Mark Tyndall is the executive medical director of the B.C. Centre for Disease Control and a professor at the University of British Columbia.
On Sept. 1, the Tobacco and Vapour Products Control Act will take effect in British Columbia. This provides a set of regulations for an electronic-cigarette industry that has been growing rapidly without any clear federal or provincial guidelines. The stated goal of this legislation is to ensure that youth are not encouraged to use vapour products. This is in response to concerns that direct marketing and access to youth will lead to nicotine addiction and be a gateway to tobacco smoking.
Smoking is one of the biggest public health challenges facing Canada and a great many countries around the world. It is hard to identify a disease that is not either caused or made worse by smoking. Because smoking has been with us so long and the health impacts are so insidious, it is not approached with the urgency it deserves. Cigarettes are a legal product that kill more than 50 per cent of the people who use them long term and are estimated to cost the Canadian health-care system $4.4-billion annually. While British Columbia can claim that its overall smoking rates are the lowest in Canada, there is little solace to be found in having 14 per cent of the population using a product that will kill more than half of them.
Although it may be argued that tobacco-control initiatives have been successful, including public education, increasing taxation, restrictions on advertising, graphic packaging, smoke-free workplaces, programs to help people quit and nicotine-replacement therapies, progress has been very slow and many of the current interventions have run their course or are becoming less effective. This is especially the case among the poor and disadvantaged who have disproportionately high smoking rates and are less influenced by current interventions. E-cigarettes should now be considered a valuable tool to reduce exposure to tobacco smoke while delivering the nicotine that drives the addiction.
It is not clear what this legislation will mean to the sales of e-cigarettes. Besides limiting sales to people 19 or older, blackening out shop windows and putting restrictions on the number of people vaping in the premises, these regulations would not require major changes at the retail level. Stores were not selling these products to minors in the first place and the vast majority of customers are people who want to reduce or quit smoking cigarettes and will, one hopes, not be dissuaded by an unattractive storefront. One effect may be increases in Internet sales as the regulations do not attempt to address the complex issue of restricting marketing and sales online.
While the regulation of e-cigarettes is timely and important, it should not be lost that e-cigarettes are an important alternative to smoking cigarettes. If all smokers were to switch to e-cigarettes, there would be a dramatic improvement in people's health and massive cost savings to our health-care system. The demand for alternatives to smoking tobacco is not only driven by public health but by the majority of people who currently smoke. Most have tried to quit and although there is room to improve access to other forms of nicotine-replacement therapy, we know that this will not be an effective long-term solution for many smokers. It is a moral imperative that people be given alternatives that could improve their health and potentially save their lives while seeking to ensure that such products help to further de-normalize smoking.
Now that there are regulations in place to help prevent the use of e-cigarettes in young people, we must turn our attention to increasing access and uptake to e-cigarettes for the nearly five million chronic tobacco smokers in Canada. Regulations are needed to ensure that the e-cigarettes themselves meet quality standards, that the vapour is free from other toxins, that the advertised nicotine content is accurate and that the health and social impacts are closely monitored. The current regulations leave the door open for the use of e-cigarettes to reduce the harms of tobacco that could facilitate a major public health breakthrough.
It is the right of every smoker to use a product that is safer – up to 95-per-cent safer according to a report from Britain's Royal College of Physicians. While we continue to collect information on the long-term health and social effects of e-cigarettes, it is very clear that the long-term effect of smoking tobacco is chronic illness and death. While this legislation is designed to prevent nicotine and vapour exposure among young people, it is now time to focus on how e-cigarettes can be used to help the people in our communities who will otherwise be dying of smoke inhalation.