Whisper it quietly, but there are subtle signs that Canada may be moving away from opposition to tobacco harm reduction that has stood in stark contrast to many of its other drug policies. In applying harm reduction to tobacco, it would join a small coalition of countries with a similarly enlightened approach. This would be great news for Canadians who smoke, and for the country’s strained health care system.
Canada has shown leadership in areas of harm reduction for other drugs. It opened North America’s first sanctioned safe consumption sites. It operates limited safe supply programs for people who use opioids. And in 2018, it became the second country in the world to formally legalize cannabis.
But in recent years, this agenda has been badly undermined by policies surrounding the form of drug use that’s associated with more deaths than any other. Specifically, Canada has fallen into the trap of capitulating to moral panic surrounding nicotine vaping products, which are used by millions of people worldwide as a vastly safer substitute for combustible cigarettes.
In February, Health Canada’s web page on “Vaping and quitting smoking” was quietly updated to be far more positive than before.
Central to Health Canada’s approach has been a determination to ban appealing flavors used in vaping products. The justifications were a highly debatable belief that flavors increase youth vaping, and the notion, refuted by population-level data, that vaping is a “gateway” into cigarette smoking.
In fact, most adults who switch from cigarettes to vapes find non-tobacco flavors helpful, or even critical, in their pursuit of harm reduction.
In 2021, a public consultation to inform a mandated legislative review of the vape-related aspects of Canada’s Tobacco and Vaping Products Act (TVPA) was overwhelmingly negative and focused on unproven downsides of vaping.
But in February, Health Canada’s web page on “Vaping and quitting smoking” was quietly updated to be far more positive than before about vaping products as smoking cessation tools. It is now unequivocal in advising people that “switching completely to vaping nicotine is less harmful than continuing to smoke.” It further advises that evidence suggests there are no “serious unwanted effects while using vaping products to quit,” and notes, “studies suggest that vaping nicotine may help a greater proportion of people quit smoking than nicotine replacement therapy (NRT) or counseling alone.”
The latest plan, released on March 10, does not mention the policy of restricting flavors.
What’s more, the threat to ban flavors seems to be dissipating. Two years ago, Health Canada’s Departmental Plan spoke of “finalizing” flavor restrictions for vapes. Last year, this was downgraded to undertaking “ongoing work on the proposed order.”
Now the latest plan, which was released on March 10, does not mention the policy of restricting flavors at all.
Taken together, these developments signal that Health Canada’s vaping policies could come to resemble the progressive, evidence-based stance taken by the United Kingdom and New Zealand, for example, rather than hostile, counterproductive regulations adopted by nations such as Australia and the United States.
There is no shortage of evidence to support this shift. Research repeatedly shows vaping to be a more effective cessation aid than NRT, which is reflected in Health Canada’s updated advice. Evidence also shows that the availability of flavors prevents people from returning to smoking. Avoiding flavor bans quite simply saves lives.
In the UK and New Zealand, vaping is widely encouraged as a cessation option for people who smoke, with Britain’s National Health Service even considering proposals to make them available on prescription, in addition to their general availability in supermarkets and other stores. The Royal College of Physicians advocates for “promoting e-cigarettes widely as a substitute for smoking.”
It always defied logic that a department broadly in favor of harm reduction for other drugs should oppose it for nicotine.
Several years ago, Canada, too, was seen as a leading light in recognizing tobacco harm reduction. But its more recent regulatory agenda, formed under pressure from anti-vaping zealots, threatened to throw all that away. It always defied logic that a government department broadly in favor of harm reduction for other drugs should oppose it for nicotine.
The prospect of change in Canada could also have international implications, helping to influence policies in low- and middle-income countries, where 80 percent of the world’s 1.1 billion people who smoke live.
It is now to be hoped that Canada will also install an accessible regulatory framework for vaping products, designed to maximize uptake among smoking populations. It would be well-advised to mirror regulation that works in the UK—and to avoid the kind of impenetrable and disastrous pre-market authorization system favored by the United States.
Admitting that you’re wrong about something can be difficult. So if recent publications are indeed signs of a wiser approach to vaping in Canada, the about-turn is as admirable as the past few years have been regrettable. Canada can and should be a world leader in reducing death and disease from smoking.
Photograph of a shop in Vancouver by Ted McGrath via Flickr/Creative Commons