Health Committee on Feb. 26th, 2018

[The Chair, Liberal, Bill Casey]

The time's up, so now we're going to Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you very much, Chair.

[The Chair, Liberal, Bill Casey]

You're welcome.

[Ben Lobb, Conservative, Huron—Bruce, ON]

There has been a lot of discussion today on plain packaging. I understand that Health Canada has always felt that it has a role in that, and certainly the provinces and local health units support them, but until the politicians and the people in power want to go after those who are creating these contraband cigarettes, and go after them with force, we're going to have plain packaging debates for the next 50 years.

The reality of this situation is that Mr. Davies and I have been here for 10 years, Mr. Casey has been here for 20 years, and Ms. Finley has been here for 15 years, and I'm sure you were talking about plain packaging in the nineties and all the way through. Until the powers that be at Public Safety and others want to get at it, we'll still be talking about plain packaging for many years.

I was going to ask Dr. Selby a question. If Dr. Strang were around, I would ask him the same question. Is there any medical evidence out there in regard to vaping—whether it's tobacco, cannabis, or what have you—and what is called “popcorn lung”? I guess that's a colloquial term. Is there any medical evidence out there to indicate that people who have vaped for a period of time could develop a case of popcorn lung?

[Dr. Peter Selby]

It's primarily been because of the contaminant diacetyl, which is the cause of popcorn lung per se.

Some studies out of Italy suggest that people who have chronic lung disease or asthma and are unable or unwilling to stop smoking may experience an improvement when they switch to vaping devices, but given the short duration of exposure that we are seeing, we're not having reports of harm from the general population if they vape, other than anecdotal case reports.

Again, as I said, the concerns are not so much with associations with the lung disease but with regard to the cardiovascular effects of these products. Again, what we really need to focus on is the relative risk for people who are tobacco-addicted or smoking-addicted to these products. From a lung perspective, other than the diacetyl, it's not clear that you could end up with popcorn lung, and diacetyl is a flavouring.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I have another question for you, Doctor. For the regulations, do you have a number that you would like to see as the percentage of nicotine found in a capsule to be used in an e-cigarette?

[Dr. Peter Selby]

There is emerging evidence, because it's not just.... The total amount of nicotine concentration needs to be considered and balanced, not so much with how much there is for the person who is going to vape it, but also with the risk to bystanders, children, or others who might get poisoned by it because they're not tolerant to nicotine. These are really the concentration effects. They are determined on that.

What we do know is that the more concentrated the nicotine is per millilitre in the e-juice, the less people vape and the less deeply they vape, but of course that is also modified by the voltage setting, which can be adjusted on the device.

I think the overall discussion will have to take a look at safety to others more than safety to the person vaping, because of the potential toxicity of nicotine to people who are not tolerant to it, especially children.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I have one last quick question for you, Ms. Doucas. On Twitter, Facebook, Snapchat, and Instagram, should there be a ban on any of the products that are related to tobacco, vaping, or what have you? You don't have to look very hard to find them there. What do you think about that?

[Flory Doucas]

I definitely think we should intervene there as much as we can. Certainly the fact that it was a Far West kind of situation and the fact that these products were completely illegal didn't make it easy for anyone to intervene, but I certainly don't think there should be any possibility of corporations using social media to promote their products this way. As a matter of fact, I know that there's strong language in the cannabis bill to prevent that.

[The Chair, Liberal, Bill Casey]

Time's up.

Now we will go to Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much.

Thank you for your testimony here today and for coming to Ottawa discuss Bill S-5 with us. It's very much appreciated.

It seems to me that there's a bit of tension in the bill. One objective of the bill is to encourage people who are smoking to give up using cigarettes to get their nicotine dosage and to move to vaping. The second intent, which I think is the more important one, is to move the next generation of Canadians away from using nicotine and to stop the addiction cycle. I'm personally really excited that we're reaching a point where we may be able to begin to significantly reduce the rates of nicotine addiction in Canada.

The numbers I've heard are that somewhere between 85% and 95% of people who take nicotine will become addicted to it, so it is a very additive substance. Because the health impacts of smoking are so dire, I don't think we really understand the impact of chronic nicotine usage over a period of time, because people really do struggle with the health impact of smoking, which is so much more dramatic.

Ms. Doucas, you mentioned concerns. We heard the same thing from the Cancer Society. They wanted to make sure that lifestyle advertising was not permitted with vaping, and the minister was quite clear that she would support an amendment to that effect, so we're dealing now with brand promotion only.

The second issue that you raised was location, and the Cancer Society likewise raised location. I came across an August 2017 Health Canada consultation document, a proposal for the regulation of vaping products, which advises that they intend to use regulations to limit advertising for vaping products in or near locations that are attended predominantly by youth, such as schools, parks, and recreational and sporting facilities. There would also be restrictions placed on advertising in certain media, as well as a prohibition on advertisements on television and radio during certain times of day, and that kind of thing.

With the amendment the minister said she'd endorse and if the regulations deal with location, do you feel that we're doing enough to protect our youth from being drawn to vaping products and to nicotine through vaping?

[Flory Doucas]

No, I don't. I don't think this should be left to regulations.

There's likely going to be a gap between the time the bill gets royal assent and those eventual regulations. Why don't we use the precautionary principle? Ban it now, and allow it as permitted by regulations. I think that's a far safer approach.

It will also require regulatory impact analysis. There is a balance to be met here. Why don't we get the actual numbers? Who's drawing the line?

[John Oliver, Liberal, Oakville, ON]

If a Department of Health person were here, they'd probably say we need some brand promotion because we need to get smokers paying attention to vaping as a healthier way than smoking to get their nicotine dosage .

Do you have an observation on that?

[Flory Doucas]

Yes. I think one of the compromises that could be reached is to focus on, or open up the door to, channels that are primarily used or seen by adults but not by kids. That would definitely close the door to TV, radio, and the Internet. Perhaps printed newspapers, printed magazines, publications, and those kinds of media might be better tailored for that.

Certainly the bill would allow for manufacturers to send information to identified adults. Anybody going to a vape shop, giving their names, putting their names down—they would have to be adults to go into the vape shop—and asking for more information could receive more information. To my mind, this is targeted advertising, and that's just far more appropriate.

[John Oliver, Liberal, Oakville, ON]

I don't disagree with you on that point.

I have a question for Dr. Selby, and you as well. There is a proposal from the Cancer Society that, besides packaging, each individual nicotine product have a health warning on it. Do you think it would be a worthwhile amendment to this act to have greater or more specific health warnings on the products themselves, on each cigarette or each vape tube?

[Flory Doucas]

It's a good idea to allow for distinguishing between illegal products and legal products. We're looking for markings. It would certainly help on that front. Also, given that we've seen packaging that can be thrown out, especially for some of the other products, having an actual label and warning on the specific product that a consumer manipulates for a long period of time makes sense.

[John Oliver, Liberal, Oakville, ON]

Dr. Selby, do you have any comments? Oh, sorry; I'm out of time.

Thank you.

[The Chair, Liberal, Bill Casey]

Now we'll go to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. Do we have Dr. Selby or Dr. Strang with us?

[The Chair, Liberal, Bill Casey]

My understanding is Dr. Strang can see us and hear us, but we've lost the connection, for which I apologize to Dr. Strang on behalf of the committee.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Madame Doucas, what public health purpose is served by lifestyle advertising of nicotine products in any form?

[Flory Doucas]

I don't know. I don't think there is any in our minds and in the minds of all the health groups. Dr. Ostiguy, whom you heard a few weeks ago, who is a promoter of e-cigarettes and believes that smokers need to have access and to be told about these products, himself doesn't believe we should be promoting these products in such ways, especially not through lifestyle advertising.

[Don Davies, NDP, Vancouver Kingsway, BC]

At my age, my definition of youth has changed somewhat.

There are three provinces in this country where the legal drinking age is 18: Alberta, Manitoba, and Quebec. That means there are 18-year-olds, 19-year-olds, and 20-year-olds in bars. To me, those are youth. They are young people. If I understand correctly, this bill would permit lifestyle advertising of vaping products—not harm cessation information, but lifestyle promotion of nicotine through vaping products targeted through contests, giveaways, and lifestyle advertising. Of course, that will be targeted to people in those bars who don't smoke, as well as smokers.

In your view, is that a wise smoking policy?

[Flory Doucas]

No, not at all. The idea that we would want to confer an aura of sophistication, of glamour, of sport or whatever, on this highly addictive drug, comparable to heroin on many accounts in terms of its addictiveness.... Wanting to associate it with a lifestyle is just completely inadequate.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Selby, to the same kind of question, you've already said that nicotine is not desirable, and we certainly aren't trying to see more Canadians take up nicotine in any form. In your opinion, insofar as this bill would allow lifestyle advertising for nicotine, albeit in places frequented by so-called adults, is there any public health purpose served in terms of lifestyle advertising of nicotine products in any forum, including in bars?