Thank you very much.
I know you've heard from a lot of speakers, so I'm going to be brief. I'm a researcher. I've conducted research on tobacco products, and we're preparing a clinical trial on e-cigarettes. I want to focus on two issues today: I have some Canadian evidence that you may not have heard, and I'm going to try to provide some context to what you've heard from others.
I think it's clear that an e-cigarette is a drug-delivery device in the same way that nicotine replacement therapy is a drug-delivery device, and a cigarette is a drug-delivery device. What separates them is the mode of delivery and how they deliver nicotine. Cigarettes deliver nicotine via smoke deep into the lungs in a manner and at a dose that maximize addiction. As you've heard, it's not the nicotine that causes the cancer or most of the health effects but the chemicals released during burning in the smoke. As long as cigarettes produce smoke, there's very little or no possibility of reducing their harm.
The main difference between e-cigarettes and nicotine replacement therapy is that e-cigarettes deliver nicotine into the lung rather than using mouth or throat absorption. The consequence is that e-cigarettes are more rewarding to use—not as much as cigarettes are but far more than the patch and the gum are.
The abuse liability, the extent to which they're addictive, we don't know. They're almost certainly more addictive than the nicotine patch or gum are but also certainly less so than cigarettes are.
You've had a lot of discussion about health risks. Let me be clear: there's no doubt that vaporized nicotine inhaled into the lungs will pose a risk to users. We don't know the full nature of that risk, but we do know that this risk from e-cigarettes is many times less than the risk from smoking cigarettes. It could be 100 times less, or it could be 500 times less, but there's no doubt that e-cigarettes pose less risk than cigarettes do. The risk is likely to be higher than that associated with conventional NRT.
A lot of the debate has focused on the absolute risk of e-cigarettes, but this shouldn't obscure the fundamental issue. The public health benefit or harm from vaporized nicotine will not be determined by the absolute risk alone of these products but by how they affect cigarette use. There are three ways they can affect cigarette smoking. They may help people to quit. They may help sustain smoking among users, and they may promote uptake among youth. You have probably heard people argue both sides of that debate. The fact is there's evidence to support all three outcomes. We know that many smokers use vaporized nicotine e-cigarettes to get off smoking. There is evidence—it's not conclusive—from trials and other experiments that they may be an effective cessation aid.
When we asked Canadian smokers recently, we found that they are just as likely to say that they'll use an e-cigarette to quit smoking as they are to say they will use nicotine gum or a patch, and they are about twice as likely to want to use e-cigarettes as they are to want to use prescription medication. In countries like the U.K., smokers are using e-cigarettes more than other forms of smoking medications to quit, and that's despite the fact that those medications are widely available and subsidized in a way that they're not currently in Canada.
I would suggest that it's easy to overlook or to minimize the potential benefit of vaporized nicotine to smokers. Smokers are a highly marginalized group. They have disproportionately lower income; they're less educated; they have very little political capital. Most Canadian smokers have tried to quit, and half of them are likely to die if they don't stop inhaling smoke. There are 4.5 million of them.
In most of these policy discussions, smokers have received very little consideration. I'd suggest that this is unfortunate. I don't believe that it's melodramatic to state that for many hundreds of thousands or perhaps millions of these Canadian smokers that vaporized nicotine may be one of their better options for avoiding death through their addiction to cigarettes.
At the same time, we know that other smokers are using e-cigarettes in ways that sustain instead of reduce their smoking. About a third of e-cigarette users in Canada say that they use e-cigarettes for times when smoking isn't allowed. That can help sustain their smoking when they might otherwise quit due to smoking restrictions at work.
In terms of smoking uptake, it's also true that an alarming number of youth are experimenting with cigarettes. Some recent data from Ontario and Quebec suggests that anywhere from 15% to 30% of youth are trying e-cigarettes. That includes virtually all youth smokers, but it also includes non-smokers. In Quebec, close to one-quarter of non-smoking 11- to 17-year-olds have tried e-cigarettes.
In terms of their rate of current use, which we define typically as use in the past month, that is quite low. Among non-smokers, it's usually somewhere around 1% in countries like the U.K. or the U.S. There's an exception to this. The Quebec study suggests that 4% of 11- to 17-year-old non-smokers were using e-cigarettes in the past month. That's about 24,000 kids in Quebec. So we have very high rates of experimentation. We still have relatively low rates of conversion to regular use among non-smokers, but that could well change as the technology in nicotine delivery improves.
I would suggest that in Canada we have a very large uncontrolled experiment with vaporized nicotine, and the course of that experiment is being dictated by marketing and unknown product design and specifications. That experiment should be dictated by regulation so it can be shaped in terms of public health. Ultimately, I would suggest that the public health benefit or harm from vaporized nicotine will be determined by how it is regulated.
I would suggest that the current regulatory framework we have in Canada is not viable. There is broad confusion among consumers about the risks of these products and what's in them. When we asked the cigarette users whether they have nicotine in their products, many did not know, and many were incorrect. We have a prohibition on e-cigarettes with nicotine in Canada that is not effective.
We recently went to four cities and about 80 retail outlets, and nicotine-containing e-cigarettes are widely available and accessible. Our best estimate is that millions of Canadians have tried e-cigarettes. The ban is not working. Current regulations have not prevented youth access to or use of either nicotine or non-nicotine e-cigarettes. These products that people are using have no product standards. When we purchased some e-liquid nicotine several weeks ago, we were told that it's okay, because a biochemist in Ottawa made it. I'm not sure about your biochemists here, but that doesn't constitute product standards.
I think it's clear that an illicit black market in vaporized nicotine will continue to thrive until smokers have access to regulated vaporized nicotine in Canada.
Finally, the current framework isn't well suited to the next generation of products. These products are going to blur the distinction between what is an e-cigarette and what is a tobacco product. In the handout, I have provided you with a picture of a Marlboro HeatStick, made by Philip Morris International, which is being test-marketed in Japan as we speak. The principle is the same: it uses vapour, but it's an actual tobacco product. What this means, as far as I understand, is that this product will be legal to sell in Canada under the Tobacco Act, but it will be vaporized nicotine that you're inhaling. This product is likely to be as harmful as or more harmful than most e-cigarettes on the market today, and it is quite simply illogical to allow a product to be sold that vaporizes tobacco relative to one that vaporizes nicotine.
I would suggest that we need a regulatory framework that is proportional to harm. It does not make sense that you can sell cigarettes in every corner store and gas station, but you cannot sell a vaporized nicotine product. As long as cigarettes are available for sale, I would suggest that adult smokers should have access to cleaner forms of nicotine, and that regulation needs to ensure that only adult smokers have access to these products.
I was part of a group to support FDA decision-making. We tried to come up with minimum standards, and I have provided some of those in your handout. As you've heard, some jurisdictions have gone further than regulating e-cigarettes as a tobacco product. I think you've heard about the U.K. system, which has licensed the first vaporized nicotine product as a medicine. I think there are regulatory options.
I would like to thank this committee for considering this issue, because it's a very important one to a lot of Canadians, and it has real potential to impact public health. Thank you very much.