Respected chair, members of the House of Commons Standing Committee on Health, thank you for inviting me to speak about Bill S-5. I am Dr. Peter Selby. I'm a medical doctor and professor at the University of Toronto, specializing in addiction medicine with a strong focus on tobacco addiction treatment as a clinician, researcher, and educator. I am the deputy physician-in-chief of education at the Centre for Addiction and Mental Health, where I also hold a post as a clinician scientist. As some of you may know, CAMH is the largest hospital of its kind in Canada.
I can tell you that I witness first-hand the devastation of addiction to tobacco and the difficulty my patients experience in quitting, even with the best help available. I also have programs running in over 300 sites in Ontario. I can tell you that the patients who are coming through those sites across the province are struggling. At best, only one in three will respond to the treatment available. When we have a goal to get to 5% by 2035, we need to get current smokers to stop now. It's indisputable that in addition to prevention, the most effective thing we can do now to save lives is to get current smokers to stop. However, we are stuck in tobacco control, in part because we haven't done enough of what works, of what we know works. There is a “know-do” gap. For example, we know that price, availability, and attractiveness of the product, especially to young people, are big promoters of why people will access these products, use these products, continue to use these products, and, might I say, relapse back to these products after they make an attempt to quit.
As a society, we need to be detoxified from the advertising that has made all of us collectively believe that smoking cigarettes—which, if you think about it, delivers 7,000 chemicals and 60 known cancer-causing agents and is the number one cause of house fires and premature deaths—is cool and a personal choice. Addiction is not a free personal choice, because when nicotine is delivered through combustion, it actually robs people of a choice to varying degrees. If you don't believe me, go outside any hospital in the middle of winter and tell me how many people you see out there puffing away at a cigarette while they have an IV going into their arm. No person who exercises free choice would choose to do that willingly when they're in a hospital because of a condition often caused by that addiction.
We should note that although nicotine is the addictive substance in the cigarette, the overall harm is caused by the combustion of the tobacco and the paper that is holding that tobacco, and the fact that it forces people, once they become addicted, to have that reloading almost every 90 minutes. It means that on average, Canadians who smoke are smoking 13 cigarettes a day, almost one per waking hour. In other words, it's a design flaw in how people are forced to get their nicotine if they want or need it.
We need to catch up to other countries that have introduced plain packaging, with the associated enhancements of warnings on the cigarette itself, and crack down on contraband tobacco manufacture and sales. We need to undo this attack on the choice of the addicted smoker by making the cigarette less attractive, with associated information on the package to prompt people to quit and to help them seek help if they are unable to stop on their own. Anything less is allowing commercial entities to prey on people with addictions, who more and more are the most vulnerable people in society.
Therefore, plain paper packaging needs to be supported. There is good evidence for it, scientific evidence. There's good evidence that as part of comprehensive tobacco control, it is an important strategy. People can look at it as if it's the only thing, but I don't think the Canadian tobacco control strategy is in its infancy; it requires enhancements to make sure it's more robust. I would not look at plain packaging as the magic solution, but as one more way in which we can advance the goals of a healthier society and a healthier next generation.
Having said that, I'll turn my attention to electronic devices that deliver nicotine. They are very promising innovations that we need to figure out and support in their development. The current products on the market have suffered from a lack of regulation, and I think this bill will allow for that innovation to occur and will also allow for that to potentially make cigarettes obsolete.
The regulations that have been proposed make sense and will allow researchers such as myself to study these devices. If we want to make a health claim for cessation, then we can go through this process and obtain evidence-based scientific proof that electronic devices, like other nicotine replacement products, can help people to quit tobacco. On the other hand, if a claim can't be made but we see a substitute that can reduce, by an order of magnitude, the exposure to many of those products of combustion, then we need to study it. The legislation and the regulations should allow for ongoing surveillance and study so that we can make sure there are standards in place for what exposure should be and for the maximum exposure allowed. Included in this should be the way the product is manufactured, the electronic juices put into it, the flavourings allowed or not allowed, and where and how it should be consumed. All these things need to be put in so that we can find the balance whereby people who are unable or unwilling to stop the use of cigarettes can choose to do something that will mitigate the harm to them.
That fits in with how Canada's drug policies have evolved, whether it's supervised injection facilities or cannabis legalization. We need to understand that legalization doesn't mean no rules. Rather, it means strong regulations to reduce the attractiveness and uptake by youth, which would include the advertising restrictions suggested in the submissions from the Canadian Cancer Society and my esteemed colleague Dr. Strang. We need to make sure this is put in place so that youth don't find it attractive because it has flavourings and labelling that make it seem like a cool thing to do. At the same time, these products and the facts about them should be made available to people who are addicted, in such a way as to help them switch from the combustible form and start breaking away from their addiction.
I will stop my comments there. Thank you.