Vaping needs heavy-handed regulation

The tobacco industry's efforts to grow the vaping business is reminiscent of their cigarette marketing a few decades ago.

Inhaling cigarettes transfers multiple carcinogens to the smokers' lungs. This results in emphysema and cancers, especially of the lungs, which are often fatal. As well, the reduced lung capacity puts strain on the cardiovascular system, resulting in heart disease.

The tobacco industry fought hard to deny these connections, and hid its own evidence confirming them.

Tobacco contains nicotine, which its users find addictive. The industry boosted the tobacco content of their product to make it harder for smokers to quit. The average non-smoker lives 10 years longer than a smoker.

Pressure from health advocates eventually broke the dam. The industry was assaulted with successful multi-billion-dollar lawsuits. Restrictions were placed on marketing and distribution, packages were required to carry gruesome health warnings, and smoking in public spaces was widely prohibited. Smoking has become distinctly unfashionable.

It is hard to eliminate an industry that was so deeply entrenched. But these measures have gradually reduced the proportion of smokers. Half of Canadians smoked in 1965. That dropped to 26 per cent in 2001 and 13.6 per cent in 2015. Disturbingly, the proportion grew back to 15.1 per cent in 2017.

More recently, the industry has developed e-cigarettes, used for vaping. These heat a tobaccobased fluid, usually flavoured. The user inhales the vapour, which delivers addictive nicotine to the lungs. This is believed to be less dangerous to the user than tobacco smoke, although there are no comprehensive research data on the topic.

Vaping has already been connected to thousands of illnesses and dozens of deaths in the United States. Most but not all of those have been attributed to illegal black-market products. A case involving a 17-year-old in Ontario who came close to needing a lung transplant was reported last week.

The industry has brought the same moral compass to the promotion of vaping as it did for cigarettes. It argues that the product can provide harm reduction by helping adult smokers to get off cigarettes. But the marketing efforts make it clear that they have a wider target.

Packaging is designed to attract younger users. Advertising restrictions are circumvented by using social media, and signage in retail outlets. Flavours and tastes include mint, cookies, and ice cream. It's working. The Globe and Mail reports a survey result that nearly 40 per cent of 16-to19-year-olds have tried e-cigarettes. For some, it may become a gateway drug to cigarettes. The longer-term risk is that vaping becomes as entrenched in society as smoking was.

The backlash has begun in the United States. Industry leader Juul has been sued by New York, North Carolina and California. The city of San Francisco, where Juul is headquartered, has banned e-cigarettes entirely.

Canada and the provinces have not been aggressive, at best mimicking the rules used for cigarettes. A much more rigorous approach is called for, based on the premise that the only valid role for the product should be to aid in smoking cessation.

Rules should be developed in consultation with adults who have been successfully using the product to avoid smoking. They should include:

A total ban on advertising including in-store promotion. No free samples.

Retail outlets to be licensed and limited in number in the same way as private liquor outlets. No vaping in the outlets, or anywhere else that smoking is prohibited. Frequent inspections of outlets with possible loss of licence. Tightly restricted mailorder sales.

Strictly enforced age limit of 19 to purchase.

Flavour choices limited to those that are already being successfully used for smoking cessation by former adult smokers.

Drab packaging, including an appropriate health warning.

The industry has shown that it cannot be trusted to avoid teenagers as a market. It wants to expand well beyond former adult smokers, for a product whose long-term health implications are unknown.

It is crucial to limit vaping to those whom it may help in smoking cessation. That will be good for our population health and reduce strain on our health-care system.

BRUCE MacKINNON