response’’ to’ … · 2017-05-30 · response’’ ’ to’ ’...
TRANSCRIPT
Response to
Consultations on the Future of Tobacco Control in Canada
prepared for
Health Canada
April 12, 2017
April 12, 2017 Consultations on the Future of Tobacco Control in Canada Room 1605 -‐626 Mail Stop 0301A 150 Tunney’s Pasture Driveway Ottawa, ON K1A 0K9 To Whom it May Concern, The Canadian Vaping Association (CVA) is a membership driven organization and the official voice for the vaping industry in Canada. We advocate on behalf of the hundreds of manufacturers, the thousands of employees in over eight hundred vape product shops and for the hundreds of thousands of vapers throughout Canada. We have been working closely with Health Canada, the federal government and provincial governments on issues related to harm reduction through the use of electronic cigarettes. We advocate vaping as an alternative to combustible cigarettes. Our Association boasts membership from coast to coast to coast with every Province and Territory represented by our governance structure. We are participants in legislative initiatives that have been introduced across Canada at the provincial level and nationally in the Senate round of the recently introduced legislative amendments to the Tobacco Act. We believe we are fair and reasonable in our approach with government and the amendments we seek, at all levels of government , only serve to strengthen all regulation for vaping as an alternative to smoking now and into the future. Furthermore, our stake in the future of the industry is incumbent on our demonstrated integrity and credibility, which we believe will lead to confidence in CVA by Regulator(s). Integrity is critical. To that end, CVA wishes to advise Health Canada that our organization, its members and those on the Board of CVA have no conflicts of interest either actual or perceived by virtue of us having no relationship with the tobacco industry or the pharmaceutical industry-‐ whatsoever! Furthermore, CVA makes no claims that vaping is a smoking cessation tool nor do we claim that vaping has health benefits. We advocate for vaping as an alternative to those wishing to stop smoking cigarettes and seek an alternative to inhale nicotine. Indeed we are well aware and appreciate that promoting products and services for cessation or quitting smoking are the sole purview of skilled and highly trained health professionals. What we as vape advocates and vape shop owners and
operators do is ensure that those who seek an alternative to combustible cigarettes and who consider purchasing vape products are detailed by qualified individuals, at the point of purchase, trained to deliver information to patrons seeking to understand how to use the vape product and the quality liquid(s) used with vape technology. We are grateful for the opportunity to provide Health Canada with our thoughts, views and considered opinions on its call to action on Tobacco Control. Our efforts herein comprise the input from CVA public policy expertise, our professional legal advisory and our clinical partners – who are physicians in pain management and addiction counselling. We look forward to reviewing the final report. In the meantime, should you have any questions or comments please do not hesitate to contact the undersigned. Respectfully Submitted by: Canadian Vaping Association Lead Contacts Marc Kealey, CVA Member and Darryl Tempest Public Policy Counsel Executive Director [email protected] [email protected] c: CVA Board of Directors Christopher Macleod Esq., Cambridge LLP Rajeev Sharma Esq., Sharma Lawyers LLP Anthony Chris MD, FRCSC
Discussion Issues A. Less than 5% by 2035 and Other Targets Health Canada seeks input into realistic balances for reducing the overall use of tobacco to less than 5% by its target date. In this section of the discussion paper, Health Canada asks if a target for vaping product use among youth who do not use tobacco be included in its overall strategy. CVA categorically disagrees that any such target ought to be considered. Here’s why. There have been myriad research showing no decline in tobacco use among high school students. The basis of the findings in the aggregate seems to rely on the misidentification of nicotine as tobacco. It is this fundamental error in definition that seems to fan the flames of anti-‐vaping legislation globally. CVA believes that characterization of vaping products as ‘tobacco’ is an abuse of the definition of tobacco and we believe the attempt to introduce this in the Tobacco strategy may be designed to link the two, which is patently incorrect. Tobacco is NOT nicotine much like Smoking is not vaping. In fact, in a recent study in the USA “Monitoring the Future”i, researchers conducted a survey and found that only 20% of what had been characterized as experimental use of vaping products among vape product users who were identified as youth reported vaping nicotine. In fact, the Monitoring the Future Study which suggested the “gateway theory” to smoking as a result of vaping was soundly refuted and criticized by public health experts in Europe who noted: “There are many questions that need to be asked about these conclusions. The first is that the measures of both vaping and smoking are weak and could include simple experimentation – there is no measure of either regular vaping or smoking, and in fact the smoking measure at follow up included those who had tried a cigarette even once. There is nothing to suggest that these young people have become regular smokers and therefore could suffer the health harms that smoking causes. The second is that many things not measured in the survey could have influenced the change in risk perception between baseline and follow up. The third, which the authors acknowledge, is that there are lots of factors, which influence whether someone starts smoking. Some of the most important (susceptibility to smoking, and whether friends and family smoke) were simply not assessed in this study.
“Yet arguably the most significant problem with this article is that it is completely silent about the context in which the study took place. In short, there is key information from Monitoring the Future that appears nowhere in the text. “The missing information is that cigarette smoking amongst teenagers in the USA has steadily declined since the late 1990s. As measured in the MTF survey, past 30 day smoking peaked at 28.3% in 1996 and fell to 5.9% by 2016. In fact since 2011 when e-‐cigarette use began to rapidly rise in the USA, there has been a particularly marked decline in teen cigarette smoking, from 11.7% to 5.9%. Declines have also been observed in all other forms of tobacco use from when the MTF survey started measuring them (i.e. smokeless tobacco, cigars) to 20161. The real headline is that teen smoking in the USA is at an all-‐time low, including during the period when e-‐cigarette experimentation was rising. If e-‐cigarettes were causing tobacco smoking, these trends would be reversed” ii In our own aggregated review of research and literature on vaping, we, at CVA, uncovered that since vaping technology has increased in public acceptance as an alternative to smoking sales of alternative methods like nicotine gums and patches are dwindling. We know that tobacco companies are trying to introduce products to the market to capture users on the vaping trend by manufacturing and marketing their own electronic cigarette brands, but this is being stonewalled by the vape community (manufacturers and vape product shop owners and operators) who are not interested in buying (or selling) vaping products from the very industry that got them hooked on cigarettes in the first place. Health Canada is well advised and we recommend that Health Canada reach out to the vaping community through CVA to seek advice and input on what’s really going on rather than confusing the public through suggestions and comments by public policy makers, politicians and other stakeholder groups that nicotine is tobacco. Furthermore, at a time when the government is legalizing marijuana, Health Canada appears to be focusing negative attention on vaping and vaping devices that are proven to be a less harmful alternative to smoking by magnitudes.
B. Protecting Youth CVA is on record stating that Regulation of the industry must ensure that access to vaping and vape products must be restricted to individuals over the age of majority. We as an industry and the lead voice for vapers in Canada would never endorse access to vaping or vape products to youth. That noted and yet again, it appears that Health Canada through its Tobacco Control Strategy wants the public to infer that cigarette smoke and vapour from vape products are similar and therefore vape products and vaping ought to have broadened restrictions in the same way as cigarettes. Here’s why we disagree with the assertion that vaping be banned like cigarettes: Internationally acclaimed studies have proven that cigarettes are not only highly addictive, but very dangerous.
It is widely known that there are over 4000 chemical compounds created through the combustion of a single cigarette. The most hazardous chemicals are carbon monoxide,
nitrogen oxides hydrogen cyanides and ammonia. It’s also widely known, too, that about 70 of those chemicals are known to cause cancer – including polonium.
Compare that with chemicals and compounds in e-‐cigarettes and the vapour from them:
• Nicotine (optional) • Propylene glycol (not
Ethylene glycol -‐ which is toxic). This chemical compound is approved for use in asthma inhalers and nebulizers. In fact, the USA FDA classified propylene glycol as "generally recognized as safe".
• Vegetable glycerol – which has low toxicity and is generally used in medications, cosmetic and food items
• Flavours – which are food grade and generally recognized as safe. The flavour makes up a small percentage of the e-‐liquid, but because they are digested the long-‐term affect has yet to be determined.
It is widely believed, and CVA agrees, that more study needs to be done on this, but the ingredients in vape products are not identified as cancer causing and are recognized as being magnitudes safer than tobacco.iii This noted, we recommend that inferences to vaping vapour as similar to tobacco exhalant NOT be part of the Tobacco Control Strategy. Further, CVA recommends that addition of an advisory council to provide input to Health Canada on the effects (if any) on vapour from vape products. In the interim, CVA and its sister organization ECTA (E-‐cigarette Trade Association) will continue its work to create an accreditation program and certification program to provide Regulators and the public with accurate and responsible information about the effects (if any) of vaping and vape products. Furthermore, CVA agrees that access to vape products for youth under the age of majority ought to be prohibited (or banned) . CVA has already begun a process to include signage in vape products shops that clearly defines who is allowed access to the vape product shop AND employees are trained to demand identification from any persons deemed to look or be under the age of majority. Employees are then required not to serve or restrict the access to those persons. There should be a clear distinction between the products sold at vape product shops and endorsed by CVA and accredited through ECTA versus cig-‐a-‐likes that look like analog cigarettes and that can be purchased today at most convenience stores
anywhere in Canada. For example, the products known as Blu™ or Vuze™. CVA accredited vape product shops do NOT sell these products nor do we endorse their use. Health Canada and, frankly most lawmakers and the media do not understand nor do they know the difference between these products manufactured by tobacco companies and the products sold at qualified vape product shops. In fact, vapers use the latter product (known as Electronic Nicotine Delivery Systems or ENDS) to titrate down the level of nicotine that they may have inhaled in combustible cigarettes while they smoked. ECTA research conducted at vape product shops in communities in Ontario in 2016 points to safe levels of aerosol that is proven to be safe to by-‐standersiv. For these reasons we caution against the linkage to vaping and vape products in the same way that Health Canada treats smoking cigarettes. C. Helping Canadians who use Tobacco We are pleased that Health Canada’s Tobacco Control Strategy includes options for those who have an addiction to nicotine and that there is recognition that options other than cessation products and nicotine replacement therapies could and should be considered. To that end, we provide our comments to the possible options and questions in this section. CVA agrees with Health Canada and believes, too, that quitting smoking is the most optimal approach for improving one’s health. But we also know that many smokers are addicted to nicotine and, as such, want to enjoy the sensory delights that vaping provides as an alternative to cigarette smoking. Health Canada’s plan to reduce smoking prevalence to less that 5% is ambitious. In our view, it will be exceedingly challenging if the only strategies that Health Canada considers would be cessation and prevention. We are, however, encouraged that Health Canada through its Tobacco Control Strategy encourages harm reduction. Consider that current smoking rates are declining. The rates Health Canada suggests to less than 5%, however, may be tough to reach and therefore would render the program a failure – unless, of course, there was another strategy available. To that end, we recommend a program under the Tobacco Control Strategy whereby Health Canada would encourage smokers to switch to vape products. Do not mis-‐understand, CVA wholeheartedly endorses the promotion of other nicotine products like NRTs and such, but we do not endorse nor recommend approaches that use combustible cigarettes. We know from the aggregated and global literature review that we have amassed at CVA that many smokers find it much easier to vape as an alternative to cigarettes
rather than smoking cessation or nicotine replacement. A simple and random survey of our members would provide that to Health Canada. Seeking vaping as an alternative to smoking provides an individual with the opportunity to continue his/her use of nicotine and maintain the sensory delight(s) they have grown accustomed to through cigarette smoking. What we have come to know anecdotally at CVA is that smokers who have considered vape products as an alternative tend to titrate down the level of nicotine they use in their ENDS – thereby creating the additional benefit of creating less harm. We were struck by the definitive study in the UK released by the Royal College of Physicians who noted; “e-‐cigarettes are consumer products, and that their success in part derives from their appeal to those who would never even try to quit smoking via conventional methods or are unwilling or unable to quit. E-‐cigarettes are not medical aids to reduce craving and withdrawal during a quit attempt, but an alternative way of taking the recreational drug nicotine. It important, therefore, not to treat e-‐cigarettes as medicines, to misapply concepts like ‘efficacy’ or to rely on randomised controlled trials that are suited to singular interventions, such as administering a drug. The ‘efficacy’ of e-‐cigarettes is not a property of the device and liquid, but the outcome of a complex ecology of behavioural influences, including properties of the product, but also peer support, marketing, beliefs about risk and scare stories in newspapers, local availability, the attitude to smoking/vaping in the social and work environment, and the policy framework – packaging, warnings, restrictions, diversity, marketing, taxation etc. Users tend to progress over time, acquire vaping skills and switch products to more complex configurations, lower nicotine liquids and more diverse flavours as they migrate away from tobacco. A period of dual use may be part of a transition that lasts longer than any RCT ever would, but ends in permanent smoking cessation. Because of their poor efficacy, conventional smoking cessation techniques also involve prolonged “dual use”, but this occurs serially with successive quit attempts and relapses back to smoking then the next quit attempt and so on until success or through an indefinite cycle of cessation and relapse.” v We encourage Health Canada to continue to liaise with CVA and its sister organization ECTA as we embark on a campaign in public on harm reduction. To that end, we will propose several Harm Reduction symposia to be held across Canada with panelists who span the continuum on harm reduction and options for reducing Tobacco use. Of course, this program would require objective financial support from governments across Canada – at both provincial and federal levels – and we have begun to explore that process. Our first endeavour is through the Economic Club of Canada who will host an event in the Greater Toronto Area in spring of 2017 with a blue ribbon panel of experts and lawmakers who will offer considered opinion on the very issue of vaping in the context of harm reduction.
As another possible option we would encourage Health Canada to consider is the adoption of an Industry Advisory Committee. This Committee would be chaired by Health Canada and be populated with notable advisors from the vaping industry. The terms of reference for the Committee would be adopted when the Committee is established, but, for the most part, would ensure the involvement of the industry in the development of the promotion of vaping as an alternative to smoking and could also include but not be limited to:
• The provision of expert advice on vaping and the evidence related to harm reduction. NOTE: there are Canadian and international experts that we could deploy for this option,
• Assisting in the definition and implementation of industry related programs and services aimed at the vape industry – to encourage compliance to harm reduction strategies consistent with what CVA has described herein.
F. Building Capacity and Conclusion While we understand and support the work being done by Health Canada, we recognize too, that we have a vested interest in the business of vaping. We acknowledge that Regulation must be a part of our business strategy and the CVA is committed to being the partner with Health Canada to ensure our compliance to that end. We know, too, that research cannot and must not be done in isolation from industry partners. That is why we have encouraged Health Canada and, in fact, the Government of Canada, to work closely with CVA to ensure that the vaping industry is transparent in its operations and above all compliant to and with Regulations. In return we can provide valuable and immediate information on what is happening on the ground in communities across Canada and partner with Health Canada when using its heft at the WHO and other global forums where Government policy is being considered. We are delighted to be asked to participate in this feedback mechanism and look forward to seeing the final report. REFERENCES i Monitoring the Future -‐ Johnston, L. D., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Miech, R. A. (2015). Monitoring the Future national survey results on drug use, 1975-‐2014: Volume II, college students and adults ages 19-‐55. Ann Arbor: Institute for Social Research, The University of Michigan, 416 pp. ii SMC – Expert Reaction to Study on Teen Vaping and Future Smoking. Professors P. Hajek, Queen Mary University and Linda Bauld, University of Stirling Feb. 2017 iii Medical research:
• E-‐cigarettes: harmless inhaled or exhaled • Society for Research on Nicotine and Tobacco (PDF)
Dr Joel Nitzkin, Chair of the Tobacco Control Task Force for the American Association of Public Health Physicians, believes the hazards posed by e-‐cigarettes would be much lower than one percent of that posed by smoking tobacco cigarettes. iv ECTA – Air Quality Testing results from commissioned work of ECTA as a result of Bill 45, Ontario 2015 . Author Daniel David [email protected] v Royal College of Physicians -‐ Nicotine Without Smoke -‐ www.RCPLondon.ac.uk 2016