BEAMSVILLE, Ontario, March 02, 2023 (GLOBE NEWSWIRE) -- Member of National Assembly Enrico Ciccone recently implored Minister of Health Christian Dube to implement the 7 recommendations from a public health report on vaping. These recommendations include banning flavoured vape products, requiring a permit to sell vaping products, limiting the number of vaping stores near schools, and implementing a tax on vaping products.
In either an effort to score cheap political points, or a complete misunderstanding of the role of harm reduction, MNA Ciccone called vaping products junk and a danger to the youth of Quebec. ‘Won’t someone think of the children’ is a rhetoric tactic as old as time. Moral panic has become the tone of all media discourse on vaping. Negative news stories drive views, incentivising the media to rarely cover the public health benefits of vaping. Science has caught up to vaping and it doesn’t support the harm previously claimed by anti-vaping groups. This in turn, has forced these organizations to attempt to further their agenda by forcing their prohibitionist and moralistic mentality on the rest of us. In this case, however, we agree that flavour bans and other prohibitionist policies are a moral issue. It is certainly immoral to condemn 13,000 Quebec smokers each year to a premature death when vaping has proven to be the most effective stop smoking aid. We further question the morality of prohibiting a key component of a harm reduction product, knowingly pushing many former smokers back to an addiction that kills half its users. Further still, we question the morality of baring the vape industry from participating in harm reduction conferences and consultations, while allowing the pharmaceutical companies whose product sales are impacted by permissive vaping regulation to sponsor these events. And finally, we also have a moral objection to bans on a life-saving product and the careless disregard shown for the lives of smokers.
Governments everywhere owe it to their citizens to define the relative risk of vaping. Nicotine vaping has been found to be significantly less harmful than smoking. Public Health England has for the 7th consecutive year reaffirmed that the harm from vaping is unlikely to exceed 5% of smoking. Health Canada also states that vaping is significantly less harmful than smoking and that smokers who switch completely to vaping reduce their exposure to the harmful chemicals found in cigarette smoke.
Although the Canadian Vaping Association (CVA) disagrees with many of Member Ciccone’s comments, we agree that continuing to protect youth should be a priority. However, Member Ciccone’s call to action is flawed and misinformed at best. Taxes and flavour bans have repeatedly been found to increase smoking rates, weaken youth protections and exacerbate a rapidly expanding black market.
Flavour bans are a source of significant irreparable harm to people who smoke and their families. Smoking remains the leading cause of premature death and illness in Quebec. Each year, 13,000 Quebecers die prematurely from smoking related causes. The sole focus on policy to protect youth from experimentation, neglects the health of adults who smoke. Canadians have a constitutional right to access effective products to reduce their harm. Removing flavours reduces vaping’s efficacy as a harm reduction product while also lessening vaping adoption by adult smokers. These policies negate the health of millions of smokers globally. We would like to remind Member Ciccone that Quebec has among the highest smoking rates in the country and his outrage should be focused on the problem and not the solution.
Vape Product Taxes Increase Smoking
Numerous studies find that taxing vape products increases rates of tobacco use. Tax on vape products must be relative to harm or legislators risk increasing tobacco use and harming public health. Dr. Ian Irvine, Professor at Concordia University in Montreal states in his tax commentary paper that a tax on vaping products should not exceed 5-10% of the tax on cigarettes. As Canada already has a steep federal levy on vaping products, the addition of a provincial levy would make vaping products more expensive than smoking for some product categories.
A study from Georgia State University researcher Michael Pesko, published in the Journal of Risk and Uncertainty, has found that raising taxes on vaping products increases the sale of tobacco. The findings show that increasing taxes on vaping products results in a corresponding and predictable increase in cigarette use. Likewise, increasing taxes on cigarettes boosts adoption of vaping products. Unlike previous studies, the authors were able to measure the actual use of the products because they were able to access “geocoded” versions of the survey datasets they employed. This allowed for a highly accurate assessment of the effects of tax changes by studying specific geographic areas and cross-border economic activity. In addition to the surveys employed, researchers accessed scanner data of 35,000 retailers.
The researchers used data collected in two large US government surveys the Behavioral Risk Factor Surveillance System (BRFSS), and the National Health Interview Survey (NHIS) and concluded that cigarettes and vapour products are economic substitutes, if the price of one product increases, it causes a use increase of the other. In states where cigarettes prices were extremely high relative to vape products, there was no price incentive for vape users to switch to cigarettes. However, where pricing between the two products became similar with taxation, researchers found taxation pushed vapers to smoking.
In a press release discussing the findings of the research, Pesko said, “We estimate that for every one e-cigarette pod no longer purchased as a result of an e-cigarette tax, 6.2 extra packs of cigarettes are purchased instead. The public health impact of e-cigarette taxes in this case is likely negative.”
Additionally, a study conducted on Minnesota, has found that vapour product taxes increase cigarette sales. “The impact of E-cig taxes on smoking rates: Evidence from Minnesota,” found that taxing vaping products would lead to an 8.1% increase in tobacco use and a smoking cessation decrease of 1.4%. It also found that if vapour products had not been taxed an additional 32,400 adults would have quit smoking.
Flavoured Vape Products Support Smoking Cessation
There is high certainty evidence that vaping is more effective than nicotine replacement therapy products for quitting smoking. A Cochrane review, a systematic review of the top 50 studies on vaping’s efficacy, and internationally recognized as the highest standard in evidence-based health care, found that smokers who quit with vaping were almost twice as likely to be successful quitting as those who used other products like patches and gum. Vaping’s efficacy is largely credited to the customizability of the product. Unlike other quit smoking products, vaping is not a one-size-fits-all approach. The increased smoking cessation rates are attributed to the tailored options available to smokers. The abundance of delivery types, flavours and nicotine options, makes vaping effective for a larger number of smokers than traditional cessation products. Of all these customizable factors, flavours have been identified as the key driver to adult adoption and cessation success.
Within the Canada Gazette, Part 1, Vol. 155, No. 25, Health Canada makes the following acknowledgements regarding the role of flavours for vaping adoption and cessation for adult smokers:
- Health Canada is aware of self-reported information from people who vape indicating the important role flavours played in helping them transition away from smoking, and in continuing to help them maintain abstinence from smoking.
- Measures to limit flavours in vaping products to reduce their appeal to youth may also make these products less attractive to people who either vape as an alternative to cigarettes or to stay abstinent from smoking.
- Fruit flavours are the preferred choice for adults and youth.
- A recent study conducted in both Canada and the United States shows that a variety of non-tobacco flavours, especially fruit, are popular among adults who vape, particularly among those who have quit smoking and are now exclusively vaping.
- [A study] indicates that people who vape, and use “sweet flavours” (which included 11 different flavour groups, namely fruit, candy, and desserts), were more likely to transition away from cigarette smoking and quit cigarette use, at least in the short term, compared to those who used tobacco-flavoured or unflavoured vaping products.
Additionally, a consumer survey report, Canadian vapers: Attitudes Towards Flavour, found that:
- Flavour is the top factor for Canadian vapers when choosing their e-liquid.
- Over half intend to continue using their favourite flavours if they are banned, both in provinces with restrictions and those without.
- Canadian consumers adapt their flavour preferences to the restrictions, but are much more likely than US vapers to return to combustible products in the face of any clampdown on flavours.
Youth experimentation does not justify the dismissal of hundreds of thousands of declarations regarding the importance of flavours for quitting and the emerging science. Flavours aiding in smoking cessation is not a phenomenon unique to vapour products. Research into nicotine replacement therapies (NRTs) finds that flavours reduce cravings and increase success rates.
In contrast to the proposed flavour restrictions, all oral NRT products are available with flavours. These products are available off the shelves of pharmacies and grocery stores and have no age-verification requirement.
The proposed policies will increase crime and weaken youth protections
The ease of manufacturing and importing illicit vape products, coupled with the demand that will be created for untaxed flavoured products, makes vape products attractive to contraband channels. These channels have already grown notably following the implementation of the federal nicotine concentration limit of 20 mg/mL. The Canadian Vaping Association has clearly outlined and warned every government across the country about the rapid expansion of the illicit market. Vape products are incredibly simple to manufacture and Member Ciccone’s proposed policies will result in a flourishing black-market.
A consumer survey found that half of vapers surveyed plan to continue using a flavoured product even if they are banned. This demonstrates the ease at which contraband vape products can be obtained and the lack of enforcement to stifle these channels.
As is the case with any controlled substance, youth are especially susceptible to the black-market and the absence of regulation circumvents age, labelling and advertising requirements. If other adult products were regulated consistently with the concern over past 30-day vape use, both cannabis and alcohol would require severe restrictions, as both daily and past 30-day use prevalence are greater than nicotine vaping. Alcohol is considerably more harmful than nicotine vaping and despite use being more prevalent than vaping among youth, flavour restrictions have not been considered. This is likely because like vaping, youth are not consuming alcohol for the flavours.
All controlled substances are known to negatively effect brain development, however alcohol carries greater external risks such as car crashes, falls, drowning, suicide, violence and can lead to being a victim of violent crime. Given that alcohol is known to cause cancer and its use among youth is more than double that of vaping, we ask Member Ciccone why he is not urging his colleagues to ban birthday cake vodka or cannabis gummy bears?
The answer is likely because prohibition policies are ineffective and erode youth protections, an outcome that has been seen in many regions. Recently, Australia announced that it will walk-back its ban on vape products to end the black-market and reduce youth experimentation. "Prohibition has failed once again. Banning nicotine vapes has only created a thriving black market that gives children easy access to nicotine products," said Greens health spokeswoman Cate Faehrmann. We encourage Member Ciccone to speak with Ms. Faehrmann or other policy makers to understand the demonstrated harm of prohibitionist policies.
Quebec doesn’t even need to look outside of Canada for guidance to understand the impacts. The combination of a flavour ban and increased taxation has already been implemented in Nova Scotia. Within 90 days the legal industry was decimated and replaced by the black-market. Nova Scotia has yet to produce any data to suggest that these policies had any effect on reducing youth vaping.
The solution
As Member Ciccone correctly stated in his speech, he is not a scientist or a health expert. Recommendations on vaping or any public health policy are best left to subject matter experts and academics who recognise the value of vaping to society and the complexities involved in regulating it. Though the CVA disagrees with some of the 7 recommendations, others are reasonable, practical and have shown to be effective in other regions.
Quebec should implement stronger specialty vape store licensing utilizing municipal public health agencies. Being able to identify vape outlets is the first step to consistently enforcing regulations and conducting secret shopper programs.
Additionally, prohibiting new vape shops from opening within a reasonable distance of schools is a practical recommendation that would reduce visibility and inducements to vape from reaching youth. The CVA would support this recommendation if Quebec chooses to implement it.
Canada currently has among the strongest and most balanced youth protection regulations in the world. Instead of a flavour prohibition and increased taxes, Quebec should look to work with the federal and municipal governments to strengthen enforcement efforts. In the Tobacco and Vaping Products Act (TVPA) legislative review, Health Canada calls for such a working group to be formed.
Youth who try vaping most commonly cite stress as their reason for vaping. Youth desperately need better access to mental health supports and more education on the dangers of youth vaping. Education is among the most effective methods to combat youth experimentation. According to Health Canada, 26% of youth who saw educational vaping ads decided not to try vaping.
Regarding the recommendation to increase taxes, the price of vape products has already undergone a substantial increase because of the federal excise tax. The stated purpose of this levy was to dissuade price sensitive youth from trying vaping. We need only look to the regulated Cannabis industry to see that high levels of taxation have not dissuaded youth from using cannabis. Youth do not care if the source of their supply is legal. Heavy-handed taxation has not acted as a youth deterrent, but it has made it extremely difficult for legal cannabis producers to compete with the black-market.
Instead of implementing its own provincial tax, Quebec should look to enter a revenue sharing agreement with the federal government and use these funds to increase enforcement, education and mental health supports for youth.
Conclusion
Thousands of Quebec vapers are demanding that Members of National Assembly take the time to understand the issue and the importance of vape products to those who rely on them to remain free from combustible tobacco. Those that were elected to represent the interests of all their constituents must do better. It is not a choice between protecting young people or reducing smoking. We can do both. To do both, requires our elected officials to engage with their constituents to truly understand the issue and not simply vote yes to politically convenient solutions that impact the health of thousands of Quebecers. Vapers are not being hyperbolic when their protests signs say their lives are at stake; smoking kills half of its users. Vaping is part of the solution to reduce tobacco use and illness. The vape industry shares Member Ciccone’s goal of protecting the health of Quebecers, including youth, but policy must consider the health of every citizen.
If Quebec continues down this senseless path, the Canadian Vaping Association and industry will be pursuing a legal challenge. The industry will always defend Canadian’s right to access effective harm reduction products.
Contact - Darryl Tempest, Government Relations Counsel to the CVA Board, dtempest@thecva.org
