E-cigarettes – An update

A recent edition of the CPHA Health Digest contained a policy brief concerning the sale of e-cigarettes in Canada. We noted that there were limited data to substantiate any claims about e-cigarettes, including a lack of controlled studies demonstrating their efficacy as smoking cessation products. Since then, advocates against the sale of e-cigarettes remain adamant that the product threatens to re-normalize smoking, especially in youth, and use of e-cigarettes risks undoing years of smoking cessation gains. On the other hand, popular opinion, including many celebrity endorsements, supports their use as smoking cessation aids. There have also been a couple of developments that are worth mentioning.

The US Food and Drug Administration (FDA) recently proposed a change to their regulations whereby nicotine-containing e-cigarettes, as well as new and emerging tobacco products, would come under their jurisdiction.¹ If approved, these newly deemed “tobacco products” would be subject to the requirements of the Tobacco Control Act, and FDA would have the authority to issue regulations. This means that existing and new companies could be required to register, pay fees and meet premarket requirements, as well as list the ingredients found in these products. Additional public health regulations might include restrictions on online e-cigarette sales, and marketing to children. These proposals are being reviewed by the U.S. Office of Management and Budget, and we look forward to seeing the results of their deliberations.

The European Parliament has also taken steps to control the sale of nicotine-containing e-cigarettes by approving rules that would effectively ban advertising for them. In addition, if approved by the member state legislatures, it could require e-cigarettes to contain less than 20 milligrams of nicotine per millilitre of inhalant by 2016, and that packaging carry graphic health warnings and be childproof.² In Canada, the BC Healthy Living Alliance has published a position statement that supports the requirement for additional research on the use of e-cigarettes as smoking cessation devices, and the need to both regulate the industry and provide regulation on the consumption of e-cigarettes.³

The control of e-cigarettes in Canada, however, remains the same. The nicotine-containing product is not permitted for sale, while non-nicotine-containing e-cigarettes can be sold. Despite these regulations, high consumer demand exists for the nicotine-containing product and vendors continue to sell them in most metropolitan areas. In the last 4 years, Health Canada has investigated over 250 complaints about the sale of nicotine-containing e-cigarettes and issued cease-and-desist orders in most cases.⁴

Finally, a new study has been published that shows the effect of “vaping” on the smoking habits of adolescents.⁵ This study indicated that students who used e-cigarettes were more likely to be established smokers of real cigarettes and planning to quit, than students who did not smoke. These results are interesting but they shouldn’t be considered conclusive until corroborated by further studies.

In spite of these advances, there continues to be a limited amount of corroborated evidence concerning both the health effects of “vaping”, and the influence of “vaping” on our smoking habits. If nicotine-containing e-cigarettes are as effective as popular opinion suggests, then the manufacturers should submit applications containing the necessary information for their regulation as a smoking cessation device. In addition, our research funding organizations should support targeted studies that investigate the influence of “vaping” on our smoking habits, especially those of our most at-risk communities.

This field is clearly developing rapidly and CPHA will maintain a watching brief.