Good morning. Bonjour.
Thank you very much for the opportunity to address the committee on this important public health issue. As you heard, my name is Melodie Tilson. I'm the director of policy for the Non-Smokers' Rights Association, better known as the NSRA.
The NSRA has been at the forefront of tobacco control in Canada for the past 40 years, leading many campaigns for precedent-setting measures to reduce the scourge of disease and death from tobacco industry products, including comprehensive tobacco control legislation through the 1988 Tobacco Products Control Act and its successor the federal Tobacco Act, and the world's first graphic warnings on cigarette packs, to name a few.
I personally have been working in tobacco control for 24 years. I have devoted most of the past three and a half years to understanding the potential risks and benefits of e-cigarettes and to providing leadership to the health community on this issue. I can honestly say that e-cigarettes are the most challenging and divisive issue that I have faced in my career in tobacco control.
The fact that this issue is so challenging underscores the importance and urgency of the committee's deliberations, as you just heard from my colleague. There has been an explosion in the promotion, sales, and use of e-cigarettes, as well as in research on the subject, since Health Canada issued its regulatory notice in March 2009, and yet Health Canada's response has been to ignore the rapid changes in the marketplace and in the science. lt is essential that the federal government develop and implement, on an urgent basis, a new regulatory framework for e-cigarettes that reflects current knowledge and is responsive to new developments.
Let me state from the outset that the Non-Smokers' Rights Association believes that e-cigarettes hold great promise as aids to help smokers quit cigarette smoking, but aIso that they present potential serious risks to tobacco control. The current regulatory framework, however, does not serve the interests of either smokers or non-smokers. Although e-cigarettes with nicotine and e-cigarettes that make a health claim cannot legally be marketed or sold in Canada, both are readily available from retailers. Experience over the past five years has made it clear that having a different set of measures governing e-cigarettes without nicotine merely provides an enormous loophole that undermines controls over the promotion and sale of e-cigarettes with nicotine. Moreover, as you heard from the Health Canada officials who addressed the committee, there has been almost no enforcement of the prohibition on the sale of e-cigarettes with nicotine.
The intent of a new regulatory framework governing e-cigarettes should be to maximize the benefits for smokers while minimizing the risks to users, to non-smokers, especially youth, and to bystanders.
ln terms of the benefits to smokers, there is a growing scientific consensus that e-cigarettes are much safer than cigarettes. They contain no tobacco and there is no combustion. Smokers deserve access to a safer form of nicotine delivery that can also satisfy their addiction to smoking behaviours. Committee members heard from witnesses such as Dr. Gaston Ostiguy that e-cigarettes have been valuable in helping hard-core smokers quit smoking. My colleagues and I likewise know of smokers who were finally able to quit smoking using e-cigarettes. However, there is a paucity of high-quality scientific studies proving that e-cigarettes are an effective cessation aid. Only two randomized controlled trials, considered the gold standard in research, have been published to date. Both were small studies of first-generation devices. Both showed cessation rates on par with those produced using the patch. ln the United Kingdom, e-cigarettes are now the preferred quitting aid among smokers, and smoking rates have declined at the same time that e-cigarette use has increased, but that does not mean that the relationship is causal. The research, both small studies and large surveys, consistently shows that most smokers who use e-cigarettes continue to smoke. lt is not yet known, however, whether this dual use of tobacco and electronic cigarettes is a stage on the road to quitting or whether it serves in fact to forestall quitting.
Many of the potential risks to health and safety from e-cigarettes could be reduced or eliminated fairly simply if manufacturing standards for e-cigarette devices and liquid were developed and enforced to ensure that the products operate consistently and reliably, that no impurities are introduced during the manufacturing process, and that the products do not malfunction under normal use, such as through leakage of the e-liquid or overheating or explosion of the battery.
With regard to the risks to tobacco control from e-cigarettes, the research findings are contradictory concerning whether the promotion and use of these new products will renormalize tobacco use and serve as a gateway to nicotine addiction and/or tobacco use among youth. Research from the U.K. is often cited as proof that there is no e-cigarette uptake among non-smoking youth and no gateway effect. However, research in other countries paints a different picture.
Research in Poland on 15- to 19-year-olds found a substantial increase in both experimentation and current use of e-cigarettes from 2010-11 to 2013-14, as well as a substantial increase in both the dual use of e-cigarettes and cigarettes and smoking rates. In Finland, 10% of adolescents who experimented with e-cigarettes were non-smokers. Research in both Canada and the U.S. found relatively low but increasing rates of ever and current use of e-cigarettes among non-smoking youth and young adults. Furthermore, it is still relatively early days in Canada, where we have not yet seen a no-holds-barred approach to e-cigarette promotion, as they have right now in the U.S. The use of e-cigarettes where smoking is banned is still relatively rare.
For these reasons, NSRA believes the federal government must take a cautionary approach by legislating tight controls on marketing and use of e-cigarettes until the research provides definitive evidence that e-cigarettes pose no risk to tobacco control or to non-smoking youth.
The most straightforward way to regulate e-cigarettes would be to include them in the federal Tobacco Act. Doing so would accomplish a number of important regulatory objectives. It would end the current perverse situation whereby e-cigarettes with nicotine are subject to a much stricter regulatory regime than the most hazardous nicotine delivery device: the cigarette. lt would ensure that e-cigarettes with nicotine are legally available to smokers. lt would reinforce the perception of e-cigarettes as a consumer product, which is important to trial and acceptance by smokers. lt would help ensure continued product innovation and affordability, which are adversely affected when products are regulated as drugs. lt would also ensure equal treatment of e-cigarettes both with and without nicotine, and it would help safeguard critical tobacco control gains by subjecting e-cigarettes to similar controls as tobacco products.
Whether e-cigarettes are included under the Tobacco Act or are regulated under different legislation, there are a number of specific measures that the NSRA believes to be of critical importance: a ban on sales to minors; restrictions on advertising and promotion, including a ban on lifestyle advertising, celebrity endorsements, the use of cartoon figures, and sponsorships; a ban on false and misleading claims; a ban on advertising that evokes a tobacco product; and a ban on cross-branding of an e-cigarette with a tobacco product.
We also believe it's important to ban the use of e-cigarettes in indoor public places and workplaces where smoking is banned, and to prohibit product characteristics that target youth, in particular, such candy flavours as bubble gum and sweet tart.
We also believe that mandatory product labelling is critical, including full ingredient disclosure, information on the presence and strength of nicotine, and meaningful warnings regarding the possible risks of e-cigarette use as well as the relative risks of e-cigarette use as compared with smoking tobacco cigarettes.
We know with certainty that one out of every two long-term smokers will die from their tobacco use and that for every death there are about 20 smokers suffering from a tobacco-caused illness. Most smokers want to quit, but the success rate of current cessation aids is abysmally low. E-cigarettes hold great promise for their ability to deliver nicotine effectively and to mimic smoking behaviours, but it is these same qualities that create risks to tobacco control.
While we await more conclusive research, the federal government must act to ensure that smokers have access to the safest possible e-cigarettes with nicotine, while implementing measures to prevent youth uptake and a new form of socialized nicotine addiction.
Thank you.