Health Committee on Feb. 26th, 2018

[Diane Finley, Conservative, Haldimand—Norfolk, ON]

Dr. Selby indicated that price and availability were two of the big things that determine whether somebody smokes. Let's look at the decision to smoke and which brand to smoke as two separate things. If price and availability are key factors, then that—

[Dr. Robert Strang]

So also is advertising.

[Diane Finley, Conservative, Haldimand—Norfolk, ON]

—makes contraband much more attractive, especially when it can be a tenth of the price.

You indicated that those reports were exaggerated. A number of years ago, I had a briefing from Public Safety and related departments, and if anything, their evidence, and what I learned subsequent to that in great detail, indicated that Public Safety's estimate of contraband, which is in the neighbourhood of 30% market share in this country right now, is not an exaggeration but an understatement.

If we're trying to reduce harm, why would we eliminate the opportunity for law enforcement and consumers to not be able to distinguish what product they're buying by going to plain packaging and plain cigarettes?

[Dr. Robert Strang]

Well, again, if you look at the totality of the evidence.... My understanding from people who have looked at this in detail is that the evidence does not support that plain packaging creates a significant increase in the use of contraband products, especially when you have plain packaging as part of a comprehensive tobacco control strategy, part of which is policing and criminal justice efforts that are enhanced to deal with contraband.

[Diane Finley, Conservative, Haldimand—Norfolk, ON]

But if law enforcement can't identify what's legitimate and what's not because of the plain packaging and tubes and the proposal in this bill that they would be identical, then those two don't mix.

[Dr. Robert Strang]

My understanding is that the plain and standardized packaging still requires tax stamps and other identification that will allow a distinction to be made between legal tobacco products and contraband tobacco products.

[Diane Finley, Conservative, Haldimand—Norfolk, ON]

I've seen evidence that those are easily counterfeited. Besides that, contraband is significantly worse in terms of harm than regular cigarettes. It could be as little as 25% tobacco. There could be animal parts and all sorts of other nasty things in there.

What this bill would do would be a gift to the contraband industry.

[Dr. Robert Strang]

Every time any successful steps have been made in tobacco control in the last couple of decades—whether it's smoke-free places, restricting point-of-sale advertising, increasing pricing—the same argument is always brought out: that it will increase contraband.

I've had direct conversations with my provincial counterparts in Nova Scotia who deal with contraband tobacco. They clearly say that the information given to them by front groups, such as convenience store associations, is exaggerated and doesn't match up with their data on contraband tobacco.

I think we have to be very careful to keep contraband in the right context. It's always been thrown out as a way to delay and distract progress in tobacco control, and when those tobacco control measures have been implemented, we have not seen an increase in contraband—except in the nineties, when that contraband was being directly driven by big tobacco.

[Diane Finley, Conservative, Haldimand—Norfolk, ON]

This bill would call for standard tubes, standard filters, standard formulae. If a manufacturer were to come up with a harm reduction filter, it would not be allowed on this under this bill. Would you support that?

[Dr. Robert Strang]

I don't think you can actually do harm reduction on tobacco products themselves. We need to look at other alternatives for how we help people move to other forms of delivery of nicotine. We have patches. We have gums. We have the potential for vaping products. That's where we should be focusing, and not on tobacco products. We've had a long history with the tobacco industry pretending that its cigarette products can somehow be made safer, and they have not been.

[Diane Finley, Conservative, Haldimand—Norfolk, ON]

Thank you.

Dr. Selby, you indicated that smokers need a lot of help and support in quitting. However, this bill would not allow advertising, even to doctors and specialists like yourself, of the mere existence of many harm reduction products, such as non-combustibles. I'm not just talking about the classic e-cigarette, but some of the newer ones that are out there that are achieving significant success in other countries where they're being recognized for harm reduction. Their use is not contemplated in this bill, and if this bill were to pass as is, you wouldn't be able to know about those products and you'd have fewer tools to help consumers who are trying to kick the habit.

Do you have any comment on that?

[Dr. Peter Selby]

Yes, I have a couple of comments. Going back to some of the work around plain packaging, as well as the products and how people who are addicted will view them, I will say that colleagues of ours have done some studies with brain scans in the U.K. Very interestingly, the package warning labels are not seen by smokers when they come with the brand, but on plain packaging they are seen, and that has been proven in brain scan studies now.

That said, we do understand that there needs to be a way in which we look at this.

In terms of not advertising or not promoting to physicians, and if you're speaking about heat-not-burn products, if that is true, then is there a reason that the tobacco industry has...? They are manufacturing those. Why don't they stop manufacturing combustible cigarettes altogether and just simply have the heat-not-burn products?

That's one question. Right now this is confusing everybody, because these are actually tobacco products that are being heated. They don't necessarily have the same level of reduction that is possible through vaping products, so is that really a harm reduction product? Is that really a product for doing that?

[The Chair, Liberal, Bill Casey]

I'm sorry, but time's up.

[Dr. Peter Selby]

I would think that any kind of marketing of a cessation aid needs to follow the pathway of a cessation aid. If it's coming with a claim of harm reduction, then it needs to show that it is a harm reduction product. Again, you're right. We need factual information.

As Flory pointed out, if Health Canada tells us about the risk continuum and smokers have an idea of the risk continuum, I would trust Health Canada rather than a manufacturer that wants to have a competitive advantage and has already fooled us before—for example, with the filters in the past—that these products are somehow safer.

I'd rather trust a Health Canada statement in which scientists are putting that risk continuum out than trust somebody advertising to me that these are harm reduction products.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Go ahead, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Selby, do you know if Bill S-5 applies to the vaping of cannabis products?

[Dr. Peter Selby]

I'm not 100% sure if it does or not, but it certainly should consider it, because at least some of the devices on the market right now can be easily modified to vape the oils, resins, or wax that can be extracted from cannabis. Potentially, other than the combustion they're getting from joints, it could apply, but I'm not completely sure if this bill will apply to that or not.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Strang, do you know if Bill S-5 will regulate vaping? This is what I'm trying to drive at: is it specific to nicotine or tobacco vaping, or is it the vaping of substances generally, including cannabis? Do you know?

[Dr. Robert Strang]

My understanding is that it's vaping products as they pertain to the delivery of nicotine.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll tell you why I ask.

I was in a dispensary in Vancouver last week—our break week—and this particular dispensary had a wide variety of concentrates. What I learned there was that for health reasons, well over 50% of the customers who come into that store prefer to vape or deliver the cannabis by a vaping tool, as opposed to smoking the raw flower.

Do you have any comment on the relative harm or preference? I know that concentrates won't be legal under Bill C-45, the cannabis act, for a year after the normal legislation passes, but does either of you, Dr. Strang or Dr. Selby, have any comment in terms of whether or not we should be trying to drive people to ingest their cannabis products through vaping as a healthier alternative to smoking?

[Dr. Robert Strang]

We certainly, in low-risk cannabis, use guidelines. One key point there is to have a non-smoked or non-vaped form of cannabis, because there's growing evidence that even vaping produces ultrafine particulates, which are then inhaled, and which, as I said in my remarks, are the likely cause of the growing evidence that there's a substantive cardiovascular risk from vaping. Ideally we would, for both cannabis and the delivery of nicotine, have non-smoked or non-vaped methods as the preferred way of delivery.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Selby, I want to talk about nicotine itself. It seems to me that the totality of the evidence we've heard so far is that cigarettes are terrible for our health for a million reasons, and that using ENDS, electronic nicotine delivery systems, is by far preferable for those who are dependent on nicotine. I'd like to isolate just what the health impacts of nicotine itself are.

First, how addictive is pure nicotine? If a person were starting to use a vaping machine to ingest nicotine, would it have the same addictive properties as smoking cigarettes?

[Dr. Peter Selby]

I'll take that question in two parts.

First of all, nicotine is extremely addictive if it comes in a high concentration and is combusted and delivered in the way that cigarettes deliver it. That's our known way in which it becomes addictive, and people have great difficulty stopping. The second, obviously, is chewing tobacco, which again has very high rates of nicotine absorption.

With vaping devices, if they aren't regulated the way we would regulate them, then people could find themselves getting addicted because we haven't regulated the strength of the liquids. We haven't regulated how it's manufactured. We haven't regulated how the device delivers nicotine or where it's used. We haven't created that control in the way that we have regulated alcohol as to where and how it can be consumed and what the concentrations are. We have to get to that, and we'll have to do the same thing with cannabis.

Yes, there will be a risk of people getting addicted, but as I had mentioned earlier, from a harm perspective the absolute harm from nicotine is, as Flory talked about, a relative risk.

Let's say cigarette harm is at a certain level. If a smoker moved completely to vaping and nothing else, they would bring their harm down to a lower level. If they quit completely, they would bring it down lower, to here. For a non-smoker, their harm is here. If they take up nicotine, they've just bumped their harm up to here.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I can interject and ask you a quick question, Dr. Selby, would you agree from a policy perspective that we don't want to encourage people who don't smoke to take up vaping nicotine, do we?

[Dr. Peter Selby]

That's right. We don't want to encourage people who otherwise would never have smoked, and who otherwise would not use it, to use it in such a way that then.... We know people experiment with lots of things, but we don't want that experimentation to turn to addiction. It doesn't appear to be the case, at least from what we can tell with the totality of the data, that currently people are experimenting with vaping and becoming lifelong vaping users. We have seen that with cigarettes; we are not seeing it with vaping devices.