Health Committee on Oct. 21st, 2014

[Hilary Geller]

We aren't aware of any e-cigarette manufacturing that happens in Canada. We certainly are aware that the vast majority of it is offshore, initially certainly in Asia. I think we're now seeing more happening in the United States. The vast majority of e-cigarettes would come into this country from abroad.

[David Wilks, Conservative, Kootenay—Columbia, BC]

I'm a little confused because it seems to me that Health Canada, being the regulatory body, would oversee the seizure of products, probably working with CBSA. We have a $3-billion business with 450 brands potentially coming into Canada. You or I could walk down to any store within two blocks of here and purchase these cigarettes but we have absolutely no regulatory framework to control it.

What would be your optimum enforcement view within one year, if at all possible? Regardless of having to study things to death to try to get to a regulatory body, where could we be in one year? We do know that e-cigarettes—some of them—contain nicotine. We know what we do with regular cigarettes with nicotine. That's pretty simple. The ones that I'm more concerned about are the flavoured cigarettes. There are some that are flavoured with illegal substances. I'll leave it. I can explain that to some degree later.

Is it possible for a child under the age of 12 to go into any store in Canada and purchase e-cigarettes and not be stopped?

[Hilary Geller]

I'll take the question. I'll start with the issue of the potential use of illegal substances in these cigarettes. Yes, we're aware of that as well. I think all I would say is that if illegal substances are used in an electronic cigarette, they remain illegal substances. If we're thinking of substances that are regulated under the Controlled Drugs and Substances Act, law enforcement has the authority they need to act.

In terms of a product coming into the country, as Peter said, the dilemma that any regulator has is, you have a limited number of inspectors, you have a limited number of dollars, and you have a universe that you have to regulate with that limited number of inspectors and resources.

In the world that Health Canada regulates, electronic cigarettes certainly—the nicotine and the flavours—are part of that, but so are prescription drugs, so are medical devices, and so are various other things that Peter mentioned. So when you're doing your risk-based approach, you're kind of balancing off the risk to the public from a bad prescription drug that's produced in a dirty facility and the harm that may cause hypothetically versus the hypothetical health effect of undeclared nicotine, or even more difficult to quantify, the potential to induce a young person to end up with a nicotine addiction. That is our struggle, to be perfectly honest. As the science develops, it will allow us to be more precise in how we make those risk trade-offs, because the product itself will be better characterized, and we will be better able to quantify the risk trade-offs that we face every day.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up we have Mr. Morin.

I'm sure all of our witnesses here today are quite versed in both official languages, but in case you're not, you might want to be prepared to take some French in here just now.

Thank you.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chair.

I very much appreciate the questions and answers that have been provided to us today on both sides of the table. We are learning a lot about electronic cigarettes. Most of all, we are learning that we don't know enough about them.

I have several questions to ask you.

My colleague David talked about regulation and I'm going to continue in that vein.

I am really shocked to learn that close to half of the 91 cigarettes that were tested contained nicotine, even if the packaging stated that they did not.

We have heard that 450 brands of electronic cigarettes are available in Canada. Are these the brands that contained nicotine, or did all of the brands contain traces of nicotine?

[Suzy McDonald]

That is a very good question.

As we said there are 450 brands, and there are probably more. The last figure was 466, and this continues to grow. Indeed, certain brands contain nicotine and others do not.

Most e-cigarettes that do not contain nicotine, that is to say the ones to be found on the licit Canadian market, are flavoured or scented and are disposable. New information on the Canadian e-cigarettes market is always coming to light, as it is a market that is growing rapidly.

You asked about the percentage of e-cigarettes that contain nicotine. My colleague cited the figure of 46%. Do you have a question for me on that topic?

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Yes.

Of the 91 e-cigarettes that were tested, half contained nicotine, even though their packaging stated that they did not. Are the companies doing this false advertising always the same ones, or should we worry about all of them?

[Suzy McDonald]

Several brands are at issue and are not produced by the same companies. We have samples of several product brands.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Well, this disturbs me considerably. We know that a lot of smokers decide to turn to e-cigarettes to get rid of their habit, but in actual fact, without even knowing it, they could be prolonging their dependency.

Addiction among young people also concerns me a great deal. According to the study you referred to, in Ontario, in 2013, 15% of young people from grades 9 to 13 had used e-cigarettes at some point in their lives. That bothers me a lot.

I understand that together, the Canadian, provincial and territorial governments want to decrease cigarette consumption, but the e-cigarette is being presented, as cigarillos are, to look sexy to young people, and they become addicted.

You also mentioned that more than three-quarters of those who smoked before the age of 20 became regular smokers at one point or another in their lives. It worries me a lot to see that cigarette use is on the rise.

Has Health Canada changed its anti-smoking awareness-raising campaign, in light of that?

[Suzy McDonald]

There are two aspects, one being the awareness-raising campaign, and the other a regulatory project that could protect young people. We don't yet have the data that would allow us to determine if e-cigarettes lead people to start to smoke. As you mentioned and as we did as well, we can see that a growing number of young people are trying these products.

If we look at what is being done abroad—and I think your colleague asked a question about that—we can also see that the United States, for instance, and the European Union, have proposed restrictions on sales to minors. That is a solution that Nova Scotia is also considering. We are studying all of these options. I think my colleague discussed the fact that this is one of the things we are looking at in the context of political action.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Mr. Lunney.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you very much.

I want to pick up on the theme we've been discussing here. You mentioned of course that Health Canada has been monitoring the scientific evidence, we've been evaluating the literature, but by Ms. Geller's admission the rapidly expanding usage is way ahead of the scientific evidence. We look at some of the facts that have come forward here about the impact on children of the ones that you intercepted and analyzed: many of them contain nicotine even though they didn't say they did on the labels. The WHO has identified a potential risk of fetal and adolescent nicotine exposure of long-term consequences for brain development. Those are things that cause me a very significant measure of concern. When we look at what you said about the study from Ontario, that 15% of students 9 to 12 had tried e-cigarettes, and a Cancer Society study in Quebec found that 34% of elementary and secondary students had used e-cigarettes, it seems to me this is rapidly becoming a major concern about the impact on children. A new generation of smokers is being created by exposure to nicotine. It seems to me there's a high-risk train that's roaring down the track here. By the time the scientific literature catches up maybe 10 years from now it's going to be a really immense public health concern with tobacco use, which has been declining, taking on a whole new manifestation here.

Maybe I'd follow up and just carry it to the next step and say that the other thing is of course that cannabis is being used in these things. I just did a little check online on all of the use of loading. Online you can see how to load your own e-cigarettes with cannabis oils and how to prepare it in about a couple of hours of creative work with the dried product. The impact of that on a new generation of young people who can smoke in front of their teachers, or in front of their parents, and because there's no smell actually think they're getting away with something....

We just did a study on the harmful effects of marijuana. It seems to me that there's a real need to get ahead of this somehow. The scientific literature may catch up, but I think we have enough evidence of the harm of nicotine to maybe put some restrictions on these products much more rapidly and restrict their use to those who might benefit in cessation programs through some of the measures identified by the American Heart Association, which had some five policy recommendations that could be employed fairly rapidly.

[Hilary Geller]

We agree. As the American Heart Association, the WHO, and others have said, there is a need for a regulatory regime that is sufficiently broad to deal with the scientific uncertainties that—you're absolutely right—will evolve over time. You want a regulatory regime that is broad enough and flexible enough to be responsive to the emerging science and our emerging understanding of the harms and the benefits, and one that protects youth. Youth protection is definitely foremost in our minds and certainly was foremost in the minds of these various international studies that you've mentioned.

Related to that, we certainly think it's important to have a regime that would protect the tobacco control gains we have made in this country. Canada remains a world leader. Something we certainly want to avoid is, through electronic cigarettes, seeing our gains in tobacco control erode.

I certainly agree with what you say, wholeheartedly.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Do you see, or does Health Canada see, any impediment to imposing some of the things that are recommended here, such as inclusion of e-cigarettes under smoke-free air laws, so as to have them smoked only in areas that are controlled such as we see at airports, and efforts to restrict youth access by making it illegal to sell e-cigarettes to minors, or restrictions on the marketing and advertising that is aimed at youth? And why not tax them high enough that only an adult who legitimately was using them to break a smoking habit might have access to these things?

Do you see any impediments to imposing that kind of regime?

[Hilary Geller]

In some of the areas you mentioned, no, I don't. For instance, I think having smoke-free spaces was discussed in response to a previous question. We are seeing municipalities act on this. It is by and large within the jurisdiction of municipalities, except in federal workplaces—and we are seeing movement there.

In some of the other areas you mentioned—for instance, restrictions on promotion to youth—there are challenges vis-à-vis the current regulatory regime. Under the Tobacco Act, these cigarettes don't currently meet the definition; therefore, the sorts of promotion regimes and restrictions and bans on sales to youth, etc., that you find in the Tobacco Act by definition are not applicable today to electronic cigarettes.

[The Chair, Conservative, Ben Lobb]

Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Mr. Chair.

Thank you folks for coming in today and talking to us about this issue.

I was struck, like many of us around the table here, with the opening remarks and the challenge of reconciling the comments that we don't have enough scientific certainty to recommend a regulatory regime and that discussion about regulatory regimes and policy recommendations is coming out of other jurisdictions and agencies. I guess all of my questions are going to be in an effort to reconcile those two parts of the presentation.

There was some discussion about the policy work being done in the department. Could you elaborate on what that policy work is and what the policy process is that would bring us to the point at which recommendations would come out of the department on this issue?

[Hilary Geller]

The policy work is focused in a couple of areas.

We are examining the Food and Drug Act, the Tobacco Act, and the Controlled Drugs and Substances Act and are going through an exercise concerning how we can use our current tools.

The gaps in how we can regulate a unique product like electronic cigarettes are emerging. We have discussed some of those challenges today and certainly we have seen them internationally pointed to as well, because these are a unique product.

We would have serious concerns about some parts; about others we're not so sure. So we are engaged in an exercise of trying to devise some sort of unique, we think, regulatory regime that would appropriately fit the risks and the benefits and the unknowns of this new product category.

I'll just note in that regard that at the FPT health ministers' meeting, Nova Scotia made a very useful proposal, to devise in cooperation with the provinces and territories a new regulatory regime that would have all those fundamental characteristics of youth protection, access for adult smokers, etc., that we have been discussing this morning.

We are in the process of working through the various options, the pros and cons, and the most efficient and effective way to regulate what is a completely new product category for us.

[Matthew Kellway, NDP, Beaches—East York, ON]

Does the department then have the capacity to do this work in a timely way? I'm wondering how Nova Scotia gets to a unique regulatory regime but the Department of Health doesn't.

[Hilary Geller]

Very simply put, it's the difference between recommending high-level principles, which are relatively easy to come to and certainly we've seen them stated in various places, and then turning that into actual, perhaps proposed, changes to legislation or regulation, and how that would actually work, what the most efficient and effective mechanism is, and what the federal role is versus the provincial and territorial and municipal roles. So it's kind of taking it from the level of concept to something that could be proposed to work well in reality.

[Matthew Kellway, NDP, Beaches—East York, ON]

I presume that's not a unique policy process, though. Other jurisdictions, I presume, approach these things in very similar ways.

[Hilary Geller]

It's not a unique policy approach. It's fair to say that if the WHO report highlights this, they did a survey of all the member states. The diversity in approach is striking. Some countries have banned electronic cigarettes outright. Others have no regulatory controls at all. Then there is a whole bunch in the middle. It's fair to say that there is no “one size fits all”. It really does depend on a country's unique structures, unique laws, and that country's analysis of the state of the evidence and what side they come down on.

[The Chair, Conservative, Ben Lobb]

Mr. Young, for five minutes, and that will conclude our first hour.

[Terence Young, Conservative, Oakville, ON]

You have an addictive product with a $3-billion market that is growing quickly. You have 450 brands and growing. There are stores popping up all over the GTA that sell these devices, and you have marketing to youth with fruity flavours, obviously to create customers for life. Does all this sound familiar? Does it bring to mind any other product?

[Hilary Geller]

Certainly there are parallels with the tobacco industry, yes. That's correct.