Health Committee on Oct. 28th, 2014

[Dr. John Britton]

I think the debate for us has been, and continues.... I'm presenting my overview and my opinions, but I don't speak for the United Kingdom; I speak for me. There have been many lines in it. One is that addiction is wrong, and as you suggest, that argument is often heard over coffee. There's the argument that doctors didn't think of this. These were not developed by a pharmaceutical company as a treatment for disease. These are a social phenomenon. So as public health physicians, we didn't think of this; therefore, it can't really be very good.

Then there's the opposition to the tobacco industry, which I entirely understand, but it is a secondary, rather than a primary, target. There's a lot of worry about gateway use and uptake in smoking. So it's been those things, and those arguments have been going on and continue now. But with the publication of the RCP report in 2007, I think those arguments came to the surface in Britain a little earlier than perhaps they did in other countries.

It's one of the truths of talking about harm reduction that until about two years ago it wasn't possible to have a conversation about harm reduction without arguing whether Swedish-Snus snuff was a good thing or a bad thing. Now it's whether electronic cigarettes are a good thing or a bad thing. I've said what I think on that matter.

[Libby Davies, NDP, Vancouver East, BC]

Just to further follow up, do you foresee a day in Britain where cigarettes would be banned, and that they would be completely replaced by e-cigarettes?

[Dr. John Britton]

As you suggested earlier, I think banning anything, and particularly anything that's addictive, is a very dangerous route to tread. But what I would like to think is that over the next coming years, in a decade or so, we will see tobacco cigarettes priced out of affordability for the great majority of people, and made much less available. So it's not that we prohibit them. We just make the obvious choice, electronic cigarettes, or at least their successors. This is a very rapidly evolving field, and in three or five years' time, we won't be talking about the products we're talking about today.

[Libby Davies, NDP, Vancouver East, BC]

I was on a flight recently and looking at the duty-free, and I was astounded when I looked at the price of a carton of cigarettes, even duty-free. I forget what it was, but I couldn't believe it; it was so high. So price is obviously part of a question around deterrence. But is there any research that tells us what the point is between price and people making decisions more based on health concerns, or is it really sort of a combination of the two? Does one outweigh the other?

[The Chair, Conservative, Ben Lobb]

I'm sorry, just for fairness of time, please give a brief answer, and then we'll have to go to Mr. Lunney.

[Dr. John Britton]

At the moment, most people who switch to electronic cigarettes in Britain do so for health reasons, although price is an issue. Price is a huge determinant of tobacco consumption, but it depends on the price of the cheapest tobacco products on the market, not the average. In Britain, our average is very high, but our cheapest products are still very affordable.

[The Chair, Conservative, Ben Lobb]

Thank you.

Mr. Lunney, take us home.

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

Thank you very much, Mr. Chair.

Gentlemen, thanks for contributing to our discussion today.

There's big concern here that you're dealing with a vaporizing delivery mechanism for all kinds of chemicals, not just nicotine. I think we're naive if we think that, for young people, putting nicotine in the chamber is going to be their drug of choice. Canada is very concerned, and it's all over the Internet, about how you prepare your own marijuana from dried marijuana with propylene glycol and ingest your marijuana that way, which bypasses the smell normally associated with marijuana, and so on. A whole range of other toxic chemicals may well be used and inserted, which have known and unknown effects. Is this part of the discussion? It hasn't come up in our discussion with you so far.

In the EU, in the WHO, have these discussions come up about the use of other products through the use of these e-mechanisms?

[Dr. Armando Peruga]

This is indeed a concern because it can be used for many other drugs. However, it's very difficult at this point to gauge the importance of this behaviour. One has to consider that they can do that not only with electronic cigarettes but also with many other things. The issue of the consumption of other, in this case illegal, drugs through some existing legal apparatus like an electronic cigarette requires a broader approach to enforcement.

It's not only a problem that pertains to electronic cigarettes. It may be compounded, however, by the fact that these products are now seen as very normal, at least in certain countries, and therefore pass totally inadvertently for others, in terms of enforcement in regard to the illegal use of drugs.

My point is that this is not a problem only with electronic cigarettes.

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

Dr. Britton.

[Dr. John Britton]

I would agree with that. Young people will find ways to consume drugs that they shouldn't, whatever we say or do. That's another issue which hasn't really been given a great deal of consideration.

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

A final question here. You mention cytotoxicity with respect to the WHO study. It was related to the concentration of flavourings in the e-liquid.

Dr. Peruga, can you briefly comment on that issue?

[Dr. Armando Peruga]

Yes, there have been a few studies. There are not many studies on that, but there has been some proof that the heating of some of these flavourings, what we call thermal decomposition, produces some cytotoxic products. That is true, but it's very difficult to gauge exactly what the importance is in terms of the final impact on health.

These comments were made more than anything to indicate that there are some concerns about toxics and cytotoxics that should be taken into account, especially as Professor Britton was saying, in order to regulate these products, to maximize the benefits but also to minimize their harms.

You can only do that through regulation. That's why one of the recommendations from the WHO is to minimize those harms through appropriate regulation and not on a voluntary basis.

[The Chair, Conservative, Ben Lobb]

Thank you very much. We really appreciate your time. We know you're very busy. Your comments and information have certainly been helpful today. Thank you very much, again, on behalf of all our committee members.

The meeting is adjourned.