Vaping devices or e-cigarettes began to appear more than a decade ago. They were designed to deliver nicotine through heated vapour — eliminating tobacco smoke and reducing its cancer-causing effects. The idea was to help smokers reduce their health risks and hopefully quit tobacco.
Today that promise has turned into a public health nightmare.
Dr. Andrew Pipe is Canada’s foremost expert on smoking cessation. He is also chair of the Heart & Stroke board of directors. We asked Dr. Pipe to explain how vaping affects health and what needs to change.
What has changed since the introduction of the first e-cigarette devices?
Vaping products have evolved rapidly, particularly in the last four or five years. Now we have a whole range of devices on the market using different forms of nicotine, which is one of the most addictive substances available.
Many products deliver a phenomenal amount of nicotine.
In the Canadian context, vapes with nicotine were legalized in May, 2018. But these products have not been regulated in any meaningful way. It has essentially been the wild west.
So we've seen an explosion in the use of these devices, in the different solutions that are used, and in the hundreds of ingredients and flavouring chemicals being added to the solutions.
Many products deliver a phenomenal amount of nicotine.
Who is using vaping devices?
The overwhelming proportion of users are teenagers or young adults.
That’s because these products have been very aggressively marketed using social media techniques and the kind of messaging strategies that the tobacco industry used years ago to target young people.
The most recent figures indicate 20% of students in grades 7-12 are current vapers and 34% have tried it. Another study found a 74% increase in the rate of youth vaping over one year.
Many of these young people are completely oblivious to the fact that they'll get addicted to nicotine very, very rapidly.
There is also emerging research to show that vaping can be a gateway to tobacco and cannabis use.
Vaping companies say they only want adult smokers to use their products to quit smoking. If that’s the case, they’ve done a terrible job with their marketing strategy.
What do we know about the health impacts?
It's going to be 20 or 30 years, perhaps, before we fully understand the implications of vaping. But we do know that vaping is linked to respiratory issues and increased blood pressure. And those who both vape and smoke are, it has been suggested, at higher risk for heart disease and stroke.
We are also seeing acute lung injuries resulting from inhalation of the chemicals in vape devices. It may be the ingredients used in flavouring, or those added when these devices are used to vape marijuana. Regardless, the outcome is serious lung damage, which in many cases has resulted in deaths.
And in young people, we also see impacts on their developing brains. Nicotine is harmful and can stunt brain development. So overall, we have a significant public health crisis on our hands.
Should adult smokers continue to have access to vaping?
Vaping is less harmful than smoking, but it is harmful, nevertheless. There are potential advantages to the use of these devices as a smoking cessation aid, but the evidence is weak and remains unclear.
I think that potential has been lost because of the limited regulations of these products. As a result many health organizations, authoritative journals and professional organizations do not recommend the use of these devices. Appropriate regulation of these devices would allow us to begin to consider their use as smoking cessation aids.
Unfortunately, we know that the majority of those who as smokers begin to use these devices, do not stop smoking and in fact become what we call dual users.
For dual users, there is evidence that they increase their overall risk of a variety of health concerns.
What needs to happen to contain this public health crisis?
First we need to play catch up. Canada has failed in terms of not introducing appropriate regulatory controls over these devices.
We need a comprehensive approach, which reflects the approaches we have taken to address the use of conventional tobacco products. Regulations should:
- Eliminate flavours, which appeal to young people
- Restrict advertising and promotion
- Regulate the content of vaping devices and solutions, including limits on nicotine
- Add health warnings to educate Canadians on the risks
- Limit sales to those 21 and older
So a whole range of regulatory initiatives are required. And then of course there's got to be appropriate enforcement.
It’s good to see that the federal government has started tackling this issue, with the announcement in December 2019 that regulation would restrict marketing and promotion to youth. But this is only a start, and we need much more to keep these harmful products out of the hands of young people and non-smokers.
What is standing in the way of the comprehensive regulation you want to see?
The tobacco industry is now big-time behind the vape industry. And with decades of experience in selling and addicting young people to harmful products, the tobacco industry is unparalleled in its ability to lie and to deceive the public, and to strenuously oppose any form of regulation.
Heart & Stroke and other organizations have been very active in making the case for regulation to governments and policy makers in every jurisdiction in Canada. We’ve called on governments to act quickly, because there’s an urgency around this issue.
Heart & Stroke position statements: