The Hon. Mark Holland on Zonnic (And an update on developments elsewhere)

This post provides updates on recent developments in tobacco control in Canada and elsewhere.

Minister Holland expresses anger over the marketing of Zonnic.

Parliament was not sitting last week, when health groups called on Minister of Health Mark Holland to suspend the sale of Zonnic, the nicotine pouch authorized by his department this summer as a smoking-cessation aid.

With the House back in session, journalists were able to question the Minister about his response. The full scrum is available on CPAC (starting at 54:32) -- with some highlights from Minister Holland's comments pasted below.

Well, first of all, I am appalled by the actions of the tobacco industry. Yet again they have tried to seek a loophole to find a new way to peddle nicotine.

It is very clear in my view that there are very serious questions about what the tobacco industry is doing here and what their intention is. It would seem that their intention is to addict new young people to nicotine - which is disgusting. I think that we have to take this seriously and are.

I'm mad. I think it is wholly inappropriate. I am frustrated that yet once again we have to go back and adjust our regulations because the tobacco industry has found some Machiavellian clever way to skirt regulation and try to addict new people.

We are looking at what actions we can take and to take those actions quickly. We want to shut down this loophole.

We are going to have to review our processes. I don't want anything going out there that is going to target new users and particularly young people. We are going to have to take a rigorous look at our processes.

The way that this [product] was presented was that it was for the purposes of cessation. We were duped.

The true intent appears to have been concealed. Obviously if we knew their intention, we would never have allowed the product.

The fact that we could have allowed this to get across the line and not seen this eventuality and not seen what they are going to do, I am deeply apologetic for. I do not want this out in the world and we are going to do everything we can to remediate it.

Minister Holland responds to questions about Zonnic
(54:32 - 103:40)

Updates on smoking behaviours from the Canadian Community Health Survey 2022

This post provides information on data collected by the Canadian Community Health Survey (CCHS) during 2022. The 5 figures presented below use data made public on Statistics Canada web-site (Health Characteristics annual estimates), Health Canada's website and the Data Dictionary for the survey which was provided to us by Statistics Canada. A downloadable data sheet  which relates to some of the figures is available.

Background: Canada's national surveys on smoking behaviour

With 65,300 participants, the Canadian Community Health Survey is the largest health survey in Canada, but it is not the only one. 

The Canadian Community Health Survey has been conducted for over 20 years, although several changes have been made over those years. The questions on smoking behaviour were redrafted in 2022 and questions on vaping behaviour were added. Major changes to the way information is collected were made in 2015 (when in-person interviews were reduced), in 2020 (when they were abandoned) and in 2022 (when on-line interviews were added to telephone interviews). As reported here earlier, the method by which data is collected seems connected to peoples' willingness to self-identify as a smoker: people who responded face-to-face were more likely to say they smoked. 

On behalf of Health Canada, since late 2019 Statistics Canada also conducts the Canadian Tobacco and Nicotine Survey, (CTNS) which now also includes questions on cannabis and alcohol use. 12,100 Canadians participated in that survey in 2022, and data from that wave were released by Health Canada this past September. The CTNS was preceded by the Canadian Tobacco Use Monitoring Survey (CTUMS, 1999-2012) and the Canadian Tobacco Alcohol and Drug Survey (2013-2017).  The CTNS collects information on-line, and the previous surveys used telephone interviews.

Figure 1: the gaps between survey estimates are closing

For many years there was a sizeable gap in the estimates of smoking rates produced by the CCHS and CTUMS/CTADS, with the larger survey identifying a million more smokers than the smaller telephone surveys. 

There was very little difference in the estimates for 2022. The CTNS collected in winter 2022-23 found 10.9% of Canadians over 15 years of age smoked daily or on occasion (10.9%), close to the CCHS estimate of 11.6% for Canadians over 12 years of age. 

There was also no difference in the estimates of past-month vaping use between both surveys. Both estimated past-month e-cigarette use at 5.8%. 

Figure 2 : More provincial variation in smoking rates than in vaping rates

With five times as many Canadians participating, the CCHS is better able to provide comparisons of substance use among Canada's smaller provinces than is the smaller CTNS. 

As tested by Statistics Canada, smoking rates are statistically higher than the rest of the country in Newfoundland, Nova Scotia, Saskatchewan and lower in Ontario and British Columbia. Vaping rates are statistically higher in Alberta and lower in Ontario. 

Figures 3a and 3b: Prevention can take the credit for driving smoking rates down.

From 2001 to 2022, the CCHS survey population grew by 7.2 million, the number of smokers fell by 2.8 million, the number of former smokers grew by 1.14 million,  (to on to 33 million), the number of experimenters grew by 0.7 million and the number of Canadians who reported they had never smoked a whole cigarette grew by 8.6 million.

The population growth in Canada during that period reflects the net impact of 1.8 million births, 1.5 million deaths, the net arrival of 1.6 million immigrants and 0.6 million non-permanent residents and the net departure of 0.16 million emigrants. 

The survey results suggest the key role that population turnover is playing in estimates of smoking prevalence. Since 2018, there was a decline both in the number of smokers and the number of former smokers, with a growth in lifetime abstainers that was more than twice as large as the loss of ever smokers.

Figure 4: Cannabis now rivals tobacco for number of users

When considering the total population, the CCHS estimates that many more Canadians have used cannabis in the past month than have smoked cigarettes (4.6 million vs. 3.8 million), with a somewhat smaller difference reported by the CTNS (3.4 million vs. 2.6 million). 

When it comes to daily use, however, cigarettes are more commonly used than cannabis (3 million vs. 2 million Canadians) or vaping (3 million vs. 1 million Canadians).

 

Figure 5: January is a key month for quitting.

In previous years, the CCHS only asked recent quitters about the month in which they quit smoking. In 2022 the information was asked of all former smokers. 

January was most frequently cited as the month in which a smoker quit (19%) followed by June (11%) and September (9%).

The urgent need for a new nicotine regulatory framework

 

Today (November 17th) is the deadline for contributions to Health Canada's legislative review of the federal tobacco law. The Minister is required by law to table a biennial report on the “provisions and operations” of the law no later than May 23, 2024.

This post reports on the key recommendations contained in the PSC response to the discussion paper. Our submission includes 49 additional recommendations aligned with their 19 consultation questions.

Key Recommendation A:

Health Canada should seize this opportunity to modernize its tobacco/nicotine strategy

• The Canadian federal approach to the tobacco industry reflects a 20th century focus on reducing consumer demand for cigarettes, particularly among young people. The objectives of the federal tobacco law (which were mapped onto vaping products in 2018) have not been revisited in 35 years.

• Although Health Canada has adopted the goal of reducing tobacco use to “under 5% prevalence by 2035” this objective is not legislated, and is not supported by an accountability framework for government or industry.

• Although Health Canada adopted “harm reduction” language in 2018, no formal strategy (and no legislative basis) has accompanied this change. There is no federal legislative or programmatic objective with respect to vaping or other forms of nicotine use by individuals over 18 years of age.

• In recent years the tobacco industry has re-invented its marketing strategies and is expanding its range of nicotine products (e.g., heat-not-burn, nicotine pouches, hybrid products) and other psycho-active products (e.g. CBD, functional food and beverages).There is currently no federal programmatic or legislative response to these market developments.

• The Legislative Review is an opportunity for Health Canada to present its analysis of developments in the nicotine market, to articulate a public health objective with respect to this market, and to make recommendations for the modernized legislative foundation that would support these objectives.