When the Framework Convention on Tobacco Control was finalized twenty years ago, it identified the need for product standards for tobacco, but kicked the setting of such standards down the road. "The Conference of the Parties, in consultation with competent international bodies,
shall propose guidelines for testing and measuring the contents and emissions of tobacco
products, and for the regulation of these contents and emissions." (Article 9)
In the decades since then, experts have been tasked with providing guidance for tobacco regulation. This work resulted in the partial FCTC guidelines on articles 9 and 10 that were adopted in 2012 and updated in 2017, which provide general encouragement for governments to make tobacco products less attractive cigarettes and leave the issue of how to reduce their addictiveness for future consideration. Another group convened by the World Health Organization - the WHO Study Group on Tobacco Product Regulation (TobReg) - meets periodically to consider and report on tobacco regulation.
Translating recommendations from these bodies into domestic regulation to make cigarettes less addictive and less attractive into has proven challenging. Even Health Canada, which pioneered many tobacco product regulations - has hesitated to tinker with the basic design of cigarettes or e-cigarettes. New Zealand's Smoke Free Action Plan announced in December 2021 was the first to include the goal of "Making it easier to quit and harder to become addicted by only having low-level nicotine smoked tobacco products for sale and restricting product design features that increase their appeal and addictiveness."
More leadership was provided this week by the RIVM, the Netherlands' National Institute for Public Health and the Environment. Twin documents were released which explain in legislator-friendly language how governments can achieve these goals. The first provides "Options to make cigarettes less appealing and addictive". The second - a "Recommended Dutch list of prohibited additives in tobacco products and e-cigarettes." - provides details on the chemicals that need to be banned to make this happen. An important conclusion of RIVM is that salt nicotine should be banned in cigarettes and e-cigarettes.
RIVM is a government agency owned by but working independently from the Ministry of Health. Its advice is intended to assist the Dutch government, but is useful too for those in other countries. The measures proposed by RIVM could be implemented in Canada by federal or provincial governments, as tobacco is an area of shared jurisdiction.
The Netherlands plan for a smoke-free generation by 2040
For the past few years, the Netherlands' approach to tobacco regulation has been guided by the National Prevention Agreement endorsed by the government and more than 70 civil society organizations. Among the goals of that plan is the achievement of a smoke-free generation by 2040 and ensuring "by that time no more children will be smoking and that no children will ever smoke again".
This agreement has spurred the implementation of a number of measures already in place in Canada, including smoke-free spaces, retail display bans and plain packaging, and the development of the goal of restricting tobacco and e-cigarette sales to adult-only specialty shops. It was also the springboard for the Netherlands adopting other measures not yet in place in Canada - like restrictions on flavourings in vaping liquids. This week's guidance from RIVM encourages governments to add another policy lever by "imposing tighter restrictions on the appearance and composition of cigarettes ... to make them less appealing and addictive."
1) Ban the use of filter ventilation. This way, manufacturers can no longer give the impression that some types of cigarettes cause less harm. In addition, policymakers could consider banning filters entirely. This would also protect the environment. Filters are made from plastics that do not break down well. This means they stay in the environment as microplastics for many years.
2) Expand standard requirements for cigarettes appearance to make them even less appealing. For example, policymakers could obligate manufacturers to make cigarettes a darker colour or to print a health warning on cigarettes.
3) Lower the nicotine content of cigarettes to a very low level (0.4 instead of 16 milligrams per gram of tobacco). This will make them less addictive. Public communication is an important part of this. Consumers need to know that these cigarettes cause no less harm than cigarettes with a ‘regular’ level of nicotine. They are only less addictive.
4) Ban ingredients that make cigarettes more appealing to new smokers, such as sugars and flavourings. They also make it more difficult for current smokers to stop smoking. Ingredients that make it easier to inhale cigarette smoke are already banned for this reason. Policymakers should make clear which ingredients are banned and make sure that these ingredients are no longer added to cigarettes. They could do this by creating a list of ingredients for which the ban can be enforced.
5) If policymakers implement stricter requirements for cigarettes, smokers may start using other, less regulated products. Policymakers can prevent this by making sure that these recommendations also apply to other tobacco products and related products.
Specific proposals for prohibited ingredients -- including nicotine salts
In the second paper, RIVM identifies specific chemicals that should be prohibited in both smoked tobacco and e-cigarettes.
The list was developed within the framework of the European Directive on Tobacco, which calls for governments to prohibit additives in smoked tobacco products which "facilitate inhalation or nicotine uptake." (s. 7(6)) and also prohibit these in nicotine-containing liquids (s. 20(3)).
The Dutch researchers built on lists that were in place in Germany and Belgium. To this list of more than a dozen compounds or categories, they proposed 3 new substances for prohibition:
* Nicotine salts
* Titanium Oxide
* Vitamin E acetate.
With respect to the proposed ban on nicotine salts, the RIVM research team based its reommendation on research that addressed higher concentrations of nicotine liquids than are currently allowed for sale in the Netherlands (or Canada). They recommend that additional research be conducted on the addictiveness potential of lower concentrations.
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RIVM list of proposed prohibited additives |
Some of the additives in this list are already forbidden for use in Canadian tobacco products, with a smaller number prohibited in e-cigarettes sold in Canada.
The Netherlands has already banned the sale of flavoured liquids in e-cigarettes, with the restriction scheduled for full implementation later this year. The flavour restrictions proposed by Health Canada in 2021, but now seemingly abandoned, sought to reduce the attractiveness of vaping products to youth, but did not address the addictiveness.
