Friday 18 June 2021

Newly-announced vaping regulations are urgently needed -- as are larger reforms of Canada's approach to tobacco companies

Physicians for a Smoke-Free Canada welcomes the federal regulatory measures announced today to protect young people and non-smokers from the marketing of highly-addictive and enticingly flavoured vaping products.

The new limits on the amount of nicotine that is permitted in vaping liquids will protect many young people from addiction. This measure will be in place in a matter of weeks and urgently required. Vaping products are highly addictive: for every eight young Canadians who vape even once, one has become a daily user. Capping nicotine concentration at 20 mg/ml will align Canada's health regulations with those in the European Union and other countries whose experience of youth vaping has been less severe than countries, like Canada and the United States, where higher levels have been allowed.

The proposed restrictions on flavours in vaping products are also urgently needed. Attractive flavourings entice young people to experiment with vaping and they increase the risk of addiction by encouraging them to continue vaping as they try out new flavours. Flavours mask the harshness of inhaling nicotine and make it easier to bring the particulates and other harmful chemicals deep into the lungs where they cause more damage. These pleasant flavours are associated with healthful products and discourage young people from understanding how harmful these products can be.

We very concerned at the misguided decision to exempt mint and menthol flavours from the proposed flavour restriction and see no reason for the government to have yielded to the pressure tactics of the tobacco and vaping industry. We know from previous experience with restricting flavourings in in tobacco products that the menthol-mint exemption significantly undermines the health benefits of the proposal as mint and menthol are favourite flavours of young people. Moreover, the evidence to support banning menthol is greater than for some other flavours,  if only because menthol flavouring has been used for much longer and its health impact has been studied in more depth. This partial ban also exposes Canada to challenges at international trade tribunals, as the United States found when its 2009 exemption for menthol was successfully challenged at the World Trade Organization.

As welcome as today's announcements are, the new regulations are only band-aid solutions. They do not address the underlying problems of the tobacco market or the structural weaknesses of the federal law. The 2018 Tobacco and Vaping Products Act has proven inadequate both at protecting young people and at reducing harm to smokers. This law was based on the dangerous and incorrect assumption that harm reduction could be achieved by giving nicotine companies more marketing power in a liberalized commercial vaping market instead of requiring them to end the sale of their most harmful products. 

Random Clinical Trials and longitudinal studies have shown that while e-cigarettes can help some smokers quit when used in therapeutic settings, they do not improve quitting rates at a population level when sold as fast moving consumer goods in convenience stores. Should Parliament restructure the law to ensure that e-cigarettes are provided only to smokers and in the context of quitting or harm reduction, then the issues of flavours and nicotine concentrations can be re-examined.

After decades of too-little-too-late regulation-making, it is time for a new approach to smoking and nicotine addiction. When Parliament returns next fall, legislators should give priority attention to the smoking epidemic and the 50,700 preventable deaths it causes each year. They should demand that the government oblige tobacco manufacturers to phase out the sale of combustible tobacco products and end their recruitment of new nicotine addicts.

Thursday 17 June 2021

Recent developments in the Canadian vaping market

This post reports on some recent activities and decisions of vaping manufacturers.

Setting an election agenda: mobilizing against vaping regulations.

Over the past few months, federal proposals to restrict the types of vaping products that can be sold in Canada have become the target of industry-funded campaigns.

The Canadian Vaping Association (CVA), which represents specialty vape shops, has focused on opposing restrictions on flavours. Through its mobilization web-site, it has arranged for about 100,000 indivduals to send emails to members of parliament -- that's about 1 in 10 of all adult vapers in Canada. This was a lobbying season, and the CVA was the most active federal lobbyist group this  April. Meanwhile, the Vaping Industry Trade Association (VITA), which represents vaping manufacturers and convenience stores, has focused on mobilizing opposition to limits on the amount of nicotine that can be put in vaping liquids. 

The impact of these campaigns will be known later this spring, when the government does (or does not) finalize its plans to put a ceiling of 20 mg/ml of nicotine in vaping liquids, or introduce proposed regulations to restrict flavours. 

Sayonara: Japan Tobacco is pulling out of the Canadian Vaping Market

In e-mails to its customers and on its web-site, Japan Tobacco has announced that its Logic vaping devices will be discontinued in Canada as of August. No explanation is offered, and the decision has not yet received much attention in the business or trade press. Japan Tobacco has not announced closures in European markets where nicotine levels are capped - like Ireland and the United Kingdom, although it has also withdrawn their brand from Iceland

Click and Collect: Circumventing bans on selling flavoured vaping in convenience stores

Ontario and British Columbia continue to allow flavoured vaping liquids to be sold, but do not allow them to be sold in convenience stores. This is a problem for the tobacco companies (like BAT/Imperial Tobacco) who have powerful contracts and existing supply systems with 28,000 convenience stores and less sway with the 1,500 or so independent vape shops across Canada. The solution?  Click and collect. BAT offers the option of an online transactions to purchase its VUSE vaping products, with pick up at the local Convenience store. 

"Beyond Nicotine" BAT moves to market CBD vaping products in Canada

BAT has promised investors that it is moving "beyond nicotine" and will be selling products that deliver other drugs. It is currently test-marketing CBD vaping pods for its VUSE devices in Manchester, England. Recent trademark registrations in Canada suggest that it is preparing to sell them here too. This May, BAT registered trademarks for three CBD designs for Vuse pods - smooth berry CBD, Cool Mint CBD and Chilly Mango, CBD. It also registered the phrase "Ryde your Rhythm" for use with CBD and tobacco products. (There may be some regulatory complications - Health Canada has signalled that it will be reviewing the flavours permitted in cannabis vaping products). 

There's an app for that:  Bluetooth-enabled vaping devices

Last winter BAT's Finance Director, Tadeu Marroco, told investors that Canada would be the pilot site for a Bluetooth enabled VUSE device -- presented as a way to conduct age-verification. ("In summary, we are entering 2021 with good momentum across all three new categories, with some exciting new launches planed. In vapor, we are launching a Bluetooth enabled version of Vuse providing electronic age verification. The product will be launched in Canada, as a pilot market in the first half of 2021")

JUUL introduced a Bluetooth connected vaping device in Canada in 2019. Perhaps in response to concerns about privacy and industry surveillance, it now claims that the related App does not monitor usage.

In 2020, the number of vaping products on the Canadian market grew, and prices dropped

The trade analyst group, ECigIntelligence, reported that between 2019 and 2020 number of vaping  products for sale in Canada doubled (from 244 to 498), while the prices fell. Prices of the cheapest category - open pod systems -- fell by 20% over the year to an average of $30. There is currently no formal registry of products for sale in Canada, unlike the European Union, where companies are required to provide advance notice of market introduction. This results in publicly-available lists of products for sale, such as those maintained by the Belgian Ministry of Health.

Canada is the world's third largest vaping market

Italian trade analists Finaria reported that Canada had the third most valuable e-cigarette market, with U.S. $1.08 billion in revenue in 2020, slightly ahead of France and Germany. Ahead of Canada are the United Kingdom (with revenue of $3.1 billion) and the United States (with revenue of $6.2 billion). This is consistent with BAT's report last December that Canada was the second in its list of  the 5 countries which made up 75% of the world's sales of closed vaping products (the others were the USA, U.K., France and Germany) . 

JUUL changes management in Canada.

In April, Juul made two significant changes to its Canadian operations. It replaced its CEO and it withdrew from the Vaping Industry Trade Association. The first decision was implemented without much fanfare: Michael Nederoff was quietly replaced with Eric Omwega. (Mr. Nederoff is now heading a cannabis business).  The following reason was provided for leaving VITA: "While we have appreciated the opportunity to collaborate with VITA (Vaping Industry Trade Association), we will not be renewing our membership as we are not aligned on too many critical policy issues. For example, we support Tobacco 21 legislation (raising the minimum purchase age of tobacco and vaping products to 21), enhanced access controls at retail, and limiting flavour options."

Tuesday 8 June 2021

Newly-released data provides more insight into smoking and vaping in Canada

 In recent weeks three new reports have been issued which shed more light on the tobacco and nicotine use of Canadians. 

Some of this newly-released data shows youth vaping in Canada remained high in 2020. Others show that over the past 3 decades, Canada has done better than most other countries at reducing cigarette smoking. 

1. The Canadian Postsecondary Education Alcohol and Drug Use Survey (CPADS) 

The first wave of Health Canada's new survey of post-secondary student drug use was released in May. Over 20,000 students aged between 17 and 25 attending 41 universities, colleges and CEGEPs participated in this survey in the fall of 2019 and the spring of 2020. 

The survey found that one in ten (10%) of the students surveyed had smoked cigarettes in the past month, and almost one in five (17%) had used vaping products (either for nicotine, cannabis or other products). A larger number - 24% - appeared to have smoked cannabis in the past month, that they reported using dried cannabis flowers or leaves, and a smaller portion - 4% - reported smoking other forms of tobacco, such as pipes, cigars or shisha.

In terms of daily use, roughly the same number used cannabis (8%) or vaping/e-cigarette use (7%). Daily cigarette smoking was 2%.

By way of comparison, in 2017-2018, the Canadian Community Health Survey (CCHS) reported that among students aged 18 to 24, current smoking was about 13% (4.5% daily and 8.3% occasional). The CCHS did not ask questions about vaping across Canada until this year.

A second wave of the Canadian Tobacco and Nicotine Survey (CTNS) of the general population conducted in the fall-winter of 2020-2021 estimated that 13% of young adults (aged 20-24) had vaped in the past month, as had 14% of teenagers (aged 15-19). A much smaller proportion of the CTNS  survey respondents had reported vaping daily in comparison with the CPADS (2% vs. 7%). 

Differences in survey methods (including questoinnaires) may have accounted for the Survey questionnaires for the CPADS were not included in the data release.

2. The Québec Survey on Tobacco and Vaping Products (QSTVP)

Quebec has restructured its ongoing survey of smoking patterns to include questions on vaping products. The results of the first wave of the survey (Consommation de tabac et des produits de vapotage au Québec en 2020) were also released in May.

The survey was conducted with more than 13,000 Quebers over 15 years of age and took place between July and November 2020. (The CTNS with the same target population involved 8,000 Canadians from across the country).

Similar to the CTNS and CPADS, the Quebec survey found past-month vaping was highest among young people and that tobacco smoking was lowest (other than senior citizens). This survey used slightly different age categories than the CTNS, and shows that: 12% of Quebecers aged 18-24 were past-month cigarette smokers and 15% were past-month vapers. Among teenagers (aged 15-17) smoking was lower (4%) and e-cigarette use was higher (18%) than with young adults. 

3. The Global Burden of Disease Collaboration and the Institute for Health Metrics and Evaluation.

In a series of articles published in the Lancet and an accompanying data release, the Institute for Health Metrics and Evaluation recently made available a wealth of information on smoking behaviours world-wide. The Global Burden of Disease collaboration pulled together data from 3,625 nationally representative surveys and made adjustments to standardize age and to address other issues that hindered comparability. 

This work was funded by the Bloomberg Foundation, and continues and expands the data gathering efforts that were previously housed within the World Bank and the World Health Organization. It complements their release last year of estimates of deaths and life years lost attributable to various diseases and causes. (This report is the basis of the estimate that  50,700 Canadian deaths are attributable to tobacco use.)

Canada has been more successful than most at reducing smoking over the past 30 years.

The good news is that around the world, smoking prevalence fell by more than one-quarter (-29.6%) between 1990 and 2019. The better news for Canadians is that here smoking prevalence fell by almost half (-47%). Among the 204 countries surveyed, Canada ranked ninth for reductions in age-adjusted smoking prevalence over this period. The leader was Brazil, where smoking prevalence fell by three-quarters (074%).

This data compilation shows that progress (and lack of progress) was found in all regions and at all national income levels. Costa Rica and Colombia did better than Sweden and New Zealand, Mexico came ahead of the United States and Germany and France did even worse than China.

The researchers counted anyone who used combustible tobacco on a daily or occasional basis as a smoker. This is different than other global rankings which compare daily smokers only, and allows a better comparison with countries where poly-tobacco use can result in a smaller proportion of smokers being daily cigarette smokers. 

In Canada, the early 2000s were years of faster progress

As shown in the graph below, the IMHE data suggests that the fastest deceleration of age-adjusted smoking rates in Canada, especially for women, was between the mid 1990s and mid 2000s. Notably, these were the years when promotional restrictions, smoking bans, graphic health warnings and tax increases were being implemented by governments across Canada.

Canada is keeping up with some, but not all, leading countries.

Canada's current rates are lower othan those in two other countries which have set endgame goals: New Zealand aims to reduce smoking to 5% by 2025, and Finland aims to reduce tobacco and nicotine use to 5% by 2030

Tobacco smoking in Canada is higher than in Sweden (although the gap has mostly been closed for women and has somewhat been closed for men). 

Canada is doing worse than Brazil, where smoking rates were about the same in 1990 and are now about half as high. In 2019, WHO identified Brazil as one of two countries  to have adopted the MPOWER suite of tobacco control measures at a "high level".