Public Use Micro File of the Canadian Student Tobacco, Alcohol and Drug Survey (CSTADS) is now available

This post provides information on the release of the Public Use Micro File (PUMF) for the Canadian Student Tobacco, Alcohol and Drug (CSTADS), 2020-2021.

CSTADS is a periodic survey funded by Health Canada on the substance use of Canadian middle and high school students. It has been conducted four times over the past decade - during the school years 2014-2015, 2015-2017, 2018-2019 and then 2021-22. The first 3 waves were conducted by the University of Waterloo, after which the work was was contracted to CCI research. 

The results of the 2021-22 wave - reported in an earlier blog post - were first made public in May, but were withdrawn from Health Canada's website soon afterwards for unspecified technical reasons. They were recently re-uploaded and updated. 

CSTADS (now CSADS) is the largest youth health survey in Canada. Information from more than 61,000 students in grades 7 to 12 was provided during class time from most parts of the country. (New Brunswick declined to participate in 3 of the waves, including the most recent one). 

Last week the data files for the 2020-2021 wave of the survey were made public on the federal Open Government Portal. These allow exploration of information not provided on the tables presented by Health Canada, and for more in-depth analysis. 

The charts shown below are derived from the PUMF file, but are presented without the benefit of statistical tests.

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By the time they leave high school, almost 1 in 5 Canadian students use vaping products at least once a week (and 1 in 8 uses them every day).

Health Canada generally groups results into two age groups, but the PUMF file allows for a review of substance use in each grade. Because substance use progresses over time and because younger children are less likely to use substances, grouping produces underestimates of the drug use by students at the end of their school years. The PUMF file, however, allows this estimate to be shown. 

High school students living in rural areas are heavier vapers.

Most students surveyed (82%) were identified as attending a school in an urban area, using Statistics Canada's definitions. Proportionately more students in rural schools reported using e-cigarettes daily. 

According to this survey, although only one-fifth (18%) of students are in rural schools, one-third (34%) of youth who vape daily attend rural schools. Although a similar pattern was seen with respect to cigarette smoking, the very low rates of daily smoking (1.5% overall) make the presentation of data without statistical tests less appropriate. 

"White" and "Aboriginal" high schoolers are heavier vapers.

The survey asked students "How would you describe yourself?" The results were grouped into 8 categories: "white", "black", "West Asian/Arab", "South Asian/Indian", East/Southeast Asian (Chinese ...)", "Latin American/Hispanic", "Aboriginal (First Nations, Métis, Inuit..)" and "Another race/Multiple."

More than half (57%) of students identified themselves as "white", with no other ethnic category composing more than 7% of responses. Three percent of students identified themselves as aboriginal.  

"White" and "Aboriginal" students were disproportionately represented among those who vaped on a daily or weekly basis (70% and 5% respectively).  

Tobacco taxes go up today .... by 15 cents per package

Federal tobacco taxes are subject to an annual inflation adjustment, which is implemented on April 1 of each year. The adjustment for 2024 brings the federal tax on a carton of cigarettes to $33.15 (or $0.17 per cigarette). The federal government also charges 5% GST on tobacco products

Each province also applies taxes to tobacco, and most also charge provincial sales tax. Because of provincial differences in tobacco taxation, the taxes on a package of cigarettes range by about $4.50 across the country. Most Canadians live in Quebec and Ontario, which have the lowest rates of taxation.

No Canadian jurisdiction imposes price controls on Canadian cigarettes, and manufacturers are allowed to set their wholesale prices at different amounts for different retailers. On the image below (and the downloadable data sheet), data is presented for the impact of taxation on a package of cigarettes which wholesales for $4.41 and for which the retail markup is set at 10% of the wholesale price and excise taxes.

Canada's tobacco taxes fall short of the World Health Organization recommendations

The WHO recommends that taxes make up 75% of the price of cigarettes. This standard will be met in some provinces for the least expensive brands, but overall the WHO considers that Canada falls well short of this mark. 

In the 2023 WHO report on the global tobacco epidemic, tobacco taxes in Canada were estimated at 63.3% of the retail price (p. 136). More than 40 countries meet the the 75% "best practice" standard for taxation - including most Western European countries and Australia and New Zealand.  

From the 2023 WHO report on the global tobacco epidemic,

Ontario's Chief Medical Officer of Health calls for better controls on tobacco and nicotine.

This post highlights an important report from the senior public health officer in Canada's largest province. 

In "Balancing Act: An All-of-Society Approach to Substance Use and Harms", Ontario's Chief Medical Officer of Health, Dr. Kieran Moore, focuses on Ontario's experience with substance use. He provides specific recommendations on four categories of substances: tobacco-vaping products, cannabis, alcohol and opioids.

The analysis and recommendations in this 81-page report do not reflect the policy of the current Government of Ontario. Ontario's Chief Medical Officer of Health has a duty to provide the legislature with an independent annual "on the state of public health in Ontario." In recent years these reports have focused on specific public health issues - last year's report focused on pandemic preparedness.

Dr. Moore's 2024 report provides a comprehensive review of the impact of both legal drugs (nicotine, cannabis, alcohol) and illicit drugs (opioids), and addresses upstream and downstream factors which influence use and harmful use.

As the title "Balancing Act" suggests, the report identifies the forces and tensions which influence public policy in these areas -- respect for individual autonomy with respect to substance use, community protection, economic benefits and harms, reducing harm without increasing use, etc.

The recommendations which flow from this analysis challenge many current policies and practices of both the Ontario and Federal government. (Not only did the Ontario government quickly distance itself from his recommendations, it chose to release the report on the Friday afternoon of a long weekend.)

With respect to tobacco and nicotine - an area largely abandoned by Ontario's Conservative government after its election in 2019 - Dr. Moore offers little support for federal government's harm reduction approach. Dr. Moore casts doubt on the potential for vaping products to assist with smoking cessation when sold as consumer products: "Studies comparing nicotine e-cigarettes to usual care/no treatment suggest only a small benefit, and the long term (i.e. longer than two years) benefits and harms of e-cigarette use are largely unknown due to short follow-up of current studies. The World Health Organization (WHO) recommends that “any government pursuing a smoking cessation strategy utilizing e-cigarettes should control the conditions under which the products are accessed to ensure appropriate clinical conditions and regulate the products as medicines."

The report's approach to vaping and nicotine do align, however, with that made earlier by Dr. Moore's provincial and federal colleagues, who provided guidance on vaping policies collectively as Canadian Chief Medical Officers of Health. This Ontario report is also consistent with the advice of Canadian health agencies and with the World Health Organization. 

For example, Dr. Moore's report casts doubt on the potential for vaping products to assist with smoking cessation when sold as consumer products:  "Studies comparing nicotine e-cigarettes to usual care/no treatment suggest only a small benefit, and the long term (i.e. longer than two years) benefits and harms of e-cigarette use are largely unknown due to short follow-up of current studies. The World Health Organization (WHO) recommends that “any government pursuing a smoking cessation strategy utilizing e-cigarettes should control the conditions under which the products are accessed to ensure appropriate clinical conditions and regulate the products as medicines."

Instead, Dr. Moore uses the report to call for stronger controls on nicotine products (including nicotine pouches): "Ontario still falls short of many of the World Health Organization recommendations to protect children, including banning flavours as well as any features that could appeal to youth." His specific recommendations for tobacco-and nicotine policies and programs are listed verbatim below. 

Dr. Moore's advice is good for Ontario, and would be good for the rest of the country too. 

More than 2 decades have passed since Canada had a national vision for tobacco control. The last pan-Canadian strategy (the National Strategy to Reduce Tobacco Use (NSTRTU)) was drafted by a steering committee composed of provincial and federal governments representatives as well as those from civil society.

Canada's national approach to tobacco control was abandoned in 2001 when the federal government stepped away and established its own approach. The Federal Tobacco Control Strategy (FTCS) modified the NSTRTU framework (Prevention, Protection, Cessation, Denormalization) to drop Denormalization and to replace it with the goal of Harm Reduction. Some provincial governments have subsequently adopted their own strategies, but most of these have languished without renewal in recent years. None have formally adopted harm reduction as a tobacco control objective.

Dr. Moore's report offers a sensible plan to protect public health from tobacco industry products. It will however take a major change in approach by either the Ontario and Federal government for these measures to be put in place.

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Recommendations from "Balancing Act: An All-of-Society Approach to Substance Use and Harms" related to Tobacco and Nicotine

Reinvigorate the Smoke-Free Ontario Strategy, focusing on populations and regions with high rates of tobacco use. Expand the strategy to create a comprehensive, coherent public health-oriented framework for regulating vaping and all nicotine-containing products. 

Targets 

• Adopt Health Canada’s target of less than 5% tobacco use by 2035 

• Develop aggressive targets to prevent the use of vaping products by youth and people who do not smoke 

Health Promotion 

• Continue to raise awareness among Ontarians, particularly youth, of the risks associated with tobacco and vaping products 

Regulatory Measures 

Minimum legal age of purchase 

• Increase the minimum legal age to purchase tobacco and vaping products from 19 to 21 years old 

• Consider progressively increasing the minimum legal age to purchase these products over time as a way to ban the purchase of these products by future generations 

Product Controls 

• Ban flavours for all tobacco and vaping products 

• Expand restrictions on where people can smoke or vape (i.e. not in social housing, near building entrances, exits and air intakes, in all outdoor spectator stands, beaches, and specified parts of provincial parks) 

• Require apartment landlords and condominium boards to have a smoking/vaping policy 

• Ban the use of water pipes in all places where smoking is banned 

• Expand the current regulatory framework to include specified non-tobacco nicotine products, such as nicotine pouches, and prevent their sale and promotion to youth and people who do not smoke 

• Ban the sale of disposable vaping products 

• Establish product controls to prevent the evolving risk of vaping devices being used to deliver other drugs, such as cannabis, fentanyl, and crystal methamphetamine.

Availability 

• Restrict physical store locations where tobacco and vaping products can be sold, including prohibiting any new stores within 200 metres of an elementary or secondary school or an existing tobacco/vaping retail outlet, and capping the total number of retail locations in a municipality/region (i.e. retail density)

• Impose a licensing fee for retailers of tobacco and vaping products 

• Explore measures to reduce illegal, untaxed tobacco sales outside of First Nations communities 

• Work with the federal government to ban online retail sales of tobacco and vaping products without in person age verification at delivery 

Pricing and Taxation 

• Increase the provincial sales tax on tobacco products and increase the tax each year to keep pace with inflation 

• Maintain provincial sales tax on vaping, and increase annually to keep pace with inflation 

Promotion 

• Work with the federal government to restrict:

   o online and social media advertising of tobacco and vaping products 

   o the design, appearance, and branding of e-cigarettes to reduce their appeal to youth 

• Reduce or eliminate the number of price signs allowed in tobacco and vaping retail settings visible to youth 

• Prohibit manufacturers from offering incentives to retailers (e.g. bonuses for reaching sales volume targets, chances to win vacations or entertainment tickets, lower prices based on volumes purchased), and prohibit retailers from passing incentives on to consumers 

Enforcement 

• Issue time-limited suspensions for retail outlets that repeatedly sell vaping products to minors, as is done for tobacco 

• Enforce the current limitations on nicotine concentration in vaping products (20 mg/ml), determine whether companies are using product strategies to undermine the 20 mg/ml standard, and restrict the capacity of tanks, pods and refill containers 

Treatment 

• Increase access, including free products, to evidence-based smoking cessation therapies and supports, such as the Ottawa Model for Smoking Cessation 

• Increase research and training on vaping cessation therapies and supports for youth and adults

Monitoring and Reporting 

• Establish key performance indicators for public health inspectors and others involved in enforcing tobacco and vaping policies designed to protect minors and non-smokers 

• Work with Public Health Ontario and with federal, provincial, territorial and Indigenous partners to continue to: 

   o Monitor the impact of tobacco and vaping on health 

   o Review new evidence on vaping and other non-tobacco nicotine use 

   o Assess the impact/effectiveness of tobacco and vaping policies 

   o Issue regular public reports on Ontario’s progress (key performance indicators) in reducing harms associated with tobacco and vaping use

More countries move to ban flavours and disposable vapes

This post provides an update on recent actions taken by health authorities outside Canada to address nicotine use by youth.

Flavour bans

The number of countries which have banned all flavours (other than tobacco flavour) in vaping products grew to 7 in January, when Latvia finalized its law to that effect. As with the Netherlands and China, Latvia restricts tobacco flavourings to a "white list" of permitted ingredients. The Latvian restriction comes into effect on August 1, 2024. 

Australia, which does not permit the sale of vaping products except under prescription, placed restrictions on the flavours for which prescriptions can be issued: only tobacco-flavour, mint and menthol are permitted. This measure took effect at the beginning of March. (Australia does not currently ban menthol in cigarettes).

A description of international flavour restrictions can be downloaded here. 

A list of health organizations calling for flavour restrictions can be downloaded here. 

 

Banning disposable vapes

At the beginning of 2024 only two countries which otherwise permitted e-cigarette sales banned the sale of disposable vaping products: New Caledonia and Australia. 

Over the past two weeks it has become clear that the number of countries in which disposable e-cigarettes will not be permitted will grow.  

• This week the Belgian Health Minister announced that its proposed ban, which had been suspended during a review by the European Commission, was back on track for implementation at the beginning of 2025. 
• Also this week, France formally notified the EU that it will ban these products.  The legislation currently suggests this will take place in September 2024. 
• Also this week, the Polish Minister of Health disclosed that she had received permission from the Prime Minister to introduce legislation to ban disposable e-cigarettes. 
• Last Friday, the New Zealand Associate Minister of Health announced that a law to ban disposable vaping products (and impose other controls) would be introduced.

These new announcements are in addition to proposals earlier this year by authorities in Scotland (draft regulations) and England (announced but not specified in subsequently-tabled legislation)

In early March 2024, seven European organizations with responsibility for waste management called for a ban on disposable cigarettes "by the end of 2024 at the very least."

A chronology of recent regulatory actions on vaping products can be downloaded here. 

Stop Smoking medications authorized in Canada include 4 manufactured by tobacco-nicotine companies

Three months have now passed since federal Health Minister Mark Holland told reporters that he wanted to "shut down the loophole" that resulted in Imperial Tobacco being granted authorization by the department to market Zonnic nicotine pouches. 

CBC reporter Marina von Stackelberg reported on November 30th that "When asked how Health Canada failed to anticipate that risk, Holland said he takes 'responsibility for that' and vowed to take a "rigorous look" at the processes for approving nicotine products."

This post post presents information on stop-smoking products which have been authorized for sale by Health Canada. 

The loophole the Minister is trying to close and the process for approving nicotine products is not limited to Zonnic, manufactured by a subsidiary of British American Tobacco.  

Health Canada has also given permission to other tobacco-nicotine companies to sell nicotine products as stop smoking medication, allowing them to avoid the more restrictive rules placed on their other nicotine products. These authorizations include:

* Rogue nicotine gum manufactured by a subsidiary of the cigar-manufacturer Swisher.
* Sesh+/Lucy nicotine gum manufactured by nicotine gum and pouch company Lucy Goods
* Quit (TM) gum manufactured by Fertin Pharma, a subsidiary of Philip Morris International.

A list of stop-smoking products authorized by Health Canada can be downloaded here.

Canada's two-track system for stop-smoking medicines

Health Canada's regulation of drug products is managed under the authority of the Food and Drugs Act, with specific reliance on the regulations under that act. In the case of stop-smoking medications, two distinct regulatory systems are involved.

Track 1: Pharmaceutical and Over the Counter Drugs. 

The Food and Drug Regulations set the parameters for the sale of prescription and non-prescription drugs, including the issuance of Drug Identification Numbers (DIN) to authorized products, the licensing of manufacturers, and restrictions on advertising. Medications containing nicotine are considered prescription drugs, unless they meet certain criteria for dosage levels and modes of delivery, in which case they are regulated as  Natural Health Products. 

The stop-smoking medications that are regulated as Drugs and managed under the Food and Drug regulations are Varenicline and Bupropion. Five manufacturers are authorized to sell varenicline in Canada, one of which (Pfizer's Champix) is currently not for sale. Health Canada identifies that 5 authorized manufacturers currently sell bupropion.

Track 2: Natural Health Products

The Natural Health Products (NHP) Regulations set the parameters for the sale of health products made from plant or plant material or extracts other than those in categories which are excluded (cannabis, opioids). These products cannot be sold unless than have been authorized and assigned a Natural Health Product Number (NPN). The regulations governing application for authorization, advertisements and manufacture are different (and have been found less stringent) for Natural Health Products than they are for Drugs. 

There are currently almost 100 authorizations issued by Health Canada for Natural Health Products sold as a way to help smokers quit. 

- Stop smoking products made by Consumer healthcare companies

The NHP regulations were adopted in 2003. Before they were in place, nicotine gum and nicotine patch were regulated as drugs, and were initially sold on a prescription basis. Many mainstream consumer healthcare companies (e.g. Kenvue, Haleon) are authorized to sell NRT in Canada, as are generic drug companies (e.g. Teva, CellChem).    

Health Canada has authorized many pharmaceutical
companies to sell nicotine replacement products

Beginning in 2016, Health Canada has authorized 5 manufacturers to sell Cytisine (Baptitoxine), of which at least 2 are currently for sale in Canada (CRAVV and Tobalief)

Two authorized cytisine products
are now marketed in Canada

- Stop smoking products made by Alternative medicine suppliers

Health Canada has authorized the sale of stop-smoking aids for which the evidence of effectiveness is quite small. These include include a homeopathic remedy and herbal medications made from Lobelia plants or from other combinations.

Herbal remedies authorized by Health Canada 
for sale as stop-smoking aids. 

- Stop smoking products made by Tobacco and nicotine manufacturers

Health Canada has also authorized companies which normally sell nicotine as a consumer/recreational drug to also sell it as a medication to address the addiction caused by their primary business activity.

In addition to authorizing Zonnic (sold by Imperial Tobacco Canada / British American Tobacco), Health Canada has also given permission to three other recreational drug manufacturers to sell nicotine as Natural Health Products. 

The first of these was the 2021 authorization to Lucy Goods for the sale of Lucy and Sesh+ nicotine gum in Canada. Just over a year ago, Lucy gum was introduced to the Canadian market, quickly raising concerns about the manner in which it was being sold.

Since then authorization to sell NRT has also been given to ReCreation Marketing, a subsidiary of Turning Point Brands whose mainline business is smoking accessories like Zig Zag papers and cannabis pipes. Its Solace and Fre brands are not yet for sale in Canada, although they are currently sold in the United States.

Rogue Holdings is another company that has been given permission to sell nicotine lozenge and gum. Rogue is a subsidiary of Swisher Brands, whose main activity is the manufacture of cigars. Rogue nicotine gum and lozenge are currently for sale in the USA, but do not seem to be yet sold in Canada. 

Another company authorized to sell NRT in Canada is Philip Morris International (PMI). In 2021, PMI acquired Fertin Pharma, which had previously been authorized to sell nicotine gum in Canada.

Rogue and Solace are not yet sold in Canada
(product illustrations from USA)

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Health Canada makes available the list of substances for which a prescription is required, the drugs that have been authorized for sale in Canada and also authorized natural health products. A consolidated list of these products is available here.

Are e-cigarettes safer than regular cigarettes? 107 studies are compiled to provide a disturbing answer.

This post reports on a new study which calculates the risks of using e-cigarettes in comparison with those of using cigarettes alone, or using both e-cigarettes and cigarettes, or using neither. The study was published today in the digital journal NEJM Evidence: Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes.

The lead author of this systematic review and meta-analysis is Dr. Stan Glantz, who is well known for his pioneering tobacco control research. Co-authors are Dr. Nhung Nguyen, an epidemiologist specializing in substance use and Dr. Andre Luiz Oliveira da Silva, whose experience in tobacco regulatory science includes work with the Brazilian government health agency ANVISA. (Dr. Glantz provides more information on the study here.)

Their review looked for all population epidemiological studies published between January 2005 and October 1 2023 that reported on experience of disease in the general population by e-cigarette users. In that sense, this paper is the contribution of the authors of 107 studies aimed at building the epidemiological evidence base on e-cigarettes.

The results published today are in stark contrast to previously published estimates of relative risk (see below) and call into question the view of the government of Canada and others whose policy objective is to achieve population level health benefits by encouraging smokers to switch to e-cigarettes.

The meta-analysis was restricted to disease categories for which at least 5 previous papers had been published. There were six such conditions: cardiovascular disease, stroke, metabolic dysfunction asthma, COPD and oral disease. Other diseases (including cancer) did not meet this criteria.

The results of this study: 

* do not support the conclusion that smokers who switch completely to e-cigarettes are less likely to experience cardiovascular disease, stroke and metabolic dysfunction.

* support the conclusion that vapers who do not smoke are more likely to experience cardiovascular disease, metabolic dysfunction, asthma, COPD and oral disease than are those who neither smoke nor vape.

* support the conclusion that dual users (those who smoke and vape) have 20-40% higher odds of experiencing cardiovascular disease, stroke, metabolic dysfunction, asthma, COPD and oral disease than if they only smoked. 

The importance of this paper to tobacco control

This paper challenges previous conclusions that e-cigarettes produce meaningfully lower risks to the user than cigarettes, and counters beliefs that encouraging smokers to switch to e-cigarettes reduce population-level harm.

It suggests that the relative risks associated with vaping have been seriously understated:

* In 2015,  British researchers recommended that governments consider e-cigarettes to be "95% less harmful" than combustible cigarettes. This assessment was not based on data, but on the opinion of a small group of researchers, some of whom were associated with the vaping industry. 

* In 2023, American health economists assumed that the risk of dying from vaping is 15% that of smoking when building a simulation model for health outcomes. 
* In 2022, New Zealand researchers used studies on biomarkers to estimate that "vaping could be a third as harmful to health as smoking", although they rescinded (corrected) that conclusion a year later with the admission that "data limitations with the selected studies and the assumptions involved in our method, are too problematic to allow for a valid quantitative assessment."

The implications for health policy in Canada

In 2018 Health Canada adopted a harm reduction approach to tobacco centred on smokers' switching to e-cigarettes. Six years later, their stated intention remained to "increase the number of people who transition away from smoking (to vaping)".  

Official statements by the Government of Canada on the risks of vaping are mostly vague with respect to diseases other than addiction, with an overarching message that they are "not completely harmless". Not only do federal government communications fail to specify any diseases likely caused by e-cigarettes, they further blunt their warnings by simultaneously recommending that smokers switch to e-cigarettes.

Health Canada's advice on the risks of vaping

The department has acknowledged that this approach was developed with "limited scientific evidence and much uncertainty" and that that "this lack of evidence persists". (It has recently provided $1.2 million to CAMH to conduct an evidence review). 

Uncertainty should no longer be used as a cover for Canada's harm reduction strategy.  Canada's health policies should no longer assume that smokers who switch to e-cigarettes are likely to improve their health, given the greater likelihood that they will become dual users. The government should abandon its "balanced" approach which tolerates exposing young people and non-smokers to inducements to try vaping in the (unsupported) hopes that such marketing will result in substantial population health benefits.

Applying the disease odds published today to the situation in Canada suggests that vaping policies in this country have not reduced harm, but have instead increased it. Only a small proportion of e-cigarette users in Canada are former smokers (27%), with a much larger share being dual users (34%) or never smokers (40%). (CTNS 2023).

An appropriate response to the evidence published today would be for Canadian governments to move quickly to ban inducements to vape (flavours, package designs, promotions and pricing incentives), to increase risk communication (mass media, warning labels), to curb supply and to hold manufacturers responsible for the harms their products are causing.   

Cannabis, caffeine and chocolate -- BAT's expanding footprint in Canada

BAT presentation 2021 showing
three areas of focus

Four years have now passed since British American Tobacco revamped its branding and proclaimed a "better tomorrow" business plan focused on new nicotine delivery systems, and three years since it announced that it was going "beyond nicotine" to sell other psychoactive substances ("On the go wellbeing and stimulation").

The release earlier this month of BAT's most recent annual report provides an update these activities. This post reports on those which  have particular relevance to Canada.

BAT adds cannabis to its business plan

BAT has added a fourth product category of activity. To the three areas identified in 2021 (Tobacco, New Nicotine and Beyond nicotine wellbeing and stimulation) it has now added a fourth drug - cannabis - to its strategy for "Quality Growth". 

The company notes that revenues from the global legal market for cannabis have doubled from £5.2 billion in 2019 to £11.1 billion in 2022. In this year's annual report the company boasts that cannabis is "an exciting potential category for the future".

BAT Combined Annual and Sustainability Report for 2023

Coming soon: "disruptive inhalation formats" for cannabis 

Canada is a proving ground for BAT's entry into cannabis. The tobacco giant now owns 45% of Organigram. Based in New Brunswick, Organigram is one of the larger cannabis manufacturers in Canada and sell a range of combustible, edible and vaporized products.

Organigram reports that its partnership with BAT is aimed at "innovative technologies in the edible, vape and beverage categories in addition to new disruptive inhalation formats"  BAT reports that its collaboration with Organigram "is in late-stage development of a suite of emulsions, novel vapour formulations, flavour innovations and packaging solutions which are soon to be commercialised by Organigram in the Canadian market."

Organigram Investor Presentation 2024

Water soluble cannabis for beverages and cosmetics

Organigram is not the only cannabis-related investment of BAT in Canada. Through its venture capital arm, BtomorrowVentures, BAT is funding the development of water-soluble cannabis by the Vancouver-based company Trait.  This technology is promoted as a way to infuse cosmetics and to increase the dosage of cannabinoids in beverages. In October 2023 Traitbio posted:

“The collaboration between Btomorrow Ventures and Gotham Green Partners, in particular, has been a powerful catalyst in advancing Trait’s development and commercialization activities,” says Hanny Kanafani, PhD, President and COO at Trait, “thereby enabling the launch of unique first-generation cannabinoids which, when added to waters/beverages, maintain beverage clarity and do not impart turbidity, even when added at competitive dosages.

“When added into cosmetic applications, Trait’s water-soluble materials do not require additives typically used in skincare products to maintain quality; and opens the door for unique and differentiated infused cosmetic applications.”

British American Tobacco and the candy counter

Awake chocolate manufactures caffeinated chocolate under the eponymous brand name ("each bite .... contains as much caffeine as a half a cup of joe!". It also makes chocolate designed to help people relax ("mello milk and dark chocolate bites are the perfect way to wind down. Infused with a natural botanical blend of lemon balm and L-Theanine, our delicious chocolate promotes relaxation without drowsiness.")

The company is privately owned and is based in Mississauga. British American Tobacco first invested in Awake in 2021 and increased its financing again in 2023. 

Although Mello 'relaxing chocolate' is not currently available, the caffeinated product Awake can be found in convenience and other stores across Canada.

Health groups call on Federal government to deliver on its commitment to protect kids against nicotine addiction

This post includes a copy of an advertisement placed in this Monday's edition of the Hill Times by several Canadian health organizations, as well as the accompanying press release issued by the Quebec Coalition on Tobacco Control yesterday.

Montreal, February 19, 2024 – Leading health organizations concerned about the health and wellbeing of youth in Canada have united to publish a full-page ad today in The Hill Times to draw Ottawa lawmakers’ attention to the urgent need to intervene to protect minors against nicotine addiction.

The ad is signed by Action on Smoking & Health, the Canadian Cancer Society, the Canadian Lung Association, the Quebec Coalition for Tobacco Control, Heart & Stroke and Physicians for a Smoke-Free Canada.

It highlights how flavours play a key role in attracting kids to nicotine products and calls on the federal government to ban flavours in vaping products, including mint and menthol (tobacco flavour would be allowed). Banning flavours has been on the government’s agenda since the publication of draft regulations in June 2021, although no concrete action has materialized since then.

While the government’s existing proposal would exempt mint/menthol, health groups have argued that a complete ban on non-tobacco flavours is required to protect young people from nicotine addiction, as mint/menthol is the second-most popular flavour amongst youth and young adults. A comprehensive ban would be consistent with developments in a growing number of jurisdictions, including Finland, Hungary, Lithuania, Netherlands, Norway, five U.S. states (California, Massachusetts, New Jersey, New York, and Rhode Island, as well as D.C.) and six Canadian provinces and territories.

The ad also calls for swift action to protect minors against the sale and promotion of nicotine pouches, namely by making them a prescription-only product. Under the current federal rules, nicotine pouches authorized under the Natural Health Products Regulation can be legally sold to minors in convenience stores and promoted on television, billboards and social media, including by means of lifestyle advertising.

In fact, it was Imperial Tobacco’s lifestyle promotion in favour of their new “Zonnic” pouches that pushed health groups to sound the alarm last fall. Making nicotine pouches available on a prescription-only basis would give time to both federal and provincial governments to establish a proper regulatory framework.

So far, only British Columbia and Quebec have taken steps to address this issue, by requiring consumers to go through a pharmacist to purchase these products.

Quotes:

“Several additional options are available to the Health Minister, like temporarily suspending the sale of nicotine products, which would also allow federal, provincial and territorial authorities to strengthen relevant laws and regulations. For example, nicotine pouches could be subject to many of same provisions regarding promotion that apply to tobacco and vaping products,” explains Cynthia Callard, Executive Director of Physicians for a Smoke-Free Canada.

“Nicotine is a highly addictive drug, and there needs to be adequate controls before a nicotine product is allowed on the market,” says Sarah Butson, Senior Director, Public Affairs at the Canadian Lung Association. “Nicotine pouches are popular with youth in other countries – a trend not observed with other forms of smoking cessation products. We are concerned about a rise in popularity by Canadian youth and the resulting early exposure to nicotine.”

“Nicotine gum was initially only sold by prescription in Canada, and only later on was a non-prescription approach allowed,” says Manuel Arango, Director of Policy & Advocacy at Heart & Stroke. “Using that same precautionary approach for a new type of nicotine product is totally reasonable and could be done easily and quickly.”

“This is the first time in more than 100 years that it is legal for a nicotine product from a tobacco company to be sold to minors in Canada,” says Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society. “Tobacco companies cannot be trusted. It is essential that the federal Health Minister take action on an urgent basis.”

“Imperial Tobacco can claim all it wants that its pouches are intended for adult smokers who want to quit, but unlike other manufacturers of nicotine replacement therapies (NRT), this company deliberately chose to distribute its product through convenience stores and promote them with lifestyle messaging and images of young adults,” explains Flory Doucas, Co-Director and Spokesperson of the Quebec Coalition for Tobacco Control.

“The Minister said last Monday that we can expect an announcement regarding nicotine pouches ‘in the coming days’. We look forward to seeing what the Minister plans to do. We hope that the government will be consistent in protecting kids from nicotine addiction and will rapidly move to ban all flavours in vaping products. Time is of the essence when it comes to kids getting hocked on nicotine,” said Les Hagen, Executive Director of ASH Canada.

Newly released JUUL documents show the company felt welcomed by Canadian and UK health regulators

At the end of January the first release of 4 million internal documents from JUUL were made public on the UCSF Industry Documents Library. The disclosure of these documents was a condition of the 2021 settlement between the State of North Carolina. The documents date from 2015 to 2019. 

Among the 280,000 documents contained in this release are some which show that  JUUL felt its products were not only acceptable to regulators, but were initially welcomed by them. 

CANADA

Vaping products were legalized in Canada in May 2018. A few weeks later (August 13, 2018) JUUL officials met with representatives of Health Canada. Their notes of this meeting suggest some mutual enthusiasm for the sale of JUUL products in Canada: "We had a very positive meeting with Health Canada this morning.... The main takeaway was that they are excited to have new entrants into the market for nicotine-containing e-cigarettes that are compliant with the regulatory framework that they have put in place."

The JUUL meeting report says that government officials suggested that the company work reports that it was suggested to them that they "work with credible academics in Canada to generate research on safety and health impact of our products." 

Health Canada's report of the meeting is somewhat different. (The department makes public notes from its meeting with tobacco and vaping companies). On the question of the the government's receptiveness to the launch of JUUL, their notes record "JUUL asked if HC had any concerns with its upcoming market entry. HC responded that JUUL would need to ensure compliance with the Tobacco and Vaping Products Act and the Canada Consumer Product Safety Act."

UNITED KINGDOM

During the previous summer (June 2017) JUUL went out for "an excellent dinner" with the tobacco control program lead at Public Health England (Martin Dockrell) and the chief executive of ASH UK (Deborah Arnott).  

This was a year before JUUL was launched in the UK , and the company was trying to figure out its regulatory approach. The meeting notes show that two avenues were considered -- one where the device would be licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) - a process that JUUL was cautioned could take a year or two. 

Their meeting notes report that the Public Health England representative suggested an alternative and faster route. If they marketed JUUL as a "novel tobacco product", there was no need to seek pre-approval. "We hadn't considered this pathway till Martin suggested it," the notes record. The memo concludes in bold that "This previously unconsidered approach has the potential to be very attractive."

A record of this meeting prepared by Public Health England has not been located. 

Varia: Newly-posted information on Government of Canada web-sites.

This post identifies information recently posted on some federal government websites that is relevant to tobacco control.

Compared with cannabis and alcohol, Canadians continue to think smoking and vaping are less acceptable and more risky.

On January 12, Health Canada released the results of the most recent Cannabis survey. This is the sixth release of the annual survey, which is one of the few Canadian surveillance tools which looks at the social acceptability of using legal recreational drugs by mode of delivery. 

Of the six behaviours (oral cannabis use, smoked cannabis use, vaped cannabis, alcohol drinking, vaping nicotine and smoking tobacco ), smoked tobacco continues to be the least socially acceptable behaviour, followed by vaping. 

This survey also asks about perceived risks of product use. Again, tobacco use and vaping are perceived to be the most risky. There have been statistically significant shifts in perceptions of risk for both vaping (higher then lower) and tobacco (lower) when compared to 6 years ago.

The survey also found that using dried leaf (smoking) cannabis remains the most popular form of delivery (60% of past-year users), but that this has fallen in recent years, with increasing use of edibles and vaping. Among daily cannabis users, dried leaf is the most common form of use (31% of dried leaf users are daily users). The combined use of tobacco and cannabis has fallen slightly since 2018 (from 30% to 24%). 

Twice as many post-secondary students are vaping as smoking.

The results of the 2020-2021 Canadian Postsecondary Education Alcohol and Drug Use Survey (CPADS) were posted on the federal government website in January. This survey engaged 31,643 Canadian students aged 17 to 25 enrolled in any program at a university, college or CEGEP. 

Alcohol remains the most frequent substance consumed (two-thirds of students in the past month), with Cannabis coming second (29% past month use, 8% daily use), vaping third (17% past month use, 8% daily use) followed by smoking (8% past month use, 2% daily use). Gender differences in vaping and smoking were not observed.

New trademark registrations may signal new products

In January, Corporations Canada reported new trademark filings by Philip Morris for:

* vaping products (VEEV CLEAR TASTE, VEEV NOW ULTRA V);

* snus (ADVANCE FIFTEEN, ADVANCE NINE), 

* heated tobacco (RIVIERA PEARL, TEREA STARLING PEARL, TEREA BLACK SUNSHINE)

* PR campaigns  (STAY CURIOUS)

From these it seems reasonable to assume that:

* Philip Morris is following the path laid by British American Tobacco in seeking authorization to market their Zyn/Velo nicotine pouches in Canada, but to use a different brand name (Advance/Zonnic) in doing so.

* PMI is introducing a fourth version of its vaping product to Canada (in addition to the capsule Veev One, and the disposables Veev NOW 2ml and Veev NOW 5 ml)

Changing surveillance tools 

Although it has not made an announcement to this effect, Health Canada has terminated its support for the Canadian Tobacco and Nicotine Survey, making the winter of 2022-23 the last period in which this survey was conducted. 

The 2024 questionnaire of the Canadian Community Health Survey contains 8 questions on vaping, and the Rapid Response Module (a smaller sample component of the survey) has one question on quit intention, one question on "other" tobacco products and two questions on nicotine pouches. These were released in late December 2023. 

In January, Health Canada issued an Advanced Contract Award Notice for a $700,000 contract with the University of Waterloo for a "Evaluating and understanding cigarette smoking, nicotine vaping, and policies on both products among adults in Canada in the international context" The contract appears to be for an additional wave of the ITC study of smokers and former smokers, with increased sampling in each province.

I Quit for Me

Health Canada has updated and re-branded its Quit4Life resources. The new resources became available on the web-site in January. The website also asks young people to answer a long survey on smoking and vaping and their feelings of addiction (including 8 options for gender!). Those who participate are invited to contact Health Canada for a follow-up survey.

Administrative modifications to the federal Vaping Products Tax

Canada has imposed a tax on vaping liquids at retail since January 2023 and a number of provinces have indicated that they will be partnering in this tax (with a rumoured start date of July 2024).

Amendments to the Excise Act on how this tax will be administered are the subject of a bill currently before Parliament. 

In January the Finance Department provided an explanation on the impact of these changes. (They shift the point at which manufacturers must remit taxes.) 

Updated data sheets on tobacco taxes and cigarette consumption in Canada

This post provides links to updated data sheets on tobacco tax revenues, industry earnings, cigarette sales and smoking rates. Some highlights are provided below.  

Appreciation goes to those working in the government agencies which have collected this information and made it available.

• Taxes on cigarettes in Canadian jurisdictions
• Tax revenues from tobacco sales, 1990 to 2022
• Manufacturers’ and federal tax revenues from cigarette sales.
• Tobacco tax revenues per smoker, Canada 2011 to 2022
• Provincial cigarette and fine-cut sales per smoker

 

1) The average Canadian cigarette smoker provided governments with $1,862 in tobacco-specific taxes in 2022

Almost all (90%) of the federal tobacco tax is collected on manufactured cigarettes, with taxes on cigars and loose tobacco totalling about 340 million. Provincial governments do not provide detail on revenues from different types of tobacco. 

These revenues represents an average of $1,685 in tobacco taxes collected from each of Canada’s 3.8 million cigarette smokers – with the federal government reporting $779 in tobacco tax revenue per smoker and provincial governments reporting between $616 and $1,311 per smoker during the year. 

Almost two-thirds (63%) of Canada’s smokers live in Quebec and Ontario, where where tobacco taxes are lowest.

Related data sheets: 

• Taxes on cigarettes in Canadian jurisdictions
• Tobacco tax revenues per smoker, Canada 2011 to 2022

2) Total tobacco tax revenues in Canada fell by 10% year over  year.

Overall, tobacco tax revenues across Canada fell by 10% in 2022-2023 compared with the previous fiscal year. 

Federal revenues from tobacco excise taxes fell by $217 million, from $3.18 billion to $2.96 billion (-7%). All of the provinces experienced a decline in tobacco tax revenues, from a provincial total of $3.93 billion in 2021-22 to $3.4 billion in 2022-2023. The drop was greatest in British Columbia (-25%), Newfoundland (-23%), Alberta (-17%), New Brunswick (-16%) and Nova Scotia (-15%) and Manitoba (-14%). It was smallest in Prince Edward Island (-0.2%), Ontario (-7%), Saskatchewan (-9%) and Quebec.

Total provincial tobacco tax receipts have dropped by one-quarter (24%) over the past two years, and by almost one-third (31%) once inflation has been taken into account.

Related data sheets: 

• Tax revenues from tobacco sales, 1990 to 2022

3) Industry revenues from cigarette sales are falling -- but are keeping up with inflation better than federal tobacco tax revenues.

Tobacco manufacturers are required to report to Health Canada the number cigarettes they sell, and also to report on their wholesale revenues (including federal taxes) from these sales. This data is periodically released by Health Canada in an aggregate form for each calendar year.

From this data a comparison with the revenues to manufacturers and the federal government from cigarette sales during the calendar year can be made. Before 2014, government and industry generated equivalent gross revenues from cigarette sales and taxes. Since 2014, industry revenue has been significantly higher than federal tax revenues from cigarette sales.

Related data sheets: 

• Manufacturers’ and federal tax revenues from cigarette sales.

4) Tobacco companies report selling 13.4 cigarettes per day per smoker.

Across Canada, the the number of cigarettes (and fine-cut equivalents) reported sold per smoker ranges from fewer than 10 per day in Newfoundland to 15 per day in Quebec, with a national average of 13.4 per day (4,838 per year). 

The number of cigarettes sold per smoker has fallen slightly since 2018. Possible reasons for this are explained in the next section. 

Related data sheets:

• Provincial cigarette and fine-cut sales per smoker

5) Smoking surveys and sales statistics tell different stories about reductions in tobacco use.

Between 2021 and 2022, estimates of the number of smokers in Canada fell by 1% (from 3.830 million to 3.804 million) and the number of cigarettes reported sold fell by 12% (from 20.9 billion to 18.4 billion). 

This is not the first time in the past decade that there has been a large difference in the year-over-year estimates of smoking (from Statistics Canada's Canadian Community Health Survey) and reported cigarette salse (from industry reports to Health Canada). A similar difference was found in 2020, when smoking rates fell much more deeply than did cigarette sales (-11% vs -3%). 

Such discrepancies could result from a number of factors, including:

▪ changing patterns of nicotine use (e.g. smokers shifting to or away from e-cigarettes)
▪ normal variance in the estimates of smoking behaviours 

▪ changes to survey methods which lower or increase prevalence estimates (as happened in 2020) 

▪ increases or decreases in unreported illicit cigarette sales  
▪ incomplete reporting by manufacturers

In 2022, tobacco companies commented on an unexpectedly large reduction in reported sales in 2022, particularly in the western provinces. In a submission to the Ontario Court, Imperial Tobacco reported: "A review of the cash flow actuals vs. forecast for the period from February 28, 2022 until August 29, 2022 shows a decline of $212 M in collections (equivalent to -8.3%). This is driven by a lower sales volume than expected for this period. Although the volume decline is affecting all the regions, it is significantly more severe in the Western provinces. ITCAN’s belief is that this steep decline is affecting not only ITCAN’s business but the entire legitimate cigarettes category. ITCAN’s observation is that a significant and unexpected increase in demand for illicit products is the main cause of the decline."

Sales data reported to Health Canada confirm that legal tobacco sales fell by a greater percentage in British Columbia in 2022 than the reduction in the number of smokers would account for.

Related data sheets:

• Provincial cigarette and fine-cut sales per smoker