One could be forgiven for thinking that Canada is getting it right with regards to tobacco harm reduction (THR). The Canadian government’s approach is often compared with the United Kingdom, a leader in THR, if there are any to be found in the world. Journalists emphasize that Canada’s approach is more humane and focused on harm reduction than a country like the United States. The reality could not be further from the truth. Canada has taken a hard line, not just against people who smoke but against people who use nicotine in any form. The truth is that Canadian governments at both the federal and provincial levels and Health Canada, our public health agency, have initiated a war against people who use nicotine. And nobody really cares.
For a long time, Canadian governments and public health agencies were focused on the effects of smoking. This is the right place to put one’s focus, with Health Canada estimating that 48,000 Canadians die of a smoking-related illness each year. But a while back, there began to be signals that a change in focus was afoot. Less discussion of the harms of smoking, more talk of nicotine and how we can and should eliminate nicotine use in the population.
What would cause such a groundshift? Why turn attention away from the deadly effects of smoking and towards nicotine use, when we know that nicotine itself poses no serious harms? In a word- vaping. When the people who use vapour products predicted that they would change the world, they weren’t wrong. But they probably didn’t foresee how it would play out. In their minds, the brand new technology had the potential to shift millions of people away from combustible tobacco- saving lives, in effect. They were right on that front. But it also triggered a paternalistic backlash that has seen otherwise rational people scramble to prevent an “epidemic” of nicotine use.
The backlash came as a surprise to a lot of people who vape. These people were celebratory: not only had they quit smoking (surprising a good many who hadn’t intended quitting, like myself) but they saw vaping taking off, transitioning millions of people around the globe off cigarettes. And all this without a single taxpayer cent, no vaping program or helpline, no government interference, no coercion or shame. The expectation among many was that vaping would be heralded as a massive win for public health. What they, and I, didn’t realize at the time is that there would be a “wrong way” to quit smoking.
There is a strong preference in the tobacco control world for complete abstinence and vaping does not fit the bill. Vapour products are a substitute for cigarettes. They aren’t technically a smoking cessation product, even if they do cause people to quit smoking. It’s a distinction without much of a difference if our concern is to get people off cigarettes and the deadly effects of smoking, or prevent them starting in the first place. But it is a massive difference if that is not the primary goal and that’s where this gets messy.
A lot of people working in tobacco control (TC) and other public health agencies see it as their primary mission to take down “big tobacco”, not to help people stop smoking. What they have in common with their old nemesis is not caring how many people who smoke have to die in the intervening years. Smoking is your problem to solve, not theirs. When they say “quit or die”, they mean it literally. A substitute product, however many magnitudes safer it is, does not further the goal. In fact, many see a substitute product as a substantive threat to their end goal. Their preference is to denormalize nicotine use of any sort and stigmatize people who use nicotine (similarly to what was done with people who smoke), thus eliminating any off-ramp for the tobacco industry and ensuring that it is never able to reestablish itself.i This is an entirely different goal from saving lives.
It explains why people who work in TC can be so cavalier, why they are so contemptuous of people who smoke and who vape, and why they absolutely can’t be counted on to further the goals of tobacco harm reduction. To them, people who use nicotine stand in the way of their objective, to eliminate an industry with a devious historical record. They have become the supervillain in their own saga, laser-focused on a singular end goal no matter the tactics or the loss of life.
This should be a bigger news story, especially given some of the sensational but nonsensical claims and the social justice issue at the centre of it all, but the simple fact of the matter is that hardly anyone cares. We’ve long adjusted our attitudes towards people who smoke. People who smoke, or used to, have even internalized it. Smokers are stupid. They made their own choice. Smokers lack willpower and they smell. They shouldn’t be allowed in the same spaces. On and on. We no longer require an anti-smoking campaign: we know it by heart. It’s just not that effective anymore.
We’re long past the gains made from informing the public of the dangers of smoking. The dangers are well known and yet people continue to smoke, continue to take up smoking, and continue to die. A different way forward is needed and it requires tobacco harm reduction activists to take up the space of tobacco controllers, a big ask given the funding and organizational disparities between the two groups. We need real heroes in this space though, ones who are focused on saving and extending lives, nothing else. 48,000 lives lost a year means we can’t be distracted by any other goal.
That won’t be easy. Health Canada has indicated that they are not prepared to abandon the old tobacco control model, a combination of coercion and shame, instead preferring to broaden it to include people who vape (or “use nicotine”). If HC’s plans are enacted by this Liberal governmentii the setback to public health will be immense. For instance, in the most recent (December 19, 2020) Canada Gazette concerning vaping, the government acknowledges that cutting the nicotine in e-liquids by 70% would result in more people smoking- but that is precisely what they propose to do. Nary a peep from the mainstream media or the opposition parties, it’s worth noting, even with sensational tidbits like that sprinkled throughout the document, from the same public health body that tells you “Switching from tobacco cigarettes to vaping will reduce your exposure to many toxic and cancer causing chemicals.”
And they don’t intend to stop there. HC and the Liberal government have indicated that they will be looking at flavours next: namely, whether adults rightly need flavours. It’s a strange question (of course they do, people generally ‘need flavour’) but not out-of-line with the approach that HC has applied specifically to people who smoke or vape: that they’re somehow not just regular people but a subset species. It may be obvious that of course adults want and need flavours, in all sorts of things that they consume from food and beverages to medicines, but that hasn’t stopped everyone from policy makers to health reporters weighing in on whether people who use nicotine do as well.
In fact, since HC took over the vaping file in 2018 they have been steadily whittling away at its effectiveness, appeal, and availability, with simultaneous efforts from both provincial and federal governments. For example, while flavours are a topic of concern again, the issue of “child friendly” e-liquid flavours like creme brulee and tiramisu has already been resolved. The government banned dessert and confectionery flavour profiles in 2018. They also banned pictures on e-liquid bottles, and any logo or depiction of animals or people real or imagined on any packaging or inside of a vape shop. Listening to reporters and politicians and public health workers talk, you wouldn’t know that. They accuse the industry of peddling cotton candy flavoured e-liquids with names like Unicorn Poop to lure in children and suggest that the only way to proceed is to ban all flavours. It’s blatantly false and easily fact-checked but never is. It’s intended to disparage people who vape and people working in the industry and it’s effective, so it doesn’t need to be true.
Health Canada has also refused to move an inch on relative-risk statements, though they’ve been promising progress for years. They have relative-risk statements about vaping on their own website but as of May 2021, it is still illegal for a vape shop or retailer to advertise their products as less harmful than smoking (an undisputed fact). Further, because vapour products are a consumer product they cannot be marketed for smoking cessation. It doesn’t matter that studies have shown that it is as or more effective than any approved cessation product, or that vaping was conceived of by a pharmacist as a means to help people like his father to quit smoking, or that millions of people around the globe have achieved just that with vaping. So the industry has advertised things like colour and form and flavours and vapour, being careful to avoid testimonials (also illegal) and quit-smoking claims. In turn, the government complains that the industry is trying to make vaping sexy. They set up the conditions and then complain about the (completely predictable) result. Considerably less sexy would be the relative-risk statements that the industry has been pleading for and testimonials from people who quit smoking through vaping, but Health Canada shows no sign of supporting that.
This is all happening at the same time as hardliners make gains at the provincial level. Almost every province has enacted legislation that restricts access and/or product availability. Nova Scotia went so far as to ban all flavours in e-liquid and restrict the nicotine to 20 mg/ml or less and consequently saw a 25% increase in smoking. (The same path Health Canada has indicated it wants to go.) BC came up with the strange idea of banning e-liquids with no nicotine, on top of punitive taxes and plain packaging requirements. Ontario limited options for rural citizens by restricting the sale of certain products to vape shops, eliminating convenience stores as points of access for people who smoke even though that’s exactly where they buy their cigarettes. P.E.I. just banned flavours, and Saskatchewan will limit offerings outside of specialty shops and have increased the provincial tax. The list goes on. (See Timeline of selected regulatory actions on electronic nicotine devices for a comprehensive list of regulations across Canada.)
It’s also notable that whether at the federal level with Health Canada or at the provincial government levels, legislation is constantly in progress. It is being introduced and rolled out over years, not months. No sooner has one measure been introduced (and the industry and consumers adapted, or dropped off as the case may be) than another is presented. Sometimes the new regulation results in the loss of an entire category (such as HC’s ban on open-systems), sometimes it requires the disposal of tens of thousands of products and a new labelling regime, sometimes it closes off points of access. It almost always involves an introductory speech about “protecting children” (because of course) and pits the government and “public health” organizations against citizens who smoke or used to and the threat they present to society.
Health reporters, even the really good ones covering other harm reduction issues, have largely ignored the vaping story and the social justice aspect of it. That it disproportionately impacts segments of the population who are already marginalized doesn’t sufficiently appeal, even being a trending topic among media. Most reporters have been all too happy to pile on people who use vapour products and the industry more broadly, revealing how little real attachment they have to harm reduction principles. Some of the same people who (rightly) lambast governments for their inaction on the contaminated drugs supply and their ineffective, outdated approach to people who use drugs are only too happy to promote misinformation, fear, and stigma about people who use nicotine.
There is every indication that Health Canada, along with the federal government and their provincial counterparts, are poised to all but officially wipe out vaping in Canada by rendering the products ineffective, unappealing, and difficult to access. They’ve been working at it piecemeal over the years and we’re in what appears to be the final stretch with nicotine, flavours, and cost (in the form of taxes) all on the table. Every measure has been introduced with the aim of “making vaping less appealing” to prevent the uptake by young people and people who haven’t previously smoked, with the acknowledgment that this will also turn some people back to smoking and prevent others from quitting. That this is at cross-purposes with the 5 by 35 goaliii does not raise an eyebrow with the folks at Health Canada and other overeager policy makers.
It is so much harder to turn things back than to prevent them happening, and we’re already a fair ways down this road. It’s important that harm reduction advocates are clear-eyed about their goal to combat the health effects of smoking on people. That means centering people who smoke in the conversation, not seeing their numbers as a hindrance to a goal, but that there is still work to be done to correct the inequalities that exist. It means supporting people who smoke where they are at, not where we would have them be, and recognizing that one person’s ‘bad habit’ may be a part of another person’s support system. And it means not misleading them with regards to safer options in an effort to control them.
Right now, that also means pushing back against Health Canada and the federal and provincial governments with every bit of energy that you can muster. This piecemeal attack is not an accident. It’s meant to wear people down. The rolling legislation is having the intended consequence: shuttering vape shops a few at a time, frustrating advocates so that they’re too tired to continue, splitting advocates on whether concessions are necessary or self-defeating, changing the public perception of what a “real quitter” is, and sending people back to smoking. By the time policy makers are done, they will have manufactured the proof that they need that vaping is not the effective tool it once was. Policy makers and public health officials have made clear their animosity towards citizens who use nicotine and it’s up to us to defend them, defend ourselves, and prevent rollbacks to public health gains. It’s not what we wanted to be doing during a pandemic but it’s what we must do.
Things that you can do
Call or write to your Member of Parliament and your Member of Legislative Assembly. Your representative is not aware of your stance on the issue unless you tell them, even if you sign a petition. It is critical that politicians know how voters in their jurisdiction feel. Write to the Health Minister as well, at both federal and provincial levels, or cc. them on your correspondence with your representative. You can find your MP here and you can find your MLA’s contact information by searching “Member of Legislative Assembly” + your province.
Talk to your friends and family and coworkers about your story with smoking and vaping and tell them how restrictions would/do impact you, and how they would impact people who smoke or vape across the country. Ask them to support your efforts by writing or calling their representatives, or adding their name to a petition.
Sign the petition to the House of Commons to Save Flavours. This petition asks that a range of flavours continue to be permitted in e-liquids, ahead of the federal government’s anticipated announcement on flavours later this year. Add your name so that your concern is counted and to add weight to the petition.
Call out misinformation. It is an exhausting and endless task but it is necessary. Call it out publicly when possible.
i The focus on the tobacco industry’s involvement in the vapour product category is overstated. The majority of companies in the category have no affiliation with tobacco companies.
ii None of the major parties supports people who smoke or vape and there is no indication that a change in party would yield a better result.
iii “5 by 35” is Canada’s campaign to reduce smoking down to 5% of the population by 2035.
