Thank you very much for the opportunity to speak to the committee today. I would like to introduce myself. I am an emergency physician and a medical toxicologist. I am a consultant at the Quebec Poison Control Centre. I'm also an assistant professor of medicine at McGill University and I'm the current president of the Canadian Association of Poison Control Centres.
I have no financial or scientific conflict of interest to disclose. I will make this presentation in English, but I will be very happy to entertain questions and comments in both official languages.
Our association is a small, non-profit, scientific organization established in 1982, mostly to promote national communications and research in medical toxicology. Our membership includes specialists in poison information, nurses, pharmacists, emergency physicians, and medical toxicologists.
Without insulting anybody's intelligence, I would like to remind you exactly what a poison centre is. It's a health organization providing information to the public, 24 hours a day, seven days a week, also to health care providers in the management of suspected poisoning, both accidental and intentional. We deal with a long list of toxins, including medications, also a very long list of non-pharmaceutical products.
There are five Canadian poison centres that are funded by the provincial health care system to provide telephone services 24 hours a day, 7 days a week, free of charge for the caller. We deal with over 160,000 exposures to drugs and toxins every year, mostly calls from the public. We manage to keep up to 70% of the people at home after they call us.
Poison centres have very important value. It's estimated that every $1 invested in poison centres can save up to $13 to the health care system, mostly by avoiding unnecessary use of medical resources.
Our data is interesting because the information on the incidence and severity of the exposure reported to a poison centre is valuable in many ways, for providing early warning of major symptomatic exposure and also identifying new trends in product use and regional differences in populations at risk.
Many countries have toxicological surveillance systems, but, unfortunately, at this point Canada is not one of those countries, although we're collaborating with Health Canada to set up such a system.
Most specifically on the topic of e-cigarettes, I would like to start by saying that we're mostly concerned about the liquid nicotine content of e-cigarettes and about the growing popularity of e-cigarettes.
Our two concerns are the following:
Nicotine is a potent toxin, and liquid nicotine solutions used in e-cigarettes have the potential to cause serious poisoning. We are concerned that a liberal approach to regulation may have the predictable consequence of making liquid nicotine solution more available to the public, and mostly to children. We know that children who are less than six years of age are at a high risk for accidental poisoning at home. It's likely that the number of pediatric nicotine exposures will increase in the future.
The second big concern is the fact that nicotine is a highly addictive substance, and we believe efforts should be made to limit the use of nicotine by non-smokers. Increasing the availability and marketing efforts aimed at teenagers may contribute to increasing the magnitude of the problem of nicotine addiction in the future.
I would love to be able to present Canadian statistics to you today, but we don't really have any, although the numbers given to me match the American statistics.
This was published recently this year by the CDC, in the United States. We can see on this graph—the bottom line is the line with the e-cigarette and liquid nicotine exposures—that calls to U.S. poison centres for e-cigarette exposures are going up. Also, compared to more traditional tobacco products, e-cigarette exposures are more likely to be associated with adverse affects.
Nicotine poisoning is very serious. You can be exposed to liquid nicotine and get sick after an oral ingestion, but it's also absorbed through the skin. Clinical manifestation of nicotine poisoning appears quickly within an hour. We don't keep those people at home; we send almost everyone to the hospital.
Mild toxicity can lead to vomiting and tremors, but severe toxicity can be associated with seizures, coma, and cardiovascular collapse. The management is mostly supportive. We don't have an available antidote for liquid nicotine.
The toxic dose is subject to debate right now, but we know that very small amounts of liquid nicotine can be symptomatic and dangerous both for children and adults. Liquid nicotine solutions that are available vary in concentration. Liquid nicotine for e-cigarettes varies anywhere from between 5 milligrams to 20 milligrams per litre, and, unfortunately, they are very often available in flavours that are appealing to children and teenagers.
We think that public education is needed. E-cigarettes should be kept away from children. Liquid nicotine should be locked away in a cabinet. All of the used material should be disposed of properly to prevent exposing children to the liquid left in containers. In the event of an oral skin exposure, we would like the public to call poison centres for immediate advice. And with nicotine being a highly addictive substance in all forms, e-cigarettes should not to be used by teenagers.
Our recommendations are the following:
First of all, liquid nicotine for e-cigarette users should only be available in child-resistant packaging. The sale, distribution, labelling, and marketing of e-cigarettes should be regulated. The sale of e-cigarettes to minors should be prohibited. The labelling of containers should indicate the nicotine concentration, with appropriate safety warnings. Marketing strategies targeting teenagers should also be prohibited. Lastly, our position is that regulation of e-cigarettes and liquid nicotine solutions should probably be regulated in the same way as pharmaceutical products. It would definitely be the safest approach.
Thank you very much.
I would like to remind everybody that we're in the business of protecting all Canadians from all dangers, and liquid nicotine is a part of that.
Thank you very much for your attention.