and the Northwest Territories have all prohibited the sale of flavoured vape products, with Manitoba recently considering the same.
In the U.S., the Food and Drug Administration (FDA) approved the first menthol flavoured vaping products at the end of June. An official with the FDA, Matthew Farrelly, said in a statement that the agency had “concluded that the benefit of adult smokers” switching to e-cigarettes “was sufficient to outweigh the risks to youth.”
On July 1, the Canadian government introduced a tax on vaping products that increases the cost of a vape pod between 12 and 24 cents.
But while regulations, taxes and restrictions are debated in Parliament, advocates say these measures are misguided. Some proponents of vaping as an alternative to tobacco say that limiting flavours and increasing taxes would be a step backward, forcing would-be tobacco smokers to return to a more harmful alternative.
Some critics have accused the federal government of “sitting on its hands” when it comes to youth vaping. But vapes also have arguably done some real good, particularly for those who have been able to completely quit tobacco.
So, what is Canada to do? Does vaping pose a legitimate public health threat or is it a far safer alternative for those who would otherwise be vulnerable to the known harms of cigarettes?
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The supposed mythical harm reduction offered by Vapes has never been quantified. Howerver the continued posturing of the Harm Reduction from Vapes is creating a harm to impressionable children in itself. Yes, the loss of some 6-8000 toxicants from a combustible product is noteworthy BUT the delivery of addictive nicotine /w additives is clearly a harm to the respiratory epithelium of the respiratory tract that many not immediately register a clear pathology from the insult of nicotine. It will likely take years of exposure, just like the Lights. Raw heated nicotine of Vapes are another form of maintaining addiction rather than the full commitment to a drug free life. The full harm reduction is No vapes, No new delivery nicotine delivery products like LEVIA (delivering nicotine /w PEG).
We need to address the Issue of Dual Use:
Research on the effectiveness of e-cigarettes as a smoking cessation aid is mixed. While some studies suggest that e-cigarettes may help some smokers reduce or quit smoking, others indicate that dual use may not significantly reduce smoking rates. This uncertainty raises questions about the role of e-cigarettes in promoting smoking cessation, particularly among dual users.
The harm reduction argument also hinges on the principle that switching from smoking to vaping can significantly reduce exposure to harmful substances. The drastic reduction in harmful chemicals compared to traditional cigarettes supports this viewpoint. However, the uncertainty surrounding long-term effects and the potential for dual use (smoking and vaping simultaneously) complicates the issue. The dual-use phenomenon mentioned by Dr. Cunningham indicates that many individuals may not entirely transition away from cigarettes, undermining the potential health benefits.
Nearly half of e-cigarette users concurrently use cigarettes, and many smoke more frequently than they use e-cigarettes. This is concerning because dual users are exposed to both cigarette and potential e-cigarette toxicants and the data are mixed regarding the ability of e-cigarettes to promote smoking cessation. The prevalence of dual use among youth is also notable.
Dual Use Risks: Educate patients about the risks of dual use, where individuals use both combustible cigarettes and e-cigarettes. Research indicates that dual use does not significantly reduce exposure to harmful substances compared to smoking alone. Dual users continue to face the risks associated with smoking while potentially adding new risks from vaping.
Incomplete Cessation: Highlight that many dual users may not achieve complete cessation of smoking, which diminishes the potential harm reduction benefits. The presence of nicotine in both products can maintain addiction and complicate quitting efforts.
Health Implications: Explain that dual use can lead to continued or increased health risks, including respiratory issues, cardiovascular disease, and other potential long-term consequences from exposure to the chemicals in both smoke and vapor.
Behavioral Reinforcement: Discuss how dual use can reinforce smoking-related behaviors, making it harder to quit both smoking and vaping. The convenience of vaping in situations where smoking is not allowed can perpetuate nicotine addiction and complicate efforts to quit.
Clear Goals for Cessation: Encourage patients who use both cigarettes and e-cigarettes to set clear goals for quitting both products. Emphasize the importance of aiming for complete cessation rather than relying on vaping as a long-term substitute for smoking.
Provide Support for Dual Users:
Tailored Cessation Plans: Work with patients who are dual users to develop a tailored cessation plan that addresses both smoking and vaping. This plan should include behavioral support, counseling, and potentially the use of approved smoking cessation aids.
Monitoring and Follow-Up: Regularly monitor the progress of dual users, addressing any challenges they face in reducing or quitting both smoking and vaping. Adjust the cessation plan as needed to support their journey towards a smoke-free and vape-free life.
Incorporating discussions about dual use into patient education and counseling can help clarify the risks and guide patients towards more effective and healthier cessation strategies. It’s crucial to provide comprehensive support and accurate information to help patients make informed decisions about their health.
REFERENCE:
Coleman SRM, Piper ME, Byron MJ, Bold KW. Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence. Curr Addict Rep. 2022 Dec;9(4):353-362. doi: 10.1007/s40429-022-00448-1. Epub 2022 Oct 17. PMID: 36467719; PMCID: PMC9718538.