Canada looked set to embrace tobacco harm reduction, similar to the United Kingdom. At least until July 2019, when a research paper by a group of high-profile public health scholars in the United States, the UK and Canada appeared in the BMJ, a medical journal published by the trade union of the British Medical Association.
The authors concluded that, in Canada as in the US, there was an increase in youth vaping between 2017 and 2018.
It was the typical tale. However, the researchers also determined that in Canada, unlike in the US, there had also been a significant uptick in youth smoking—lending credence to an often-debunked and challenged theory of a “gateway” from vapes to combustible cigarettes.
The problem was—as Clive Bates, a public health consultant and the former director of Action on Smoking and Health in the UK noted at the time—the BMJ paper’s figures were wrong. Almost exactly a year later, the journal issued a correction, seemingly hidden in a statistical supplement. Nonetheless, the controversial paper—critiqued in tobacco control and harm reduction circles—has apparently made an impact.
In December 2020, Health Canada, the agency responsible for the country’s health policy, proposed to establish a nicotine limit of 20 milligrams per milliliter (mg/ml) for all vaping products. Just as BMJ did, Health Canada “identified the availability of high-nicotine concentration vaping products in the Canadian market since 2018 as one of the key factors that has contributed to the rise in youth vaping,” the department stated.
The idea of nicotine caps for vaping products has been gaining steam in other jurisdictions over the past few years, for example in the European Union.
An open comment period on Canada’s proposed restriction has just closed. Tobacco control experts, vapers and activists have all been challenging the government’s proposed regulation, claiming that it’s flawed.
“By setting a nicotine cap, Health Canada would be throttling the nicotine delivery of the most compact and easy-to-use alternatives to cigarettes,” Bates told Filter. “The proposal is a gift to the cigarette trade and another reason to keep people smoking.”
Bates and David Sweanor—an industry expert and chair of the Advisory Board for Centre for Health Law, Policy and Ethics at the University of Ottawa—were among those who recently submitted comments to the Canadian government. In part, they expanded on how vaping displaces adolescent smoking. If adults or teens are going to consume nicotine, as some always will, public health logic dictates that they should be encouraged to divert to the less dangerous option.
Countless other experts have been just as vocal in their protests to Health Canada. They include respected scientists in the UK, Lynne Dawkins, Sharon Cox and Catherine Kimber; tobacco control experts in the States like David Abrams, Raymond Niaura and Jonathan Foulds; and consumer advocates such as Amelia Howard, a sociology PhD student at the University of Waterloo.
Tens of thousands of vapers have joined them. Health Canada has revealed that it received 23,000 postcards from people “who vape who were opposed to additional measures and who reported either quitting smoking with vaping or attempting to quit smoking with vaping.”
And contrary to the usual, anti-vaping direction of media pressure, the Financial Post published an op-ed on March 16 by Ian Irvine, a Canadian economics professor, arguing that “Canada’s nicotine caps will kill people.”
It remains unclear whether—and if so, when—the proposed regulation will go into effect.
“It was a hard switch [from cigarettes] with earlier technology,” Howard told Filter. As someone who vapes nicotine in higher concentrations, she explained, she would be directly affected if the proposal became law. “There’s no learning curve,” she said, with easy, single-pod vaping products. “And you can typically buy them where you can buy cigarettes.”
“This law would prohibit that sort of switching,” Howard went on. “I think a lot of people would just return to smoking.”
The barrier to entry for simple pod or single-use devices is much lower. Public health agencies in the US and abroad have long trumpeted this as a reason why such options are popular among teenagers. That’s the main problem: The effectiveness of these products is being used as a primary argument against them. The very potential of their ease of use—just as the flavors that help adults transition to vapes are targeted for supposedly tempting kids—is stigmatized.
Because these devices are so easy to use, youth find them attractive, the argument goes. But their simplicity is welcome for many current smokers searching for safer alternatives; they don’t require the hobbyist attitude prevalent among old-school vapers who favor open mods.
And just because many adult vapers might not prefer these sort of high-nicotine vaping products, that isn’t enough of a reason to ditch them entirely, given the huge potential health benefit for every single person who switches.
“Justifying such a policy by saying that the majority of vapers do not require the higher-nicotine-strength products makes no more sense than saying we should ban naloxone as the majority of opioid users do not need it, or indeed mandating door heights of a maximum of six feet because the majority of people will be fine with that,” David Sweanor told Filter. “It shows a total abandonment of basic public health principles about meeting people where they are and understanding lived experience.”