Statement from the Council of Chief Medical Officers of Health on Nicotine Vaping in Canada

Statement

January 22, 2020

During National Non-Smoking Week, the Council of Chief Medical Officers of Health (CCMOH) wants to highlight that smoking continues to pose a significant risk to the health of Canadians with over 45,000 people dying from smoking-related causes each year. We recommend that Canadians needing support with nicotine addiction speak to  a health care provider and seek out proven cessation therapies, such as medication or approved nicotine replacement therapies.

At this time, we also remain significantly concerned by the substantial rise of nicotine vaping among Canadian youth. In follow up to our previous position statements on this issue in July 2014, April 2019 and October 2019, we provide the following set of regulatory and policy recommendations that we believe are necessary to be taken by federal, provincial/territorial and municipal governments to address this rapidly emerging public health threat. We acknowledge that governments have already taken steps to implement some of these recommendations.

This statement pertains to nicotine vaping devices. The CCMOH released a related statement on cannabis vaping on January 6, 2020.

The overarching objectives of these recommendations are to protect young people from inducements to use vaping devices by regulating such devices as equivalent to tobacco products, and to encourage smokers who use vaping devices to use them solely to end or reduce their use of all nicotine-containing products.

These recommendations are made in the context of the emerging evidence of the short and long-term harms associated with the use of vaping products. We recognize that evidence is still emerging on the effectiveness of nicotine vaping products to help smokers decrease or stop their use of all nicotine-containing products. It is important that the regulatory and policy approaches for vaping products be reviewed as the evidence of health risks and benefits evolve. For example, if it becomes clear that vaping products are effective in helping people stop or reduce their use of all nicotine-containing products, then it may then be appropriate to approve, license and regulate vaping products in the same way as other tobacco cessation products.

Opportunities for both federal and provincial/territorial jurisdictions

Federal action would be preferred to create national consistency, but individual provinces/territories can consider individual action.

  • Ban all flavoured vaping products and then provide regulatory exemptions or market authorizations for a minimum set of flavours to support smokers who choose to use vaping to end or reduce their use of nicotine-containing products
  • Limit the nicotine content in vaping products, including pods, to a maximum of 20mg/ml (levels lower than this may further decrease the addictive potential for youth) and adopt other appropriate standards regarding nicotine delivery
    (e.g. temperature, use of nicotine salts) as evidence on vaping products evolves
  • Regulate all constituents of e-liquids based on potential to cause harm when inhaled rather than oral ingestion
  • Tax vaping products in a manner consistent with maximizing youth protection while providing some degree of preferential pricing as compared to tobacco products
  • Consider making the age of 21 the minimum sales age for both tobacco and vaping products, knowing that establishing the legal minimum sales age requires balancing policy objectives to minimize an illegal market while delaying the onset of youth use through limiting access through social sources
  • Create requirements for age-verification of internet purchases of vaping products that are the same as those required for cannabis
  • Enhance surveillance and reporting of vaping product use and population health impacts

Opportunities for Federal Jurisdiction

  • Restrict the advertising/marketing/promotion/sponsorship of vaping devices in a manner consistent with maximizing youth protection, including online advertising/promotion and social influencers, while allowing adult-oriented marketing of vaping devices as a product that supports adult smokers solely to end or reduce their use of all nicotine-containing products
  • Require product manufacturers to disclose all ingredients of vaping devices to Health Canada as a condition of being marketed, including establishing consistency in reporting nicotine levels in both open and closed vaping systems
  • Require plain and standardized packaging along with health risk warnings for all vaping products
  • Include vaping as part of smoke-free restrictions for locations under federal jurisdiction
  • Enhance compliance, enforcement and public reporting of the provisions of the Tobacco and Vaping Products Act

Opportunities for Provincial/Territorial Jurisdictions

  • Ban all point of sale advertising of vaping devices and products with an exception for specialized vaping product stores accessible only to those of minimum age
  • Require a vendor’s licence for those selling vaping devices and products
  • Include vaping as part of provincial/territorial smoke-free restrictions
  • Routinely use youth test purchaser programs for all tobacco and vaping product retail locations

Opportunities for Municipal Jurisdictions:

  • Include vaping as part of municipal smoke-free restrictions
  • Restrict the density of tobacco and vaping products retail sites and ban the sale of vaping products and devices within at least 250 metres of a school

Along with these policy and regulatory actions, we recommend that federal, provincial and territorial governments continue to work collaboratively to:

  • Enhance public awareness and educational initiatives on the risks of vaping products targeted at youth, parents, educators and health care professionals
  • Establish comprehensive cessation initiatives for people with nicotine addiction, especially for youth
  • Monitor and research the short and long-term health effects of vaping products
  • Research the effectiveness of vaping products in supporting smokers to end or reduce their use of all nicotine-containing products
  • Research the effectiveness of policy approaches to address youth vaping

A number of other products for the delivery of nicotine have or are being developed (e.g. heated tobacco devices, oral nicotine products). We encourage federal and provincial/territorial governments to work together to develop a broad regulatory approach to all alternative methods of nicotine delivery (i.e. other than tobacco products) that offers strong youth protection while allowing appropriate access for adult smokers to products if they are proven effective in decreasing or stopping the use of all nicotine-containing products.  A key component of any such regulatory approach should be the requirement for the manufacturer to provide enough evidence to satisfy the regulator that allowing any new product on the market is in the public interest before that product can be legally sold.

Dr. Theresa Tam
Chief Public Health Officer of Canada

Dr. Bonnie Henry
Provincial Health Officer, British Columbia
Chair, Council of Chief Medical Officers of Health

Dr. Brendan E. Hanley
Chief Medical Officer of Health, Yukon
Vice-Chair, Council of Chief Medical Officers of Health

Dr. Janice Fitzgerald
I/Chief Medical Officer of Health, Newfoundland and Labrador

Dr. Heather Morrison
Chief Public Health Officer, Prince Edward Island

Dr. Robert Strang
Chief Medical Officer of Health, Nova Scotia

Dr. Jennifer Russell
Chief Medical Officer of Health, New Brunswick

Dr. Horacio Arruda
Director of Public Health and Assistant Deputy Minister
Ministry of Health and Social Services, Québec

Dr. David Williams
Chief Medical Officer of Health, Ontario

Dr. Brent Roussin
Chief Provincial Public Health Officer, Manitoba

Dr. Saqib Shahab
Chief Medical Health Officer, Saskatchewan

Dr. Deena Hinshaw
Chief Medical Officer of Health, Alberta

Dr. Michael Patterson
Chief Medical Officer of Health, Nunavut

Dr. Kami Kandola
Chief Public Health Officer, Northwest Territories

Dr. Evan Adams
Chief Medical Officer, First Nations Health Authority, British Columbia

Dr. Tom Wong
Chief Medical Officer, Public Health, Indigenous Services Canada

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