This post reports on five recent events relevant to regulating vaping products in Canada.
This week, Health Canada released the results of its fourth wave of inspections, finding that 60% of the specialist retail vaping outlets were not obeying the Tobacco and Vaping Products Act. This report focused on inspections of brick-and-mortar stores conducted between August 2021 and March 2022.
This industry's socks are still around its ankles. In the first two inspection reports (235 stores between July-September 2019 and 845 stores between October and December 2029), Health Canada found more than 8 in 10 stores were breaking the law. During the COVID period (July 2020 to March 2021), inspections were focused on 304 social media accounts, of which more than half displayed illegal promotions.
Gas and Convenience stores continue to be more compliant than specialist stores, with 11% failing the most recent test, compared with 12% and 14% three years ago.
2) University of Waterloo researchers report on what vape shops are selling
Their review of bricks-and-mortar shops was conducted between April and May 2021 and the on-line survey was done in January to May 2021. This was a moment in time before federal restrictions on nicotine content were in place, although they were established in two provinces (British Columbia and Nova Scotia). During this review, a ban on flavours was only in place in one province (Nova Scotia), but two others (British Columbia and Ontario) did not permit the sale in places where young people could enter.
This survey also found high levels of non-compliance. "Many online retailers did not comply with provincial nicotine limits and/or flavour bans. For example, 76% of e-liquids identified online in provinces with a full ban on fruit flavours contained a fruit flavour."
The researchers propose that age verification processes were needed to protect young people from accessing these web-sites in provinces where sales are limited to age-restricted venues. Health Canada first indicated its intention to establish regulations on age-verification in February 2021, but has not disclosed further details since that time.
3) Environics finds vapers do not have difficulty overcoming flavour restrictions
Better age-gating does not address the range of concerns about vaping flavours. The focus of many regulators has now moved from putting in adult-only stores to broader restrictions on flavourings, as the governments of Nova Scotia, Prince Edward Island, Newfoundland, Northwest Territories have alrady done. Other options include prohibiting internet sales of vaping products, as Quebec does.
Another recently-released report shows that supplier behaviour undermines these regulations. In early 2022, on behalf of Health Canada, Environics Research asked Canadian vapers about the products they used and whether they accessed flavours that were prohibited by provincial regulations. (POR 024-21, Factors Associated with changes in vaping behaviour during 2020).
They found that adult vapers had little difficulty overcoming the restrictions if they wished to:
"Youth and, to a lesser extent young adults, in Nova Scotia were most likely to report having been affected by the ban on flavours. Most of them found other ways to get flavours, such as homemade flavours being sold at school, or buying flavours from people at school who ordered them online. Some also reported they would buy flavours from stores that still sold them under the table.
"Adults in Nova Scotia were less affected by the restrictions, since many had previously smoked and preferred tobacco vaping flavour and others procured flavoured products online or by driving to a neighbouring province."
4. U.S. Food and Drug Administration does not yet see a public health benefit to menthol e-cigarettes
This was the first decision by the FDA regarding menthol flavourings. Under U.S. law, since September 2020, each product has been separately evaluated before being authorized for sale (although unauthorized products remain widely available). Authorization can only be issued if evidence is provided to the FDA that the product will protect public health - in effect that it will support smoking cessation and will not increase youth use.
Of those products that have received marketing authorization from the FDA, the only flavour permitted has been tobacco-flavour. Last year, the FDA recently explained its rationale: "For flavored ENDS (i.e., ENDS with e-liquid flavors other than tobacco or menthol, such as fruit), there is a known and substantial risk of youth initiation and use; accordingly, an applicant has a higher burden to establish that the likely benefits to adult smokers outweigh that risk. For tobacco-flavored ENDS the risk to youth is lower; accordingly, a lesser showing of benefit may suffice. Assessments for menthol flavored ENDS will be addressed separately. When it comes to evaluating the risks and benefits of a marketing authorization, the assessment for menthol ENDS, as compared to other flavored ENDS, raises unique considerations."In its first decision on menthol, the regulator explained that it was not convinced that the potential benefits of menthol Logic e-cigarettes were greater than those for tobacco-flavoured ones: "the evidence provided within the application does not demonstrate that these menthol-flavored e-cigarettes are more effective in promoting complete switching or significant cigarette use reduction relative to tobacco-flavored e-cigarettes among adult smokers."
Moreover, it found that menthol presented a higher risk for young people than did tobacco-flavoured: "For non-tobacco-flavored e-cigarettes, including menthol-flavored e-cigarettes, existing evidence demonstrates a known and substantial risk with regard to youth appeal, uptake and use. "
Seventeen months ago, Health Canada took a different view on menthol, concluding that the potential risks to youth could be offset (balanced) by potential benefits for smoking cessation. In the June 2021 Proposed Order Amending Schedules 2 and 3 to the Tobacco and Vaping Products Act the department explained "by prohibiting all flavours with the exception of tobacco and mint/menthol, Health Canada aims to strike a balance between reducing the appeal of vaping products, to protect youth from inducements to use vaping products, and leaving some flavour options for adults who smoke and who have transitioned, or wish to transition, to vaping."
The consultation period on Health Canada's proposed flavour restrictions ended in early September 2021. The department has not provided an update on its intentions since then.
5. Quebec government survey confirms young people are highly vulnerable to vaping.
The survey confirms key findings from other survey on smoking and vaping in Canada: vaping has emerged as a nicotine-delivery system with widespread use among youth while cigarettes remain the preferred source by older Canadians. Although young people tend to be exclusive vapers, almost one-third also smoke cigareattes. Vapers older than 25 are as likely as not to continue smoking. (Translated figure shown below)
Translation of the INSPQ's release "Vaping among Quebecers: data from the 2020 Quebec Survey on Tobacco and Vaping Products"
"Since they appeared on the Quebec market more than a decade ago, vaping products have experienced a dramatic increase in their use among adolescents and young adults. Faced with the emergence of this new mode of nicotine consumption, the Ministry of Health and Social Services mandated the Statistical Institute of Quebec to conduct the Quebec Survey on Tobacco and Vaping Products 2020 This is the first cross-sectional survey of vaping products in Quebec to be conducted among people aged 15 and over, with a second edition scheduled for 2023. Although the survey focused more broadly on the use of tobacco products (cigarettes, cigarillos, cigars, pipes, hookahs, chewing tobacco, heated tobacco), the objective of this document is to describe the use of vaping products and the behaviors associated with them, as well than the perceptions of Quebecers aged 15 and over with regard to the consumption of these products.
Here are the main findings that emerge from the analysis of data from the 2020 Quebec Survey on Tobacco and Vaping Products:
* The prevalence of vaping in the 30 days preceding the survey is 4%. It is higher among adolescents (18%) and young adults (15%) than among those aged 25 and over (2%).
* Among Quebecers who had smoked cigarettes or vaped in the previous 30 days, 11% reported using both traditional cigarettes and electronic cigarettes. This proportion is also higher among those aged 15-24 (21%) than among those aged 25 and over (8%).
* Vaping products are used daily by around one in two vapers (48%), with this frequency of use being more common among vapers aged 25 and over (59%) than among the youngest (37%).
* Less than half (43%) of vapers use liquids whose nicotine concentration exceeds 20 mg/ml, although this practice is much more common among 15‑24 year olds (63%) than among those 25 and over (24 %).
* Nearly two-thirds of vapers (66%) perceive themselves to be slightly or not at all dependent on vaping products, including a higher proportion of 15-24 year olds (75%) than 25 and over (58%).
* Specialty shops are the main source of vaping devices or liquids for about six in ten vapers.
Several events that occurred in 2020 and 2021, such as the various measures put in place to fight the COVID-19 pandemic or the new legislative measures governing the use of vaping products in Canada, could have contributed to changing the portrait of the situation of vaping in Quebec. In this sense, the next cycle of the EQTPV will make it possible to follow the evolution of the use of vaping products within the Quebec population following these changes."
