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November 10, 2019
In previous articles we examined whether restricting flavours or points of sale would decrease youth uptake of e-cigarettes. It’s important that when we consider enacting legislation we determine a clear goal and the metrics we’ll use to determine success. If we don’t set measurable goals at the start, we leave open the possibility of further restrictions or outright bans if/when we don’t succeed. Bearing in mind that there are some organizations/persons who want to wipe out vaping altogether, agreeing with or even championing restrictive measures that will ultimately fail to live up to promises is a losing strategy. Let’s examine the effect that limiting nicotine might have.
Currently the Canadian government caps nicotine at 66 mg/ml. That’s actually a reasonable limit based on the data that we do have: it is high enough to be attractive to smokers looking to make the switch (the critical group of interest) and low enough that it does not warrant concerns of toxicity. You wouldn’t want to vape 66 mg/ml in a rebuildable atomizer which are ideally suited to lower milligram nicotine but it is well suited to closed (pod) systems with less battery power and lower heat. Credit to the Canadian government for examining nicotine limits carefully and coming to an evidence based decision.
As talk about youth uptake has heated up in the last while, people are (naturally) looking for reasons that make vaping attractive to youth. While some have pointed to flavours and ease of access, others have highlighted concealability and nicotine levels. Some have pointed to high nicotine levels being attractive to youth because of the head rush.
It is true that if you vape a high nicotine device, there is an initial head rush- much the same as one gets off a cigarette. But, like a cigarette, that buzz is short-lived (and non harmful in and of itself) and not repeatable unless a long enough period passes between cigarettes (or vapes). That anyone is vaping regularly for the head rush is nonsensical. And as ex-smokers, I feel like we know this so it’s difficult for me to get my head around why we would support that idea.
I’ve spoken with more parents than I have teenagers recently so I am not dismissing that some kids may be saying that they are vaping for the rush. But I do take it with a grain of salt. Young people say a lot of things, especially to sound cool. My long experience with nicotine tells me that anyone (teenager or adult) who says they like the head rush they get from a vape isn’t vaping very regularly. What kids are doing “for the buzz” is drugs: alcohol, cannabis, and a variety of illicit drugs to be specific. Health Canada has this data, as does Statistics Canada (we covered this in previous articles).
Would restricting nicotine in e-liquids to less than the current Health Canada recommendation have an effect on young people trying e-cigarettes? Possibly a minimal effect (just as banning flavours or further restricting sales might have a minimal effect), sure. For those kids who are able to get their hands on vapes but not on other substances (like alcohol or cannabis, etc) and are using vapes sparingly enough to get a head rush: it might affect their interest. They might also doctor their own e-liquids or buy high nicotine products from social sources (the black market always sees gains in a prohibitive market).
But what of the knock-on consequences for adult vapers and current smokers who may choose to quit smoking by vaping? We always need to ask that of any proposition. It has been suggested by some that we should limit nicotine to 20 mg/ml or less to make vaping less attractive to young people. Let’s leave aside the argument that we don’t evaluate other adult choices by the same measure. It has been suggested that because the UK does this we would be in line with their regulations. It’s true that in many regards, the UK has proven the gold standard with respect to support for vaping. But that’s not to say that the regulations they instituted in early days are without fault or that we should blindly follow suit on every measure.
On January 16, 2014 Dr. Konstantinos Farsalinos along with other notable signatories wrote to the EU to complain of errors in the tobacco products directive based on his work. Specifically, Dr. Farsalinos points to the nicotine limit of 20 mg/ml and the EU’s misinterpretation of his findings. Taken from the letter:
“The Commission quotes (1) Dr. Farsalinos’ papers (2,3) to justify the claim that 20mg/ml of nicotine matches the average cigarette delivery. Dr. Farsalinos has written to the Commission stating that they have misinterpreted his findings. His research instead shows that 20 mg/ml e-liquid provides less than one-third of the nicotine delivered by one tobacco cigarette (4,5). 50mg/ml is needed to roughly match a tobacco cigarette. All other existing studies confirm this (6-9). Some 20 to 30% of electronic cigarette users use liquids above 20mg (8,10). Higher nicotine content liquids are typically used by the most dependent smokers, who have the highest risk of smoking-related damage, and who benefit most from switching to electronic cigarettes. Most such heavy smokers need more than 20mg/ml to switch from smoking to vaping.”
[As an aside it's worth mentioning that while HC restricts nicotine to <66 mg/ml, all of the major brands associated with high nicotine, closed pod systems (STLTH, Vype, Juul, MYLÉ) limit their nicotine to 50 mg/ml within Canada, of their own accord.]
Anyone examining the issue of restricting nicotine should read the full letter. Our Canadian government is actually ahead of the UK with respect to nicotine limits. Importantly, they take into consideration the value of reaching “the most dependent smokers, who have the highest risk of smoking-related damage.” It is critical to keep front of mind that an estimated 45,000 Canadians die of a smoking-related disease each year.
As the devices that are used in conjunction with high nicotine salts also tend to be small, closed systems they have the added appeal of being easy to use and inconspicuous. While yes, these are both attributes that might appeal to young people, they also appeal to the elderly, the disabled, to professionals who value discretion, and to many smokers who don’t particularly want a hobby so much as a route away from smoking.
When a person, or group, feels that their back is up against the wall it can be tempting to make concessions in an attempt to preserve some freedoms. We should always be careful to examine whether those concessions are at our own expense or whether we are offering up other people’s freedoms though, in addition to whether they are based on a false premise (limiting nicotine to 50 mg/ml or less might be a discussion worth having). Many people who would support a nicotine restriction have been vaping (and away from cigarettes) for some time and are quite comfortable using lower nicotine concentrations. (I am, for instance: you could take away all closed systems and restrict nicotine to 3 mg/ml and I would be unaffected. Raise that to 6 mg/ml and my husband would also be unaffected.)
Supporters of the initiative to restrict nicotine to <20mg/ml also point to the fact that high nicotine e-liquids were not available when they quit smoking by vaping so it is possible (it was never 20 mg/ml in Canada though, we had 24mg/ml from the start). The argument doesn’t sound much different from the one ex-smokers who quit by other means use, “I did it so you can too.” That is the kind of moral posturing that we, the vape industry and community, hoped to stand in contrast to. (I would, however, expect that any company that does genuinely believe this argument- that high nicotine is attracting youth and should be restricted as adults don't need it- pull the product from their shelves on principle. There is no need to lobby or wait on government intervention ahead of doing what one feels is the right thing to do.)
The point being that while there is no real evidence to support the argument that restricting nicotine to 20 mg/ml would meaningfully impact youth uptake (or that they wouldn’t simply access nicotine another way), there is evidence that it would impact adult smokers and vapers. And we are never arguing on solid ground when we must rely on sacrificing the rights of some for the rights of others. When we do that, we’re not so much talking about rights as we are about privilege.
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