Health Committee on Dec. 2nd, 2014

[Neil Collishaw]

I am not.

[Terence Young, Conservative, Oakville, ON]

But you're in charge of research.

[Neil Collishaw]

I work for doctors, but I'm not one myself.

[Terence Young, Conservative, Oakville, ON]

Okay.

We had an accomplished surgeon here who was promoting the freer use of e-cigarettes, and who owns a company that produces e-cigarettes and also has a franchise or an invention that helps people worldwide turn hookahs into e-cigarettes.

Would you see that as a potential conflict of interest for a medical doctor, who's promoting a product like that and is going to make money when the product has freer sales? Can we rely on his evidence as being objective?

[Neil Collishaw]

I would agree that it is a potential conflict of interest.

However, as I and my colleagues have said this morning, there are potential risks from these products and there are potential benefits. The benefits come only in the area of possibly being something that could help people who are already smokers quit smoking and thereby reduce their hazard. If we get into an area where people who are currently not smokers are being encouraged to use these products, whether they're young people or older people, that is not a benefit to those people, nor to public health.

Let us not forget that while some people might have told you at this committee that nicotine is benign, it is not; it is an addictive product. The only circumstances I could see that there would be some benefit is if it were to help smokers to quit. We need to construct our regulations to maximize the benefit and minimize the harm.

[Terence Young, Conservative, Oakville, ON]

Thank you. That's understood.

Madam Tilson, I would like to talk to you a bit about stealth marketing. I appreciate your points on reducing advertising, and no celebrity endorsements, etc. What about product placement? Some movie stars will get several hundred thousand dollars to smoke tobacco in their movies, etc.

I also want to ask about your saying that there should be no free giveaways. I was in downtown Toronto once, and one of the drug companies had hired somebody to hand out free samples of Allegra, which is a prescription drug. I challenged the lady doing it. I asked her whether it wasn't against the law. She had a box. She said, “Well, just put a penny in there and now you've paid for it”. They have ways to get around these things. I know that they promote caffeine drinks. Sometimes they sponsor grade 8 graduations in the United States, etc.

Could you please comment? Should those things also be banned for e-cigarettes?

[Melodie Tilson]

Yes, absolutely. In fact, we have a free giveaway of e-cigarettes happening here in Ottawa as well.

What we're trying to do is what my colleague just emphasized. We want to make sure that e-cigarettes are available as safely as possible to smokers who want to quit, but not available and not promoted as the new lifestyle accessory the way cigarettes once were. We have to do everything possible to make sure there are no lifestyle promotions of any kind. Product placement in movies is one such type of promotion.

[Terence Young, Conservative, Oakville, ON]

You've mentioned here that you would like to ban the use of e-cigarettes on school grounds. Are you including inside schools as well?

[Melodie Tilson]

Yes, absolutely.

[Terence Young, Conservative, Oakville, ON]

School property, in other words?

[Melodie Tilson]

Yes. We've said that the use of e-cigarettes should be banned in all indoor public places and workplaces where smoking is banned, as well as outdoors on school grounds. Again, that's about not normalizing the use of these products for youth. Not only are we concerned that they could become a gateway to tobacco addiction, but we don't want them to become the next form of addiction that becomes socially acceptable.

[Terence Young, Conservative, Oakville, ON]

Thank you.

[The Chair, Conservative, Ben Lobb]

That worked out quite well.

Thank you very much for attending.

We're going to suspend for a couple of minutes. We're going to bring our other guests up and then we'll reconvene.

[The Chair, Conservative, Ben Lobb]

We're back in session. We have two guests for our second hour: Mr. Harrington and Mr. Jones.

Mr. Harrington is from Consumer Health Products Canada.

Mr. Harrington, we'll have you go first. You have 10 minutes.

[Gerry Harrington, Director, Policy, Consumer Health Products Canada]

Thank you.

Mr. Chair, members of the committee, thank you for giving me the opportunity to provide input into your study of e-cigarettes.

My name is Gerry Harrington and I am the director of policy for Consumer Health Products Canada.

Consumer Health Products Canada is the trade association representing the companies that make evidence-based, over-the-counter medicines and natural health products. These are the products you can find in medicine cabinets in every Canadian home, from sunscreens to vitamins to pain relievers and allergy medications. People use consumer health products to maintain their health and manage minor ailments. This is a fundamental part of self-care, which is vital to the health of Canadians and to the sustainability of our health care system.

Consumer Health Products Canada is very proud of the contribution that our members' products make to the reduction of tobacco use in Canada. Specifically, nicotine replacement therapies regulated as natural health products, such as gums, patches, inhalers, have been demonstrated to dramatically increase the odds that a quit attempt will be successful, and have made a very meaningful contribution to the reduction of tobacco use in Canada over recent decades. These products are clinically tested as smoking cessation therapies and are supported by both self-directed and health profession administered programs aimed at ending dependence on nicotine and tobacco smoke.

lt is our view that the evidence available today strongly supports smoking cessation as the most appropriate therapeutic end point for the use of nicotine-containing products. We want people to quit smoking, and when there is a sufficiently low potential for relapse, to quit using nicotine as well. The natural health products regulations are designed to ensure that products authorized for sale under their provisions offer Canadians benefits that outweigh any risks associated with their use. Ending a user's dependence on tobacco and their exposure to the extensive and well-documented harms associated with smoking is demonstrably a benefit that far outweighs the risks associated with short- to medium-term use of nicotine. However, the science is less clear on the net benefit to patients when they continue to be addicted to inhaled nicotine.

I emphasize that this science is still evolving, and we understand that's one of the key challenges before the committee today.

lt's extremely important to note that the approval of a smoking cessation product under the natural health products regulations requires not only clinical evidence of quality, safety, and effectiveness of the product as a nicotine replacement therapy, but also the provision of labelling and other patient information and supports that guide users through a program that aims to end their dependence on tobacco. Nicotine-containing natural health products are not merely nicotine delivery vehicles; they are proven, comprehensive smoking cessation therapies with both pharmacological and behavioural program elements.

While it may be arguable that long-term exposure to nicotine and the other components of e-cigarette vapour may be less harmful than cigarette smoking—and I think that is fairly self-evident—this harm reduction model is not consistent with the philosophical or legal underpinnings of the natural health products regulations themselves. Additionally, the availability of e-cigarettes as products intended for long-term use creates significant risks to Canada's tobacco control strategy. Specifically, by mimicking smoking behaviour, widespread e-cigarette use could renormalize smoking—something I know the committee has heard from other witnesses before—undoing decades of hard-fought changes to social attitudes toward this unhealthy behaviour. Further, dual use of e-cigarettes and combustible tobacco cigarettes may delay or undermine quit attempts and couId compromise the intent of public health measures banning the use of combustible cigarettes in public spaces. We've seen even today some of the advertising that speaks directly to that risk.

Finally, the very real risk of e-cigarette use acting as a gateway to nicotine use was reinforced by recent findings published by the U.S. Centers for Disease Control that more than a quarter million youth who had never smoked a cigarette used e-cigarettes in 2013. That's a threefold increase over the previous year.

In addition to our concerns about the risk to human health associated with approving e-cigarettes for long-term use, the status quo where illegal cigarette sales flourish in the absence of any real enforcement of the existing regulations exposes Canadians to further potential harms associated with the absence of provisions to prohibit unproven health claims for e-cigarettes; the absence of quality assurance to ensure the safety of both the e-cigarette devices and the supply of nicotine-containing fluid; the absence of child-resistant packaging for the nicotine-containing fluid; the absence of control over advertising, and specifically advertising directed to minors—and when I say advertising, I include the full range of promotional activities that would be addressed in those kinds of regulations; the absence of a prohibition on sale to minors over the condition and place of sale, including accessibility to minors; and finally, the absence of recall provisions and adverse event reporting provisions. As we have heard numerous times over the course of this study, the science is still evolving and hence the value of collecting adverse events has to be considered.

Today we're talking about e-cigarettes, but we don't know what new products the future will bring. CHP Canada urges the health committee to recommend that all nicotine-containing products, including e-cigarettes, be regulated to the same standard of quality, safety, and efficacy as natural health products, and that perhaps more importantly, these regulations be enforced by Health Canada to protect the health and well-being of Canadians.

Thank you. I look forward to your questions.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next we have Mr. Dave Jones from the Tobacco Harm Reduction Association of Canada. Welcome, Mr. Jones.

I'd also like to thank you for my Twitter account. You keep me very active there. I appreciate that.

Carry on.

[Dave Jones, Director, Tobacco Harm Reduction Association of Canada]

Thank you very much.

I would like to thank the HESA committee for inviting us today. My name is Dave Jones, and I am a retired military officer. I smoked throughout my whole 40-year career, and thought I would die with a cigarette in my mouth. I'm one of those anecdotes that you hear about and that no one thinks is real, like the unicorn, but I'm here. I am now 18 months free of tobacco cigarettes, and I use a personal vaporizer.

On a personal note, my health has improved. My cardiologist, GP, and dentist are very supportive of my vaping. My story is just one of thousands of other vapers in Canada.

I am also one of four unpaid volunteer directors with the Tobacco Harm Reduction Association of Canada, a non-profit organization. We are a national Canadian vaping consumer and vendor advocacy group with extensive links to Canadian vaping groups across Canada, the U.S., and Europe.

Canadian vapers, as the consumers of this product, have been waiting to have our say on this very important public health issue facing Canada. I would state that smoking and cigarettes are the main issue, as is this: how can we support getting smokers to switch to a safer alternative, or quit safely, to alleviate the 37,000 deaths attributed to smoking each year?

There are an estimated 300,000 to 350,000 vapers. We are a grassroots movement and growing in Canada, out of about five million smokers. Methods to stop smoking vary from NRTs to cold turkey and now electronic cigarettes as an alternative to smoking. The method that one uses to stop smoking is a personal choice that should be supported and not discriminated against just because we may or may not use nicotine.

The vapers we have talked to have expressed their frustration that e-cigarettes aren't being embraced by the tobacco control community, public health organizations, and political institutions even though they are much less harmful than combustible cigarettes. We need to ensure that public health gains and benefits are balanced with the possible risks associated with electronic cigarettes. We have an opportunity to replace tobacco smoking with a safe alternative. If we put too many onerous regulations and use invalid assumptions on this tobacco harm reduction strategy, we may lose a golden public health opportunity. Ideology, rhetoric, and invalid assumptions cannot be used to make sound regulations in policy. Regulations must be based on valid, truthful, scientific facts and be evidence-based to ensure that we have safe products and usable regulations and policies that benefit all Canadians.

Cigarettes have 4,000-plus chemicals and 70 known carcinogens. Electronic cigarettes have four to five chemicals and no carcinogens that we know of. Electronic cigarettes are not combustible cigarettes. Vapour is not second-hand smoke, and nicotine is not tobacco. Smokers smoke cigarettes for the nicotine but die from the smoke and tar. We do support and want regulations.

I'd now like to give a quick overview in terms of a presentation. Please bear with me, as I was just told yesterday that I had to give this.

Personal vaporizers are not smoking cessation devices. They are a safe alternative to smoking that can be used for cessation by the vaper. The use of electronic cigarettes, the act of vaping, is not smoking. The use of nicotine outside of tobacco has never been considered smoking. Vapour is not smoke and not any source of second-hand smoke.

There are 5.6 million smokers in Canada, and we have 37,000 deaths Canada-wide. We have 350,000 vapers in Canada, with approximately 10 million vapers worldwide. Big tobacco and big pharma profits are decreasing. Youth and adult smoking is decreasing because of many factors; one is vaping. Using NRTs is not great, with a relapse rate of 95%. There is a need for support of vaping and a new approach to public health goals of getting smokers to quit—the quit-or-die approach. Public health says there is not enough information, but we have over 200 studies released and more every day. Do not cherry-pick to suit an agenda. Can we wait for conclusivity? Can we wait for 20 years while Canadian smokers die?

I have 10 items that I would like to touch on in terms of recommendations.

The first item is youth gateway. Of course there is a big concern about the youth gateway to smoking in the use of electronic cigarettes. We are also parents. We are also grandparents. We understand that there is a concern about this. However, when you look at the youth who are trying e-cigarettes, no survey has shown that they go to smoking.

We have record lows of youth smoking in Canada, the U.S., and the U.K., and it has been declining yearly. We are very glad about that because we do not want to see our youth smoking.

Some of the results we have seen, though, is that many e-cigarette users or youth users were already smokers. There have also been reports in terms of the surveys that negligible youth or adult non-smokers using or trying e-cigarettes have gone to smoking. You must remember that trying and continuous use are not the same as smoking.

These are our recommendations:

Youth age bans on e-cigarettes must be implemented immediately. Advertising should be limited to smoking for adult use. I sent the U.K. CAP advertising rules that were adopted in the U.K. just last month to this committee. I won't go over all the aspects of that.

We should also promote education on e-cigarettes to everyone and the development of a youth-adult monthly tool survey kit with better questions for our youth. The U.K. uses this on a monthly basis, so it has monthly data to better serve and understand what the trends are.

We should have close monitoring of smoking uptake and modify regulations accordingly if there is an uptake.

What is in e-liquids? It's propylene glycol, vegetable glycerin, food flavourings, and possibly optional nicotine. Nicotine is the ingredient smokers crave in tobacco. People smoke for the nicotine but die from the smoke and tar. Nicotine is also found in vegetables. It is used in all NRT cessation products, but as somebody said, most vapours decrease levels. I personally started at 24 and now I'm down to 9. Actually, I'm down to 6. We find in a lot of cases that we decrease levels as we continue to vape, and a lot of people go down to zero but still use vaping as a habit.

The question whether we need to set a limit. Most people start out on 24 milligrams if they are a heavy smoker. That is something that has to be determined as a personal choice. In the U.K. they capped it at 20 milligrams, but a lot of people over there are heavy smokers so there is possibly a problem that these smokers may not switch because of that. I'd like to note that the EUTPD, European Union tobacco product directive, is being legally challenged at this time in that specific area.

The sale of bottled e-liquids to consumers must be allowed with defined regulations in place. We agree. We need to have regulations on the nicotine and the selling of nicotine in the form of e-liquids. These things need regulations. They also need to have the proper labels and warnings.

We also must establish and actively enforce consumer standards for electronic cigarettes themselves. Cartridges, tanks, and e-liquids are consumer products that need to have consumer regulations.

Why we haven't touched upon nicotine poisonings, I'm not sure, but we do hear a lot about nicotine poisonings, especially with youth, and we are very concerned about that. In Canada it hasn't been reported much; however, we do know there is some out there. In the U.S. there are quite a number of reports, 2,700, but out of 2.2 million calls it is 2,700 calls.

Our recommendations are that we need to educate the vapers using e-liquids to be safety conscious, just like for any other product that we use in the house. The sale of bottled e-liquids to consumers must be allowed with defined regulations in place, addressing manufacturing and labelling to provide a safe and secure product. I believe that is being self-regulated right now, but we do definitely need that.

Poisoning reports should contain reasons for the contact and follow-up actions to be taken. At this time they are reported to provincial poison control centres and then to Health Canada. If there is a problem, they should also be sent to ECTA, the Electronic Cigarette Trade Association, which is the industry regulator, so that from an industry point of view we can actually make changes if it's an industry problem.

On item 4, flavours, we have done surveys on this—fruits, sweets, tobacco, drinks, and beverages. I personally use fruits as my flavour.

[The Chair, Conservative, Ben Lobb]

We are at 10 minutes. Would you be able to wrap up your presentation in about 30 seconds or so? We'll try to flesh out your presentation through the questions.

[Dave Jones]

Okay, I'll go straight to my conclusion.

Electronic cigarettes and vaping should be endorsed as a tobacco harm reduction strategy that can minimize or alleviate over 37,000 Canadian smoking-related deaths each year.

All consumer products are regulated, and e-cigarettes should not be an exception. Consumers need to feel confident that they are purchasing safe, high-quality items. But the regulation of e-cigarettes needs to be proportionate and not discriminatory, especially considering the potential they offer for eliminating the scourge of tobacco-related diseases.

Any regulations should include input from all stakeholders, including industry and vapers.

Science and evidence rather than anti-tobacco ideology and rhetoric should be the guides for public health policy and electronic cigarette products that are free of tobacco. Such policies and outcomes will save Canadian lives now and into the future.

I would just like to put forward something from Mitch Zeller of the FDA, who said that if we could get all smokers to completely switch all of their cigarettes for one of these non-combustible products, that would be good for public health.

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

We're going to go to our rounds of questions.

Up first is Ms. Sellah.

Go ahead, please.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Mr. Chair.

I listened to all of the witnesses with close attention. I thank them for having agreed to appear before us and for providing us with a lot of information. Whatever their position or objectives, their contribution will enlighten us and allow us to determine what the federal government can do about this issue.

Mr. Jones, I appreciated your testimony, which was based on your experience, very much. I sympathize. However, I would like to say that e-cigarettes were not designed to provide a dose of nicotine, even though they of course imitate the sensory experience of smoking. As we know, e-cigarettes include a battery, a cartridge and an aroma. In your recommendations, you say that e-cigarettes are neither tobacco, nor medication.

Do you not think that as a precaution it would be better to wait for the scientific studies to prove that these cigarettes are innocuous or provide any benefits? For the moment, we do not have the scientific data that would allow us to compare the advantages and disadvantages of e-cigarettes.

[Dave Jones]

Thank you very much for your question.

I do believe we need to have regulations regarding age restrictions. I think that's one of the biggest things we would like to see happen.

Of course, we need to have more studies to give us more information on whether there are any problems associated with vaping, etc., to users or bystanders. We already have that in place and we have basically stated, although not conclusively, that there is very limited harm to the user or to bystanders.

I would like to see more studies, but in terms of conclusiveness, will there ever be a day when they say this is definitely a product that is perfectly safe? There is nothing perfectly safe. Risks and safety are in shades of grey. I would like to see further studies provided by Health Canada, and of course the use of and follow-up from those particular studies to help us further in terms of regulations in the future.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Mr. Chair.

Mr. Jones, you say that you would like to see studies done, but as the witnesses who preceded you demonstrated, 20% of non-smokers are attracted to this type of cigarette.

Studies may eventually show that there are adverse affects for that category of consumers. I would like to know your opinion on that.

[Dave Jones]

The people who actually try e-cigarettes have been found not to have gone on to anything further than just trying. Experimental usage is a proven thing that is normally done with any new product, so when you look at that, you have to look at it with a very clinical eye.

Does the actual experimentation translate to actual continual usage and then possibly to smoking? At this moment, we have seen through the statistics and surveys that this has not happened. It has not translated into continuous usage or the uptake of cigarettes by youth or by non-smokers. It's like trying a new drink. You will try it, but if you don't like it, you won't go for it. So far studies have shown that people who have tried e-cigarettes have not gone on to smoking. We have record low levels of youth not smoking anymore. They have not translated from that into smoking. I think that's really shown in terms of statistics right now.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Mr. Lunney for five minutes, sir.