Monday 10 May 2021

Why does British Columbia lag behind when it comes to taking cigarettes out of pharmacies?


More than 30 years ago, Canadian health organizations began to campaign for pharmacies to stop selling cigarettes. One by one, 9 provinces and 3 territories amended their tobacco laws to end this practice. Only one province - British Columbia - has firmly declined to take this step. 

This post looks reviews provincial bans on pharmacy sales of cigarettes, and B.C.'s exceptional position to maintain them.

Selling tobacco products is incompatible with the health care responsibilities of pharmacists. 

Pharmacies have been granted exclusive control over the dispensing of many medications and are part of the health care system. Pharmacists are actively engaged in the health of their community. They provide patient counseling, medication therapy monitoring, and help identify and resolve drug related problems.

  • The sale of tobacco in a health care facility such as a pharmacy gives a false and dangerous credibility to cigarettes, and suggests that their use is compatible with health. 
  • Selling cigarettes (that cause disease) is inherently in conflict with the pharmacist’s role in preventing and treating disease.
  • Domestic and international codes of practice for health professionals call on pharmacists to disengage from tobacco commerce.  
Pharmacists need government support to remove tobacco from drug stores

Recognizing this responsibility, pharmacist organizations (including in British Columbia) have adopted policies to support the removal of tobacco from the stores in which their pharmacy practice is located. Because the owners of these stores are not health professionals, but do have responsibilities to generate revenues, the practice standards of pharmacists have not smoothly transferred to the parts of the drug store that surround the dispensing area.

In 1996, for example, the Quebec College of Pharmacists established that their Code of Ethics required that tobacco sales not take place in a pharmacy. Large pharmacy chains, including Shoppers Drug Mart and Jean Coutu, resisted this and took the Order to court. In 1998, the courts upheld the Code of Ethics,  -- and so did the Quebec legislature, which included the sales ban in the Tobacco Act.  (The history is told here on page 174-175.)

Similarly, the Newfoundland Pharmaceutical Association included a sales ban in its Standards of Practice, but found it difficult to enforce. In 2000 the provincial legislature moved to include the provision in its tobacco sales law.

The same challenges have faced pharmacists in British Columbia. The difference is that the B.C. College was unwilling or unable to enforce professional standards on pharmacy-owners and that the B.C. government was unwilling to step in to help them achieve the goals of this standard.

The College of Pharmacists of British Columbia had formally endorsed an end to tobacco sales since 2000, and in 2014, it proposed that this become a new professional standard. As in other provinces, the big pharmacy chains objected and threatened legal action. But instead of the College and the government staring down these business interests, the initiative was dropped. Since 2015 their strategic plan to end tobacco sales has been put on hold.  

Communities support tobacco-free pharmacies

Other Canadian governments have ended pharmacy sales of tobacco with the urging and support of the health community, and without any negative political, business or community response. 

The B.C. government has similarly been encouraged by organizations like the British Columbia Lung Association, the Heart and Stroke Foundation and the Canadian Cancer Society and others. A recent petition campaign led by Leo Levasseur reflects a citizen's frustration with the government's failure to legislate, while rewarding the pharmacy chain that has worked to block reform.

B.C.'s 'harm reduction' lens on pharmacy-sales is not supported by evidence

 In 2014, then Minister of Health, Terry Lake, defended the government's decision to allow tobacco sales in pharmacies as a sort of "harm-reduction" strategy: “You have the opportunity to interact with a health professional about smoking-cessation programs... some have argued that this is such a dangerous substance that it should be sold only in drugstores.”

The idea that ONLY pharmacies or other health-mandated retailers should sell tobacco products has been proposed elsewhere. While this could be a welcome innovation in Canada, the government of British Columbia has not taken any steps towards such a change in tobacco retailing.

Moreover, to date there is no evidence that allowing cigarette sales in pharmacies reduces any harm or increases support for smokers' quitting. Canadian surveys found that smokers were no more likely to report being counselled by a pharmacists in provinces where they could sell cigarettes. To the contrary, U.S. studies have shown that in areas where there pharmacies stop selling cigarettes, there are greater quit attempts.

A change of government did not change B.C.'s policy

Between 2001 and 2017, the Liberal Party held power in British Columbia. Although it introduced restrictions on tobacco sales in 2007 (including banning their sale in hospitals and other health facilities), that government resisted any restrictions of sales on pharmacies.

The New Democratic Party was in opposition during that period, and several of its members pressed for a ban on tobacco sales in pharmacies, through back-benchers motions and petitions. In 2007, the opposition health critic, Adrian Dix, pressed for British Columbia to join other provinces in banning pharmacy sales. “One of the next steps that's required to protect people from the impacts of cigarette smoke is to make pharmacies, which are a place of health, come forward into the 21st century and not allow the sale of cigarettes in pharmacies," he told the legislature. In the first 3 years as Health Minister, Mr. Dix has introduced other important tobacco control initiatives, but has kept silent on the subject of pharmacy sales of tobacco. 

When it comes to tobacco sales in pharmacies, British Columbia remains the odd-man-out among Canadian health authorities. It continues to be out of step with the advice of health professionals  - and in step with the interests of business.