Health Committee on Oct. 28th, 2014

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

In Canada, Health Canada doesn't allow any e-cigarettes with nicotine currently, but are there other jurisdictions that do permit that, and at what levels are they permitting that tobacco?

[Dr. Peter Selby]

If your question was about e-cigarettes that contain nicotine, they tend to be available in the U.S. and Europe as well. Some jurisdictions are beginning to.... The only ones that don't allow it are Australia and Canada. They are the two ones where e-cigarettes are available as long as they don't continue nicotine. Those are the two that I'm aware of, but in the U.S., as long as the e-cigarette manufacturer is not making a health claim, they can sell that product with nicotine.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

But are you aware of what content levels they're allowed? Are you aware of how much tobacco is permitted or what current regulations they have? Are they approaching this systematically?

[Dr. Peter Selby]

In general, tobacco is not put into it. It's actually nicotine that is extracted, so the other compounds and chemicals in tobacco are not there. There's a look at whether there should be a 18 mg limit or not, but again, that rationale behind that is still being debated. The regulatory framework in the FDA is beginning to look at this, but I'm not aware of others that are setting limits per se. I think that 18 mg limit is beginning to surface in some fora, but whether that's definitely going to come through I'm not in an expert position to comment on that right now.

[The Chair, Conservative, Ben Lobb]

Ms. Fry, for seven minutes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Mr. Chair.

I've heard the answers about whether or not second-hand vapour is dangerous. I have also heard about children picking up some of the vapour containers or the flavoured nicotine bottles and being at risk as a result of that. However, the reality is this: the product is now being sold on the Internet. It's very difficult to contain the Internet, as we all know. We even have people getting prescriptions on the Internet from people who have never examined them, so it's very difficult to do this.

The question then is this: If we cannot stem the accessibility of this thing because of the Internet, if we know of its dangers with regard to children and, perhaps, second-hand vapour, is it therefore not logical and practical to look at ways in which we might be able to regulate the use of this product? That's the first question I want to ask.

The second question is, do we have what we need to regulate age and also the potency of the amount of nicotine? We have seen in some instances, in dealing with other addictions, the argument made by the e-cigarette manufacturers that it can help people to get off cigarettes and is therefore a good thing. We've seen people use the methadone argument and other arguments in the case of opioids for this.

So I'm asking you what are the dangers of not regulating? What are the dangers and the harm to people of the easy accessibility? And should we not look at whether or not using nicotine in this manner might be an appropriate way to wean people off cigarettes per se?

I'm asking you this with no bias whatsoever. I haven't come to any kind of decision and opinion on this. I'm simply asking you.

[Dr. Peter Selby]

Thank you very much for that question, Ms. Fry.

When you look at regulations, I think history has taught us that people do use substances, and how can we reduce the harm to them, their families, and the communities in which they live? When we look at the regulation, I agree with you that we need to figure out how to regulate that product so that people are not choosing to buy things on the Internet that could blow up or expose them to chemicals and toxins. Suddenly, we need to regulate the practices that we have. We've done that with tobacco, for example, and so much of that could be applied to this as well. Those are certainly areas of regulation that could help.

Failing to do this, we will undermine all the progress that we've made in reducing the harm from tobacco. Yes, we are stuck, but we are certainly not at the 50% level of prevalence that we were in the fifties. We're down to 20% or thereabouts. Can we go lower? Absolutely, we can go lower. If we have a safer product how can we show that it's demonstratively safer or substantially safer, and then make it available under a regulated framework so it is mostly in the hands of adults? Of course, there's never a way that you can keep everything 100% away from children, but at least if you can keep it away from the bulk of children, most adults who are stuck with this addiction....

I am currently doing a study in family medicine right now across Ontario, and I can tell you that in that study, with no coercion, we are getting terminally ill people voluntarily wanting to quit smoking before they die. I have never seen that happen. People are dying to quit, and it is really difficult for them. If they don't have an alternative, it is really difficult.

I think we owe it to the next generation to really help move this needle by creating a regulatory framework around electronic cigarettes or electronic delivery devices to make sure that we can harness that technology for good while minimizing any harm and mitigating the harm to others.

I don't know if that answers your question, but that's where I stand on this.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I have another two minutes, so I'm going to put forward a theory and nothing more.

If one regulated e-cigarettes, so that the nicotine and all the tars and benzopyrenes, etc., that come with the combustible cigarette are gone, could one then make cigarettes illegal and allow for the vaporizers and e-cigarettes to be legal products?

[Dr. Peter Selby]

That's a great question and a very exciting one because I think we've done that before. We can go back in history, and I used that example of leaded gasoline. We got rid of it; we got rid of leaded paint and leaded gasoline, and it's been a very important public health move. What we can learn from that is that when there's a safer alternative, generally the industry is made to put the safer alternative on the road. If you look at regulations around cars and the manufacture of cars, we don't allow cars with tires that explode to be on the road anymore, or cars that catch fire when they get into an accident. We use a combination of regulation and market forces to create a better product and better health. As a physician, I can tell you that I want to see that it's not all going to happen in the clinic; it's going to happen outside of the clinic and that's going to change and improve the health of Canadians. It's not going to be on a health care delivery system where that's going to happen. We see the impacts when good policies don't come into place.

[The Chair, Conservative, Ben Lobb]

Mr. Young.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Doctor, if you were treating an adult female who drank half a bottle of vodka every day, and you were giving her your best advice and you felt she was going to take that advice, would you recommend that she switch to wine or beer because she might drink less alcohol?

[Dr. Peter Selby]

That's a great question. It's very contextualized. If, for example, we have done—

[Terence Young, Conservative, Oakville, ON]

Brief answer, please.

[Dr. Peter Selby]

If it's a yes or no answer, it would be no, if she hasn't done anything else.

[Terence Young, Conservative, Oakville, ON]

Thank you.

What is the worst health addiction we have in Canada? What causes the worst social problems, the worst health problems, the most human misery and costs to our economy?

[Dr. Peter Selby]

The consumption of combustible tobacco.

[Terence Young, Conservative, Oakville, ON]

What is the second worst?

[Dr. Peter Selby]

Alcohol.

[Terence Young, Conservative, Oakville, ON]

You may be aware that in Ontario, for example, we have one of the most sophisticated regulatory regimes in the world. It is quite excellent. When people go in to buy alcohol, they're carded strictly to age 25; the bars close at 2 a.m. and don't open again until noon; people who have bars that are overcrowded or over-serve their clients can have their licenses suspended or revoked; and we tax alcohol massively. There are no shortages of regulations and yet alcohol addiction is still one of the largest problems we have in our society and sales keep going up. We also know there are hundreds of millions of dollars, in Ontario alone, of bootleg alcohol sold in after-hours clubs, etc. Regulation are not solving the problem, would you agree?

[Dr. Peter Selby]

I would disagree on the basis that you have to compare it to what you were comparing it to. Regulations will never solve a problem 100%, but compared to the alternative—which we've learned from prohibition, which caused more problems and more deaths than—

[Terence Young, Conservative, Oakville, ON]

I understand, when it's compared to having no rules at all.

[Dr. Peter Selby]

In the absolute it won't; you're absolutely right.

[Terence Young, Conservative, Oakville, ON]

Compared to having no rules at all, yes. Understood.

Why do you professionals at CAMH take this academic approach when you're studying addictive substances instead of cautioning people against a new addiction or cautioning Canadians about the health problems and dangers caused by marijuana, or potential dangers caused by e-cigarettes? It's like you're accepting addictive drugs, like you're saying, well, they're going to be normalized so let's just legalize them, and yet we know that regulations don't always work, to say the least.

I'm wondering why you don't focus your messaging on protecting people from the dangers of addictions and new addictions instead of somehow looking for ways to normalize the use.

[Dr. Peter Selby]

I think there may be some confusion. There is no way that we are saying that by legalizing something that you are normalizing its use. I think that is—

[Terence Young, Conservative, Oakville, ON]

No, I'm saying that.