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.
How did this all get started?
In the Canadian context, vapes with nicotine were legalized in May, 2018. But at the outset, these products were not regulated in any meaningful way. It was essentially the wild west.
Many products deliver a phenomenal amount of nicotine.
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, which is one of the most addictive substances available.
Who is using vaping devices?
Almost half of vape users are youth 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 112% increase in the rate of youth vaping from 2017 to 2019.
Many of these young people are completely oblivious to the fact that they'll get addicted to nicotine very, very rapidly. Recent research shows that among young people who vape in Canada, almost 60% have tried to quit numerous times.
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’ve also seen some acute lung injuries, from inhaling the chemicals in vape devices. While the Canadian investigation is ongoing, U.S. authorities have traced these to an additive in illicit e-liquids that contain THC.
In young people, we also see impacts on their developing brains. Nicotine is harmful and can stunt brain development. Canadian vape research found that about 2/3 of young people are using the highest levels of nicotine available on the market. They are vaping most days of the week and 19-30 times a day. 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 limited and unclear.
I think that potential has been lost because of the weak regulations of these products. As a result many health organizations, authoritative journals and professional organizations do not recommend the use of these vaping devices. Appropriate regulation and oversight would allow us to begin to consider their use as smoking cessation aids.
Unfortunately, we know that most vapers are also current smokers, becoming what we call dual users. There is evidence that dual users 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 seen some recent leadership in policies to address the youth vaping crisis, but much more needs to be done to prevent youth uptake and reduce vaping rates among young people.
We need a comprehensive approach, which reflects the approaches we have taken to address the use of commercial tobacco products. Governments should:
- Eliminate flavours, which appeal to young people
- Restrict advertising and promotion
- Regulate the content of vaping devices and solutions, including limits on nicotine
- Tax vape products to reduce affordability and limit youth access
- Add health warnings to educate consumers on the risks
- Limit sales to those 21 and older.
So a whole range of policy measures are required. And then of course there's got to be appropriate enforcement.
It’s good to see that the provinces and federal government have started tackling this issue. There has been some leadership at the regional level with flavour restrictions, nicotine limits, age of purchase increases and taxation.
In July 2020, the federal government restricted 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. We also need policies that protect all people in Canada, not just those in certain provinces.
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.