tag:blogger.com,1999:blog-64727220752527767342024-03-27T06:50:43.690-07:00Physicians for a Smoke-Free Canada Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comBlogger249125tag:blogger.com,1999:blog-6472722075252776734.post-42694922168017934162024-03-27T06:28:00.000-07:002024-03-27T06:50:12.935-07:00More countries move to ban flavours and disposable vapes<p>This post provides an update on recent actions taken by health authorities outside Canada to address nicotine use by youth.</p><p><b>Flavour bans</b></p><p>The number of countries which have banned all flavours (other than tobacco flavour) in vaping products grew to 7 in January, when <a href="https://titania.saeima.lv/LIVS14/saeimalivs14.nsf/0/653DAFA6383CE566C2258AAE002AC791?OpenDocument" target="_blank">Latvia finalized its law to that effect</a>. As with the Netherlands and China, Latvia restricts tobacco flavourings to a "white list" of permitted ingredients. The Latvian restriction comes into effect on August 1, 2024. </p><p>Australia, which does not permit the sale of vaping products except under prescription, placed restrictions on the flavours for which prescriptions can be issued: only tobacco-flavour, mint and menthol are permitted. <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/reforms-regulation-vapes" target="_blank">This measure took effect at the beginning of March</a>. (Australia does not currently ban menthol in cigarettes).</p><p>A description of international flavour restrictions <a href="https://smoke-free.ca/SUAP/2021/e-cigarette-flavour%20restrictions.pdf" target="_blank">can be downloaded here.</a> </p><p>A list of health organizations calling for flavour restrictions <a href="https://smoke-free.ca/SUAP/2022/Health%20organization%20positions-flavour.pdf" target="_blank">can be downloaded here</a>. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvZSHlQ9mmhaEoFd-XFGbIVe6w_A_wtV1RU9zG7BYoYfBhTGm5Bm6Z0K17UuZMp565zYGxgNswm226N36wVjLwsw47blByfy09wC-A1q7nX3r_RlesmgDor2AYJVJNEpp1Sfol3h6D2ijajffVIxwLjVA4BenWxFHqG5bmi42JRUoq-jCCWA3JQisyqPY/s780/flavour.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="382" data-original-width="780" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvZSHlQ9mmhaEoFd-XFGbIVe6w_A_wtV1RU9zG7BYoYfBhTGm5Bm6Z0K17UuZMp565zYGxgNswm226N36wVjLwsw47blByfy09wC-A1q7nX3r_RlesmgDor2AYJVJNEpp1Sfol3h6D2ijajffVIxwLjVA4BenWxFHqG5bmi42JRUoq-jCCWA3JQisyqPY/w400-h196/flavour.png" width="400" /></a></div><br /> <p></p><p><b>Banning disposable vapes</b></p><p>At the beginning of 2024 only two countries which otherwise permitted e-cigarette sales banned the sale of disposable vaping products: <a href="https://juridoc.gouv.nc/juridoc/jdwebe.nsf/joncentry?openpage&ap=2022&page=10808" target="_blank">New Caledonia</a> and <a href="https://www.tga.gov.au/news/media-releases/new-regulation-vapes-starting-january-2024" target="_blank">Australia</a>. </p><p>Over the past two weeks it has become clear that the number of countries in which disposable e-cigarettes will not be permitted will grow. </p><p></p><ul style="text-align: left;"><li>This week the Belgian Health Minister announced that its proposed ban, which had been suspended during a review by the European Commission, <a href="https://www.brusselstimes.com/belgium/978742/first-in-europe-belgium-will-ban-sale-of-disposable-vapes-from-2025" target="_blank">was back on track for implementation at the beginning of 2025</a>. </li><li>Also this week, France <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/25714" target="_blank">formally notified the EU</a> that it will ban these products. The legislation currently suggests this will take place in September 2024. </li><li>Also this week, the Polish Minister of Health disclosed that <a href="https://www.medexpress.pl/ochrona-zdrowia/resort-zdrowia-pracuje-nad-zakazem-dla-jednorazowych-e-papierosow/" target="_blank">she had received permission from the Prime Minister to introduce legislation</a> to ban disposable e-cigarettes. </li><li>Last Friday, the <a href="https://www.beehive.govt.nz/release/government-crack-down-youth-vaping" target="_blank">New Zealand Associate Minister of Health announced that a law to ban disposable vaping products</a> (and impose other controls) would be introduced.</li></ul><div>These new announcements are in addition to proposals earlier this year by authorities in Scotland (<a href="https://www.gov.scot/binaries/content/documents/govscot/publications/consultation-paper/2024/02/environmental-protection-single-use-vapesscotland-regulations-2024/documents/the-environmental-protection-single-use-vapes-scotland-draft-regulations-2024/the-environmental-protection-single-use-vapes-scotland-draft-regulations-2024/govscot%3Adocument/Draft%2BEnvironmental%2BProtection%2B%2528Single-use%2Bvapes%2529%2B%2528Scotland%2529%2BRegulations%2B2024.pdf" target="_blank">draft regulations</a>) and England (<a href="https://www.gov.uk/government/news/disposable-vapes-banned-to-protect-childrens-health" target="_blank">announced</a> but <a href="https://bills.parliament.uk/bills/3703/" target="_blank">not specified in subsequently-tabled legislation</a>)</div><div><br /></div><div>A chronology of recent regulatory actions on vaping products <a href="https://www.smoke-free.ca/SUAP/2020/vaping-regs-timeline.pdf" target="_blank">can be downloaded here</a>. </div><div><br /></div><p></p> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-70691821091828540022024-03-06T06:10:00.000-08:002024-03-06T08:05:23.871-08:00Stop Smoking medications authorized in Canada include 4 manufactured by tobacco-nicotine companies<p>Three months have now passed since federal Health Minister Mark Holland told reporters that he wanted to "shut down the loophole" that resulted in Imperial Tobacco being granted authorization by the department to market Zonnic nicotine pouches. </p><p>CBC reporter Marina von Stackelberg <a href="https://www.cbc.ca/news/politics/we-were-duped-health-minister-regulations-zonnic-nicotine-pouches-1.7044806" target="_blank">reported on November 30th</a> that<i> "When asked how Health Canada failed to anticipate that risk, Holland said he takes 'responsibility for that' and vowed to take a "rigorous look" at the processes for approving nicotine products."</i></p><p></p>This post post presents information on stop-smoking products which have been authorized for sale by Health Canada. <div><br /></div><div>The loophole the Minister is trying to close and the process for approving nicotine products is not limited to Zonnic, manufactured by a subsidiary of <b>British American Tobacco</b>. </div><div><br /></div><div>Health Canada has also given permission to other tobacco-nicotine companies to sell nicotine products as stop smoking medication, allowing them to avoid the more restrictive rules placed on their other nicotine products. These authorizations include:</div><div>* Rogue nicotine gum manufactured by a subsidiary of the cigar-manufacturer <b>Swisher</b>.<br />* Sesh+/Lucy nicotine gum manufactured by nicotine gum and pouch company <b>Lucy Goods</b><br />* Quit (TM) gum manufactured by Fertin Pharma, a subsidiary of <b>Philip Morris International.</b></div><div><b><br /></b></div><div>A list of stop-smoking products authorized by Health Canada <a href="https://www.smoke-free.ca/pdf_1/2024/List%20of%20approved%20medications.pdf" target="_blank">can be downloaded here</a>.</div><div><b><br /></b></div><div><b>Canada's two-track system for stop-smoking medicines</b><p>Health Canada's regulation of drug products is managed under the authority of the <a href="https://laws-lois.justice.gc.ca/eng/acts/f-27/" target="_blank">Food and Drugs Act</a>, with specific reliance on the regulations under that act. In the case of stop-smoking medications, two distinct regulatory systems are involved.</p><p><b>Track 1: Pharmaceutical and Over the Counter Drugs. </b></p><p><a href="https://laws-lois.justice.gc.ca/eng/regulations/c.r.c.,_c._870/index.html" target="_blank">The Food and Drug Regulations</a> set the parameters for the sale of prescription and non-prescription drugs, including the issuance of Drug Identification Numbers (DIN) to authorized products, the licensing of manufacturers, and restrictions on advertising. Medications containing nicotine are considered prescription drugs, unless they meet certain <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/prescription-drug-list/notices-changes/notice-nicotine-salts.html" target="_blank">criteria for dosage levels and modes of delivery</a>, in which case they are regulated as Natural Health Products. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOq2kl4rYlWZ07IQLslvmew_CkbJ4mk5PuKy38ftX6cUr8HYXZjtkvfxTNKm3L1sqpw4s0CzMPYJ748kUfay6w0Ex5RvB_afBjksv9Ffkq83DvL0oCiUJedc-JraFcofsF1IIOChdIwyVQo7GxFjuyrcgneCTmVh1WalaBHVMu5lVmFdbDSXNn4GfrDlk/s615/prescription.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="615" data-original-width="542" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOq2kl4rYlWZ07IQLslvmew_CkbJ4mk5PuKy38ftX6cUr8HYXZjtkvfxTNKm3L1sqpw4s0CzMPYJ748kUfay6w0Ex5RvB_afBjksv9Ffkq83DvL0oCiUJedc-JraFcofsF1IIOChdIwyVQo7GxFjuyrcgneCTmVh1WalaBHVMu5lVmFdbDSXNn4GfrDlk/w198-h225/prescription.png" width="198" /></a></div>The stop-smoking medications that are regulated as Drugs and managed under the Food and Drug regulations are Varenicline and Bupropion. Five manufacturers are authorized to sell varenicline in Canada, one of which (Pfizer's Champix) is currently not for sale. Health Canada identifies that 5 authorized manufacturers currently sell bupropion.<p></p><h4 style="text-align: left;"><b>Track 2: Natural Health Products</b></h4><p>The <a href="https://laws-lois.justice.gc.ca/eng/regulations/SOR-2003-196/index.html">Natural Health Products (NHP) Regulations</a> set the parameters for the sale of health products made from plant or plant material or extracts other than those in categories which are excluded (cannabis, opioids). These products cannot be sold unless than have been authorized and assigned a Natural Health Product Number (NPN). The regulations governing application for authorization, advertisements and manufacture are different (<a href="https://dalspace.library.dal.ca/bitstream/handle/10222/83331/MichaelTaylor2022.pdf?sequence=3" target="_blank">and have been found less stringent</a>) for Natural Health Products than they are for Drugs. </p><p>There are currently almost 100 authorizations issued by Health Canada for Natural Health Products sold as a way to help smokers quit. </p><p><b>- Stop smoking products made by Consumer healthcare companies</b></p><p>The NHP regulations were adopted in 2003. Before they were in place, <a href="https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=6005" target="_blank">nicotine gum</a> and <a href="https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=12882" target="_blank">nicotine patch</a> were regulated as drugs, and were initially sold on a prescription basis. Many mainstream consumer healthcare companies (e.g. Kenvue, Haleon) are authorized to sell NRT in Canada, as are generic drug companies (e.g. Teva, CellChem). </p><div><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwI0m_ZTFLjqPBi9fQ_xoXLLsMOGQvgNUb-MEsyWkc7jzVxEHvh3RjTy-Uz8SRyD-YdM9ajAnJiyFKeVNYJjOiHRc9aPpvJluCTZSFm8bVqehfPH2pb_Xf8RXTl7JNMrW9_NSA5EknOoxKra1pmprhFLf-baoFz6NxyZ4t4g2QOJO4IEYvP3CX1y5OxBg/s991/nicorette.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="615" data-original-width="991" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwI0m_ZTFLjqPBi9fQ_xoXLLsMOGQvgNUb-MEsyWkc7jzVxEHvh3RjTy-Uz8SRyD-YdM9ajAnJiyFKeVNYJjOiHRc9aPpvJluCTZSFm8bVqehfPH2pb_Xf8RXTl7JNMrW9_NSA5EknOoxKra1pmprhFLf-baoFz6NxyZ4t4g2QOJO4IEYvP3CX1y5OxBg/w289-h180/nicorette.png" width="289" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="color: #3d85c6; font-size: x-small;">Health Canada has authorized many pharmaceutical<br />companies to sell nicotine replacement products</span></td></tr></tbody></table><p>Beginning in 2016, Health Canada has authorized 5 manufacturers to sell Cytisine (Baptitoxine), of which at least 2 are currently for sale in Canada (<a href="https://www.zpharm.ca/" target="_blank">CRAVV</a> and <a href="https://www.vitaaid.com/products?pcode=VA-129" target="_blank">Tobalief</a>)</p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggGID_-esch54-1_KWkjVT8JuAs1VMTIzRDk2KwZ0EUVoCKJuqxgzWnonT-lcsFrkqZ5nbTzQ1s3e0-Pefr4CC25JprL0D0thfjgAY-0lBDpkUKxARiMiQIAyv8EUKw1Iv0sty-FPvcEsjN715hFzsdkmFaOIQX5C9PqQ3iWVFbB10F-rYy80SiB-_-e8/s596/cytisine.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="430" data-original-width="596" height="158" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggGID_-esch54-1_KWkjVT8JuAs1VMTIzRDk2KwZ0EUVoCKJuqxgzWnonT-lcsFrkqZ5nbTzQ1s3e0-Pefr4CC25JprL0D0thfjgAY-0lBDpkUKxARiMiQIAyv8EUKw1Iv0sty-FPvcEsjN715hFzsdkmFaOIQX5C9PqQ3iWVFbB10F-rYy80SiB-_-e8/w219-h158/cytisine.png" width="219" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="color: #0b5394; font-size: x-small;">Two authorized cytisine products <br />are now marketed in Canada</span></td></tr></tbody></table><br /><p><b>- Stop smoking products made by Alternative medicine suppliers</b></p><p>Health Canada has authorized the sale of stop-smoking aids for which the evidence of effectiveness is quite small. These include include a <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80053856" target="_blank">homeopathic remedy</a> and herbal <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=02231490" target="_blank">medications made from Lobelia plant</a>s or from other <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80039485" target="_blank">combinations</a>.</p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiqgZ39baITTNJMVCv5kUnWMeNIeUVqSLIwvOY2QUNC08Gn_Y4U4PbCF0LlRSzcrl8Nmaun0gqjuzhDxbUzCVRbFs2oqOSvt2vx_LTx1-qOaE5VjgO7m3CYkrUraaxRAJFseax3iGjBFcH0A1zZZUMUhhWs2sak_7T6zX5lrHjBGvz3aH8E5QW_EUhvY0/s949/herbal%20remedies.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="428" data-original-width="949" height="128" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiqgZ39baITTNJMVCv5kUnWMeNIeUVqSLIwvOY2QUNC08Gn_Y4U4PbCF0LlRSzcrl8Nmaun0gqjuzhDxbUzCVRbFs2oqOSvt2vx_LTx1-qOaE5VjgO7m3CYkrUraaxRAJFseax3iGjBFcH0A1zZZUMUhhWs2sak_7T6zX5lrHjBGvz3aH8E5QW_EUhvY0/w285-h128/herbal%20remedies.png" width="285" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">H<span style="color: #0b5394;">erbal remedies authorized by Health Canada <br />for sale as stop-smoking aids. </span></td></tr></tbody></table><br /><b>- Stop smoking products made by Tobacco and nicotine manufacturers</b></div><div><br /></div><div>Health Canada has also authorized companies which normally sell nicotine as a consumer/recreational drug to also sell it as a medication to address the addiction caused by their primary business activity.</div><div><br /></div><div>In addition to <a href="https://smoke-free-canada.blogspot.com/2023/07/bat-shoehorns-its-nicotine-pouches-onto.html" target="_blank">authorizing Zonnic</a> (sold by Imperial Tobacco Canada / British American Tobacco), Health Canada has also given permission to three other recreational drug manufacturers to sell nicotine as Natural Health Products. </div><div><br /></div><div>The first of these was the <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80108821" target="_blank">2021 authorization to Lucy Goods</a> for the sale of Lucy and Sesh+ nicotine gum in Canada. Just over a year ago, <a href="https://www.newswire.ca/news-releases/smoking-cessation-brand-arrives-at-major-retailers-across-canada-as-national-non-smoking-week-kicks-off-a-nationwide-commitment-864302134.html" target="_blank">Lucy gum was introduced</a> to the Canadian market, quickly raising <a href="https://smoke-free-canada.blogspot.com/2023/04/sesh-another-nicotine-product-hits.html" target="_blank">concerns</a><a href="https://smoke-free-canada.blogspot.com/2023/04/sesh-another-nicotine-product-hits.html" target="_blank"> about the manner in which it was being sold</a>.</div><div><br /></div><div>Since then authorization to sell NRT has also been <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80112518" target="_blank">given to ReCreation Marketing</a>, a subsidiary of <a href="https://turningpointbrands.ca/" target="_blank">Turning Point Brands</a> whose mainline business is smoking accessories like Zig Zag papers and cannabis pipes. Its Solace and Fre brands are not yet for sale in Canada, although they are currently sold in the United States.</div><div><br /></div><div><a href="https://swisher.com/businesses/rogue/" target="_blank">Rogue Holdings</a> is another company that has been given permission to sell nicotine <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80122774" target="_blank">lozenge</a> and <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80119891" target="_blank">gum</a>. Rogue is a subsidiary of Swisher Brands, whose main activity is the manufacture of cigars. Rogue nicotine gum and lozenge are currently for sale in the USA, but do not seem to be yet sold in Canada. </div><div><br /></div><div>Another company authorized to sell NRT in Canada is Philip Morris International (PMI). In 2021, <a href="https://www.pmi.com/media-center/press-releases/press-details?newsId=24346" target="_blank">PMI acquired Fertin Pharma</a>, which <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80094045">had previously been authorized</a> to sell nicotine gum in Canada.</div><div><br /></div><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0fKEhuIMqcZHFmOmSD7jY0ULtoOeAr_DsEhL5FmzjMUiWNssgta1gGB94-DlN-ZyZwtr18R-Dze_2NbpmoKy4suHzvto4AuDidl1CE7fuFxV8uYKOl1o55yZqgdt1O3hL9CmgM2ADHeJtPHDXqj13_ZueFS9-CjNIsEIOfLAzHHb2s66KxA3dNl43yZQ/s1828/natural%20health%20products.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1041" data-original-width="1828" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0fKEhuIMqcZHFmOmSD7jY0ULtoOeAr_DsEhL5FmzjMUiWNssgta1gGB94-DlN-ZyZwtr18R-Dze_2NbpmoKy4suHzvto4AuDidl1CE7fuFxV8uYKOl1o55yZqgdt1O3hL9CmgM2ADHeJtPHDXqj13_ZueFS9-CjNIsEIOfLAzHHb2s66KxA3dNl43yZQ/w400-h228/natural%20health%20products.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="color: #0b5394;">Rogue and Solace are not yet sold in Canada<br />(product illustrations from USA)</span><br /><br /></td></tr></tbody></table><p style="text-align: center;">--------------------------------------------</p><p style="text-align: left;">Health Canada makes available the list of <a href="https://hpr-rps.hres.ca/pdl.php?lang=en" target="_blank">substances for which a prescription is required</a>, the<a href="https://health-products.canada.ca/dpd-bdpp/" target="_blank"> drugs that </a><a href="https://health-products.canada.ca/dpd-bdpp/" target="_blank">have been authorized for sale in Canada</a> and also <a href="https://health-products.canada.ca/lnhpd-bdpsnh/?lang=eng" target="_blank">authorized natural health products</a>. A consolidated list of these products is <a href="https://www.smoke-free.ca/pdf_1/2024/List%20of%20approved%20medications.pdf">available here</a>.</p></div></div></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-6390145763643200412024-02-27T07:25:00.000-08:002024-02-27T13:39:11.490-08:00Are e-cigarettes safer than regular cigarettes? 107 studies are compiled to provide a disturbing answer.<p>This post reports on a new study which calculates the risks of using e-cigarettes in comparison with those of using cigarettes alone, or using both e-cigarettes and cigarettes, or using neither. The study was published today in the digital journal NEJM Evidence: <a href="https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300229" target="_blank">Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes.</a></p><div>The lead author of this systematic review and meta-analysis is Dr. Stan Glantz, who is well known for his pioneering tobacco control research. Co-authors are Dr. Nhung Nguyen, an epidemiologist specializing in substance use and Dr. Andre Luiz Oliveira da Silva, whose experience in tobacco regulatory science includes work with the Brazilian government health agency ANVISA. (Dr. Glantz provides <a href="https://profglantz.com/2024/02/27/e-cigs-have-similar-risks-to-cigs-for-some-diseases-and-nearly-as-high-for-others-dual-use-riskier-than-smoking-alone/" target="_blank">more information on the study here</a>.)</div><div><br /></div>Their review looked for all population epidemiological studies published between January 2005 and October 1 2023 that reported on experience of disease in the general population by e-cigarette users. In that sense, this paper is the contribution of the authors of 107 studies aimed at building the epidemiological evidence base on e-cigarettes.<div><div><div><br />The results published today are in stark contrast to previously published estimates of relative risk (see below) and call into question the view of the government of Canada and others whose policy objective is to achieve population level health benefits by encouraging smokers to switch to e-cigarettes.<br /><br />The meta-analysis was restricted to disease categories for which at least 5 previous papers had been published. There were six such conditions: cardiovascular disease, stroke, metabolic dysfunction asthma, COPD and oral disease. Other diseases (including cancer) did not meet this criteria.</div><div><br /></div><div>The results of this study: </div><div>* do not support the conclusion that smokers who switch completely to e-cigarettes are less likely to experience cardiovascular disease, stroke and metabolic dysfunction.</div><div><div>* support the conclusion that vapers who do not smoke are more likely to experience cardiovascular disease, metabolic dysfunction, asthma, COPD and oral disease than are those who neither smoke nor vape.</div><div>* support the conclusion that dual users (those who smoke and vape) have 20-40% higher odds of experiencing cardiovascular disease, stroke, metabolic dysfunction, asthma, COPD and oral disease than if they only smoked. </div><div><br /></div></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf13bpvMBr-n2gfiD6jyc1KunyOFT1nHWSLR3tWWmNvRAylgrIxsvri5xQIC8gKAkO2rVKGdHARH4rSAm8wzYibFG0GT49iUBDQzWWYYJw68aj06nEiDytlgwHbFkQ1VqbiDrL4g68V_a20NjASeJGzOGBzEu_4Xf5aJNhqlPCY2vZM3r8d7TfqrZUAwg/s681/glantz-1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="197" data-original-width="681" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf13bpvMBr-n2gfiD6jyc1KunyOFT1nHWSLR3tWWmNvRAylgrIxsvri5xQIC8gKAkO2rVKGdHARH4rSAm8wzYibFG0GT49iUBDQzWWYYJw68aj06nEiDytlgwHbFkQ1VqbiDrL4g68V_a20NjASeJGzOGBzEu_4Xf5aJNhqlPCY2vZM3r8d7TfqrZUAwg/w400-h116/glantz-1.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div><b>The importance of this paper to tobacco control</b></div></div><div><br /></div><div>This paper challenges previous conclusions that e-cigarettes produce meaningfully lower risks to the user than cigarettes, and counters beliefs that encouraging smokers to switch to e-cigarettes reduce population-level harm.</div><div><br /></div><div>It suggests that the relative risks associated with vaping have been seriously understated:</div><div><br /></div><div>* In 2015, British researchers recommended that governments consider <a href="https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review">e-cigarettes to be "95% less harmful"</a> than combustible cigarettes. This assessment was not based on data, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00042-2/fulltext">but on the opinion of a small group of researchers</a>, some of whom were associated with the vaping industry. </div><div>* In 2023, American health economists assumed that the risk of dying <a href="https://tobaccocontrol.bmj.com/content/32/e1/e37.long">from vaping is 15% that of smoking</a> when building a simulation model for health outcomes. <br />* In 2022, New Zealand researchers used studies on biomarkers to <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-12103-x">estimate that "vaping could be a third as harmful to health as smoking</a>", although they <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13983-3">rescinded (corrected) that conclusion a year later </a>with the admission that <i>"data limitations with the selected studies and the assumptions involved in our method, are too problematic to allow for a valid quantitative assessment."</i><div><br /></div><div><b>The implications for health policy in Canada</b></div></div><div><b><br /></b></div><div>In 2018 Health Canada a<a href="https://www.canada.ca/en/health-canada/corporate/transparency/corporate-management-reporting/evaluation/tobacco-vaping-activities-2016-2017-2020-2021.html" target="_blank">dopted a harm reduction approach to tobacco</a> centred on smokers' switching to e-cigarettes. Six years later, their stated intention remained to <a href="https://www.canada.ca/en/health-canada/programs/consultation-legislative-review-tobacco-vaping-products-act/final-report.html" target="_blank">"increase the number of people who transition away from smoking (to vaping)"</a>. </div><div><br /></div><div>Official statements by the Government of Canada on the <a href="https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/risks.html" target="_blank">risks of vaping</a> are mostly vague with respect to diseases other than addiction, with an overarching message that they are "not completely harmless". Not only do federal government communications fail to specify any diseases likely caused by e-cigarettes, they further blunt their warnings by simultaneously recommending that smokers switch to e-cigarettes.</div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTqxKY6FX-cSrrH2_x6TncbH4fPyclU13DRZj7HkyNvu-GjtB8K95XmZer4C2MFGl6dk2ZfxYBQ-5LEH-2CUHltz_JVwsGKZcr5tRQL81tn594eEUumLFrD1kxxN6u93dHGoS2L-7pKdAjLsimITk8qYRmL9AHQzmFcEmur-DnTVcLARwlHLGVPCkPEwg/s690/healtahcanadarisks.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="214" data-original-width="690" height="99" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTqxKY6FX-cSrrH2_x6TncbH4fPyclU13DRZj7HkyNvu-GjtB8K95XmZer4C2MFGl6dk2ZfxYBQ-5LEH-2CUHltz_JVwsGKZcr5tRQL81tn594eEUumLFrD1kxxN6u93dHGoS2L-7pKdAjLsimITk8qYRmL9AHQzmFcEmur-DnTVcLARwlHLGVPCkPEwg/s320/healtahcanadarisks.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/risks.html" target="_blank"><span style="font-size: x-small;">Health Canada's advice on the risks of vaping</span></a></td></tr></tbody></table><div><br /></div><div>The department <a href="https://www.canada.ca/en/health-canada/programs/consultation-legislative-review-tobacco-vaping-products-act/final-report.html" target="_blank">has acknowledged</a> that this approach was developed with <i>"limited scientific evidence and much uncertainty"</i> and that that <i>"this lack of evidence persists". </i>(It has recently <a href="https://www.canada.ca/en/health-canada/news/2023/03/government-of-canada-announces-over-7-million-to-address-harms-related-to-substance-use-in-ontario.html" target="_blank">provided $1.2 million to CAMH</a> to conduct an evidence review). </div><div><br /></div><div>Uncertainty should no longer be used as a cover for Canada's harm reduction strategy. Canada's health policies should no longer<a href="https://www.canada.ca/en/health-canada/corporate/transparency/working-for-canadians/vaping-questions.html" target="_blank"> assume that smokers who switch to e-cigarettes are likely to improve their health</a>, given the greater likelihood that they will become dual users. The government should abandon its <a href="https://www.canada.ca/en/health-canada/news/2018/05/backgrounder-vaping-products.html" target="_blank">"balanced"</a> approach which tolerates exposing young people and non-smokers to inducements to try vaping in the (unsupported) hopes that such marketing will result in substantial population health benefits.</div><div><br /></div><div>Applying the disease odds published today to the situation in Canada suggests that vaping policies in this country have not reduced harm, but have instead increased it. Only a small proportion of e-cigarette users in Canada are former smokers (27%), with a much larger share being dual users (34%) or never smokers (40%). (<a href="https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey/2022-summary/2022-detailed-tables.html#tbl12" target="_blank">CTNS 2023</a>).</div><div><br /></div><div>An appropriate response to the evidence published today would be for Canadian governments to move quickly to ban inducements to vape (flavours, package designs, promotions and pricing incentives), to increase risk communication (mass media, warning labels), to curb supply and to hold manufacturers responsible for the harms their products are causing. </div></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-14872703638010106522024-02-23T08:41:00.000-08:002024-02-23T08:41:03.997-08:00Cannabis, caffeine and chocolate -- BAT's expanding footprint in Canada <p></p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3A1B-1TKLupH9ip95ao98vfc9PuVlq2nAxxJNpnEN6HOClyqQCE0Pzlb3NF1iopCVG9sz-L_79ncgLCfrhfrGFHXn3WXwZWHwoPL4aMsTYdXePIy4M7zN8AdGE8sg2L6PkzXjGaJWFQg/s559/bat-new.PNG" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="559" data-original-width="539" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3A1B-1TKLupH9ip95ao98vfc9PuVlq2nAxxJNpnEN6HOClyqQCE0Pzlb3NF1iopCVG9sz-L_79ncgLCfrhfrGFHXn3WXwZWHwoPL4aMsTYdXePIy4M7zN8AdGE8sg2L6PkzXjGaJWFQg/w256-h265/bat-new.PNG" width="256" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.bat.com/attachments/medMDBYCMVH.pdf" target="_blank">BAT presentation 2021</a> showing<br />three areas of focus</td></tr></tbody></table>Four years have now passed since British American Tobacco <a href="https://smoke-free-canada.blogspot.com/2020/03/bat-reboots-and-rebrands-for-better.html">revamped its branding</a> and proclaimed a "better tomorrow" business plan focused on new nicotine delivery systems, and three years since it <a href="https://smoke-free-canada.blogspot.com/2021/03/big-tobacco-and-new-cannabis-and-why-we.html" target="_blank">announced that it was going "beyond nicotine</a>" to sell other psychoactive substances ("On the go wellbeing and stimulation").<p></p><p>The release earlier this month of<a href="https://www.bat.com/combinedreport" target="_blank"> BAT's most recent annual report</a> provides an update these activities. This post reports on those which have particular relevance to Canada.</p><p><b>BAT adds cannabis to its business plan</b></p><p>BAT has added a fourth product category of activity. To the <a href="https://www.bat.com/attachments/medMDBYCMVH.pdf" target="_blank">three areas identified in 2021</a> (Tobacco, New Nicotine and Beyond nicotine wellbeing and stimulation) it has now added a fourth drug - cannabis - to its strategy for "Quality Growth". </p><p>The company notes that revenues from the global legal market for cannabis have doubled from £5.2 billion in 2019 to £11.1 billion in 2022. In this year's annual report the company boasts that cannabis is <i>"an exciting potential category for the future".</i></p><p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAgqF46Y9k075IexBB-yfidHlxNsdkaogEpPZ3GBduFqP8G0zt979tMdFgnKuT1rh4_QrYkis15-O6dZVR0uaL_X8GgX6Za64O5Y364Nju2oo26z-fanr6hGoTFsJrioUD5Z1A85v5fzV8JlCk3raMt393_P5teIn79pNUkMh6vDmnje54Z7RtcBHgz4o/s346/cannabis.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="102" data-original-width="346" height="118" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAgqF46Y9k075IexBB-yfidHlxNsdkaogEpPZ3GBduFqP8G0zt979tMdFgnKuT1rh4_QrYkis15-O6dZVR0uaL_X8GgX6Za64O5Y364Nju2oo26z-fanr6hGoTFsJrioUD5Z1A85v5fzV8JlCk3raMt393_P5teIn79pNUkMh6vDmnje54Z7RtcBHgz4o/w400-h118/cannabis.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.bat.com/attachments/BAT_Annual_Report_Form_20-F_2023.pdf" target="_blank"><span style="font-size: x-small;">BAT Combined Annual and Sustainability Report for 2023</span></a></td></tr></tbody></table><b><br /></b></p><p><b>Coming soon: "disruptive inhalation formats" for cannabis </b></p><p>Canada is a proving ground for BAT's entry into cannabis. The tobacco giant <a href="https://www.bat.com/DOCXBFGL.html" target="_blank">now owns 45% of Organigram</a>. Based in New Brunswick, Organigram is one of the larger cannabis manufacturers in Canada and sell a range of combustible, edible and vaporized products.</p><p>Organigram <a href="https://investors.organigram.ca/press-releases/organigram-provides-corporate-update-achieves-2-market-share-over-the-last-two" target="_blank">reports that its partnership with BAT is aimed</a> at <i>"innovative technologies in the edible, vape and beverage categories in addition to new disruptive inhalation formats" </i>BAT reports that its collaboration with Organigram <i>"is in late-stage development of a suite of emulsions, novel vapour formulations, flavour innovations and packaging solutions which are soon to be commercialised by Organigram in the Canadian market."</i></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD6b2XBrJu89BAOlXrlOjixqH2hjjx7pxLVJY0v_1RabyWRyrrXK5-_7gxiyNdL6xNQoGG-86bBdBMVCiiQllI3fNB54FsLGpYRwSEvVhZOaw45uJrf8WeqewXplm5711L1iCw9q4aeoYw1h1_42rGoDk8AHm_0_YSpDYbiuTF8rq4VlgV7j9oEkjMcDE/s1283/organigram.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="718" data-original-width="1283" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD6b2XBrJu89BAOlXrlOjixqH2hjjx7pxLVJY0v_1RabyWRyrrXK5-_7gxiyNdL6xNQoGG-86bBdBMVCiiQllI3fNB54FsLGpYRwSEvVhZOaw45uJrf8WeqewXplm5711L1iCw9q4aeoYw1h1_42rGoDk8AHm_0_YSpDYbiuTF8rq4VlgV7j9oEkjMcDE/w400-h224/organigram.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://investors.organigram.ca/sites/default/files/documents/Investor_Presentation_Q1_2024.pdf" target="_blank">Organigram Investor Presentation 2024</a></td></tr></tbody></table><br /><b>Water soluble cannabis for beverages and cosmetics<br /></b><br />Organigram is not the only cannabis-related investment of BAT in Canada. Through its venture capital arm, BtomorrowVentures, BAT is funding the development of water-soluble cannabis <a href="https://www.prnewswire.com/news-releases/trait-biosciences-closes-on-financing-led-by-bats-btomorrow-ventures-and-gotham-green-partners-and-advances-commercialization-of-unique-water-soluble-cannabinoids-301953852.html" target="_blank">by the Vancouver-based company Trait. </a> This technology is promoted as a way to infuse cosmetics and to increase the dosage of cannabinoids in beverages. In October 2023 <a href="https://www.linkedin.com/posts/btomorrow-ventures_homepage-trait-biosciences-activity-7120744266183663616-xH7I/" target="_blank">Traitbio posted</a>:<div><br /></div><i>“The collaboration between Btomorrow Ventures and Gotham Green Partners, in particular, has been a powerful catalyst in advancing Trait’s development and commercialization activities,” says <a href="https://www.linkedin.com/in/ACoAAAcVEAABtwWYjWjDFB60wRjiuTYc_UrH8Ao">Hanny Kanafani, PhD</a>, President and COO at Trait, “thereby enabling the launch of unique first-generation cannabinoids which, when added to waters/beverages, maintain beverage clarity and do not impart turbidity, even when added at competitive dosages. <br /><br />“When added into cosmetic applications, Trait’s water-soluble materials do not require additives typically used in skincare products to maintain quality; and opens the door for unique and differentiated infused cosmetic applications.” </i><div><br /></div><div><b>British American Tobacco and the candy counter</b></div><div><br /></div><div><a href="https://awakechocolate.com/" target="_blank">Awake chocolate</a> manufactures caffeinated chocolate under the eponymous brand name ("each bite .... contains as much caffeine as a half a cup of joe!". It also makes <a href="https://hypeexperiences.com/reviews/149272" target="_blank">chocolate designed to help people relax</a> (<i>"mello milk and dark chocolate bites are the perfect way to wind down. Infused with a natural botanical blend of lemon balm and L-Theanine, our delicious chocolate promotes relaxation without drowsiness."</i>)</div><div><br /></div><div>The company is privately owned and is based in Mississauga. British American Tobacco first invested in Awake <a href="https://www.osler.com/en/expertise/deals-cases/btomorrow-ventures" target="_blank">in 2021</a> and increased its <a href="https://www.btomorrowv.com/blog-articles/awake-close-cad-5-million-funding-round-with-btv" target="_blank">financing again in 2023</a>. </div><div><br /></div><div>Although Mello 'relaxing chocolate' is not currently available, the caffeinated product Awake can be found in convenience and other stores across Canada.</div><div><br /></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigIfXHI6pZK0a88vWP2nvfEZGpskjjfpflEX2LQEe700dknkXjnvwys_ri1HJOIJCkaSFhe0t-k_Xc1MlmbTUGWt40h-l_4WiWKrjxRNiuSAmO1hwp-NxPRehFj9N3XQRa3n1tQlrXOgu9umL1qxSP19kIkekJ9fLEfPiKMYArKWLMbhVFV_MCf0Xe428/s925/awake2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="593" data-original-width="925" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigIfXHI6pZK0a88vWP2nvfEZGpskjjfpflEX2LQEe700dknkXjnvwys_ri1HJOIJCkaSFhe0t-k_Xc1MlmbTUGWt40h-l_4WiWKrjxRNiuSAmO1hwp-NxPRehFj9N3XQRa3n1tQlrXOgu9umL1qxSP19kIkekJ9fLEfPiKMYArKWLMbhVFV_MCf0Xe428/w400-h256/awake2.jpg" width="400" /></a></div><br /><div><br /></div><div><br /></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-36564008292851522892024-02-20T15:41:00.000-08:002024-03-06T06:42:43.828-08:00Health groups call on Federal government to deliver on its commitment to protect kids against nicotine addiction<p>This post includes a copy of <a href="https://cqct.qc.ca/Documents_docs/DOCU_2024/AD_24_02_19_Joint_FlavourHookAd.pdf" target="_blank">an advertisement placed in this Monday's edition of the Hill Times</a> by several Canadian health organizations, as well as the accompanying <a href="https://cqct.qc.ca/Communiques_docs/2024/PRSS_24_02_19_AD_Nicotine_HealthOrgs.pdf">press release issued by the Quebec Coalition on Tobacco Control yesterday.</a></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjafBgoRMksyfHUGrviaT7GlSTMJHP8hMUBaquKw8jYtRX8AUCpMbjJng9Zp55-N-0gAD4648UzLLvJ0UE7stR2THvd8SroX0EoWoRrMhe3Z_sT0__HZbW7mQiFSuuiCc3LAv8UMrnRM7-yQmfTAY79RkN7ScybWP3Q83BRpyXcmAtZkfIT6VbbOm6KeZQ/s859/flavours%20hook%20kids.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="859" data-original-width="672" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjafBgoRMksyfHUGrviaT7GlSTMJHP8hMUBaquKw8jYtRX8AUCpMbjJng9Zp55-N-0gAD4648UzLLvJ0UE7stR2THvd8SroX0EoWoRrMhe3Z_sT0__HZbW7mQiFSuuiCc3LAv8UMrnRM7-yQmfTAY79RkN7ScybWP3Q83BRpyXcmAtZkfIT6VbbOm6KeZQ/w313-h400/flavours%20hook%20kids.png" width="313" /></a></div><br />Montreal, February 19, 2024 – Leading health organizations concerned about the health and wellbeing of youth in Canada have united to publish a full-page ad today in The Hill Times to draw Ottawa lawmakers’ attention to the urgent need to intervene to protect minors against nicotine addiction.<p>The ad is signed by Action on Smoking & Health, the Canadian Cancer Society, the Canadian Lung Association, the Quebec Coalition for Tobacco Control, Heart & Stroke and Physicians for a Smoke-Free Canada.</p><p>It highlights how flavours play a key role in attracting kids to nicotine products and calls on the federal government to ban flavours in vaping products, including mint and menthol (tobacco flavour would be allowed). Banning flavours has been on the government’s agenda since the publication of <a href="https://www.canada.ca/en/health-canada/news/2021/06/health-canada-announces-new-restrictions-to-prevent-youth-vaping.html">draft regulations in June 2021</a>, although no concrete action has materialized since then.</p><p>While the government’s existing proposal would exempt mint/menthol, health groups <a href="https://cqct.qc.ca/Communiques_docs/2021/PRSS_21_05_07_NewData_YouthVaping_FlavoursNicotine_Groups.pdf" target="_blank">have argued</a> that a complete ban on non-tobacco flavours is required to protect young people from nicotine addiction, as mint/menthol is the <a href="https://www.heartandstroke.ca/-/media/pdf-files/get-involved/yyav-full-report-final-eng-24-3-2021.ashx" target="_blank">second-most popular flavour</a> amongst youth and young adults. A comprehensive ban would be consistent with developments in a <a href="https://smoke-free.ca/SUAP/2021/e-cigarette-flavour%20restrictions.pdf">growing number of jurisdiction</a>s, including Finland, Hungary, Lithuania, Netherlands, Norway, five U.S. states (California, Massachusetts, New Jersey, New York, and Rhode Island, as well as D.C.) and six Canadian provinces and territories.</p><p>The ad also calls for swift action to protect minors against the sale and promotion of nicotine pouches, namely by making them a prescription-only product. Under the current federal rules, nicotine pouches authorized under the Natural Health Products Regulation can be legally sold to minors in convenience stores and promoted on television, billboards and social media, including by means of lifestyle advertising.</p><p>In fact, it was Imperial Tobacco’s <a href="https://cqct.qc.ca/Documents_docs/DOCU_2023/MONT_23_11_13_Ads_Publicites_Zonnic.pdf" target="_blank">lifestyle promotion</a> in favour of their new “Zonnic” pouches that pushed health groups to <a href="https://cqct.qc.ca/Communiques_docs/2023/PRSS_23_11_14_HealthOrgs_CallFor_HaltNicotinePouches.pdf" target="_blank">sound the alarm</a> last fall. Making nicotine pouches available on a prescription-only basis would give time to both federal and provincial governments to establish a proper regulatory framework.</p><p>So far, only British Columbia and Quebec have taken steps to address this issue, by requiring consumers to go through a pharmacist to purchase these products.</p><p><b>Quotes:</b></p><p>“Several additional options are available to the Health Minister, like temporarily suspending the sale of nicotine products, which would also allow federal, provincial and territorial authorities to strengthen relevant laws and regulations. For example, nicotine pouches could be subject to many of same provisions regarding promotion that apply to tobacco and vaping products,” explains Cynthia Callard, Executive Director of Physicians for a Smoke-Free Canada.</p><p>“Nicotine is a highly addictive drug, and there needs to be adequate controls before a nicotine product is allowed on the market,” says Sarah Butson, Senior Director, Public Affairs at the Canadian Lung Association. “Nicotine pouches are popular with youth in other countries – a trend not observed with other forms of smoking cessation products. We are concerned about a rise in popularity by Canadian youth and the resulting early exposure to nicotine.”</p><p>“Nicotine gum was initially only sold by prescription in Canada, and only later on was a non-prescription approach allowed,” says Manuel Arango, Director of Policy & Advocacy at Heart & Stroke. “Using that same precautionary approach for a new type of nicotine product is totally reasonable and could be done easily and quickly.”</p><p>“This is the first time in more than 100 years that it is legal for a nicotine product from a tobacco company to be sold to minors in Canada,” says Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society. “Tobacco companies cannot be trusted. It is essential that the federal Health Minister take action on an urgent basis.”</p><p>“Imperial Tobacco can claim all it wants that its pouches are intended for adult smokers who want to quit, but unlike other manufacturers of nicotine replacement therapies (NRT), this company deliberately chose to distribute its product through convenience stores and promote them with lifestyle messaging and images of young adults,” explains Flory Doucas, Co-Director and Spokesperson of the Quebec Coalition for Tobacco Control.</p><p>“The Minister said last Monday that we can expect an announcement regarding nicotine pouches ‘in the coming days’. We look forward to seeing what the Minister plans to do. We hope that the government will be consistent in protecting kids from nicotine addiction and will rapidly move to ban all flavours in vaping products. Time is of the essence when it comes to kids getting hocked on nicotine,” said Les Hagen, Executive Director of ASH Canada.</p> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-90285819744665360832024-02-08T08:35:00.000-08:002024-02-13T16:53:29.290-08:00Newly released JUUL documents show the company felt welcomed by Canadian and UK health regulators <p>At the end of January the first release of 4 million internal documents from JUUL were made public on the UCSF <a href="https://www.industrydocuments.ucsf.edu/tobacco/results/#q=collection%3A%22JUUL%20labs%20Collection%22" target="_blank">Industry Documents Library</a>. The disclosure of these documents was a condition of the <a href="https://uncnews.unc.edu/2024/01/31/university-collaboration-to-create-public-depository-of-nearly-4-million-documents-associated-with-north-carolina-vaping-settlement/" target="_blank">2021 settlement between the State of North Carolina</a>. The documents date from 2015 to 2019. </p><p>Among the 280,000 documents contained in this release are some which show that JUUL felt its products were not only acceptable to regulators, but were initially welcomed by them. </p><p><b>CANADA</b></p><p>Vaping products were legalized in Canada in May 2018. A few weeks later (August 13, 2018) JUUL officials met with representatives of Health Canada. <a href="https://www.industrydocuments.ucsf.edu/tobacco/docs/#id=zljy0286">Their notes of this meeting</a> suggest some mutual enthusiasm for the sale of JUUL products in Canada: <i>"We had a very positive meeting with Health Canada this morning.... The main takeaway was that they are excited to have new entrants into the market for nicotine-containing e-cigarettes that are compliant with the regulatory framework that they have put in place."</i></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG7h-EFBuYJis3dXq55a_BS5RY_8Ch-5pkxLPl3X6iwPT5Qf9PXO0Dndola9hhLOth3rWaAhsreglXWyFeaG3uSel-ASkQH6soZDQHoe0GHj4aiSB3SvfMXQkm2rnipMIOlrSIY0icF3XbOHWntHzQeLXrPsvs3Riy8C3XeOOaAf8pTVUIpKecMz8fijc/s1428/juul%20-%20meeting%20with%20health%20andaa%20zljy0286.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="266" data-original-width="1428" height="75" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG7h-EFBuYJis3dXq55a_BS5RY_8Ch-5pkxLPl3X6iwPT5Qf9PXO0Dndola9hhLOth3rWaAhsreglXWyFeaG3uSel-ASkQH6soZDQHoe0GHj4aiSB3SvfMXQkm2rnipMIOlrSIY0icF3XbOHWntHzQeLXrPsvs3Riy8C3XeOOaAf8pTVUIpKecMz8fijc/w400-h75/juul%20-%20meeting%20with%20health%20andaa%20zljy0286.png" width="400" /></a></div><p>The JUUL meeting report says that government officials suggested that the company work reports that it was suggested to them that they <i>"work with credible academics in Canada to generate research on safety and health impact of our products." </i></p><p>Health Canada's <a href="https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/meeting-summaries-tobacco-vaping-industry/august-13-2018.html" target="_blank">report of the meeting is somewhat different</a>. (The department makes public notes from its meeting with tobacco and vaping companies). On the question of the the government's receptiveness to the launch of JUUL, their notes record <i>"JUUL asked if HC had any concerns with its upcoming market entry. HC responded that JUUL would need to ensure compliance with the Tobacco and Vaping Products Act and the Canada Consumer Product Safety Act."</i><br /></p><p><b>UNITED KINGDOM</b></p><p>During the previous summer (June 2017) <a href="https://www.industrydocuments.ucsf.edu/tobacco/docs/#id=knxf0286" target="_blank">JUUL went out for "an excellent dinner"</a> with the tobacco control program lead at Public Health England (Martin Dockrell) and the chief executive of ASH UK (Deborah Arnott). </p><p>This was <a href="https://www.reuters.com/article/idUSKBN1K62VR/">a year before JUUL was launched in the UK </a>, and the company was trying to figure out its regulatory approach. The meeting notes show that two avenues were considered -- one where the device would be licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) - a process that JUUL was cautioned could take a year or two. </p><p>Their meeting notes report that the Public Health England representative suggested an alternative and faster route. If they marketed JUUL as a "novel tobacco product", there was no need to seek pre-approval. <i>"We hadn't considered this pathway till Martin suggested it,"</i> the notes record. The memo concludes in bold that <i>"This previously unconsidered approach has the potential to be very attractive.</i>"</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFaxbtlsVq2-R5bAuW7XHM8BwXNxUufSR1IoTW-lPsNf6sUJ7NP4tilTXK7kCRp08pcjqffOiSfzmUA5bYThpYz6xBbyKwMP_ZUikxIZv3hC5NGe5fufS0nPUWZ28_Cai2zLCX0nGrp-WQdWNckNdjPSRnm9xQjt9xp61Z1a0GPPT9WtILGlhPdQrv7nI/s1367/juul%20-%20uk%20knxf0286.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="195" data-original-width="1367" height="58" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFaxbtlsVq2-R5bAuW7XHM8BwXNxUufSR1IoTW-lPsNf6sUJ7NP4tilTXK7kCRp08pcjqffOiSfzmUA5bYThpYz6xBbyKwMP_ZUikxIZv3hC5NGe5fufS0nPUWZ28_Cai2zLCX0nGrp-WQdWNckNdjPSRnm9xQjt9xp61Z1a0GPPT9WtILGlhPdQrv7nI/w400-h58/juul%20-%20uk%20knxf0286.png" width="400" /></a></div><br /><p>A record of this meeting prepared by Public Health England has not been located. </p> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-15383352823298751832024-02-03T09:41:00.000-08:002024-02-06T02:47:42.494-08:00Varia: Newly-posted information on Government of Canada web-sites. <p>This post identifies information recently posted on some federal government websites that is relevant to tobacco control.</p><p><b>Compared with cannabis and alcohol, Canadians continue to think smoking and vaping are less acceptable and more risky.</b></p><p>On January 12, Health Canada <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2023-summary.htm" target="_blank">released the results of the most recent Cannabis survey</a>. This is the sixth release of the annual survey, which is one of the few Canadian surveillance tools which looks at the social acceptability of using legal recreational drugs by mode of delivery. </p><p>Of the six behaviours (oral cannabis use, smoked cannabis use, vaped cannabis, alcohol drinking, vaping nicotine and smoking tobacco ), smoked tobacco continues to be the least socially acceptable behaviour, followed by vaping. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwctJkg16jvuyAweTov_1RA4tIAA2Wr-nfVdumHOiH4njlBdPR7RHAXmo5WTXEILY0BGO8FGB3VCZBfduedeMN26UUnZ9kVFh8JmbkGv0YZmnYaZ3gSHIiwwOyPTb-5Ae0o8tubSjd_BIwtCvmAQVoBNDB_li05Mc7njiJ8jsVGPfdrJLXF3l0hdhcQ5s/s1052/social%20acceptability%20.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="652" data-original-width="1052" height="248" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwctJkg16jvuyAweTov_1RA4tIAA2Wr-nfVdumHOiH4njlBdPR7RHAXmo5WTXEILY0BGO8FGB3VCZBfduedeMN26UUnZ9kVFh8JmbkGv0YZmnYaZ3gSHIiwwOyPTb-5Ae0o8tubSjd_BIwtCvmAQVoBNDB_li05Mc7njiJ8jsVGPfdrJLXF3l0hdhcQ5s/w400-h248/social%20acceptability%20.png" width="400" /></a></div><br /><p>This survey also asks about perceived risks of product use. Again, tobacco use and vaping are perceived to be the most risky. There have been statistically significant shifts in perceptions of risk for both vaping (higher then lower) and tobacco (lower) when compared to 6 years ago.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPthpmzAhKfd1HKvurmEg-PQ7qrDp2kOtK29lrMzPa72zTy7L39F5S4AqJAcSO3yReObFLq05AMlz1h9JdekgW-jsMIO_J7ySTG2LhY7SnaLNbC9i6jMHWmTawDN14kNMV5Or9q65LkpQ0Q4ZpZCDFTssr8bBGp5Naos0EeVNuyrQcQ9fESHA4RPeQMSY/s1067/risks.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="662" data-original-width="1067" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPthpmzAhKfd1HKvurmEg-PQ7qrDp2kOtK29lrMzPa72zTy7L39F5S4AqJAcSO3yReObFLq05AMlz1h9JdekgW-jsMIO_J7ySTG2LhY7SnaLNbC9i6jMHWmTawDN14kNMV5Or9q65LkpQ0Q4ZpZCDFTssr8bBGp5Naos0EeVNuyrQcQ9fESHA4RPeQMSY/s320/risks.png" width="320" /></a></div><div><br /></div><div>The survey also found that using dried leaf (smoking) cannabis remains the most popular form of delivery (60% of past-year users), but that this has fallen in recent years, with increasing use of edibles and vaping. Among daily cannabis users, dried leaf is the most common form of use (31% of dried leaf users are daily users). The combined use of tobacco and cannabis has fallen slightly since 2018 (from 30% to 24%). </div><div style="font-weight: bold;"><b><br /></b></div><b>Twice as many post-secondary students are vaping as smoking.</b><div><br /></div><div>The results of the 2020-2021 Canadian Postsecondary Education Alcohol and Drug Use Survey (CPADS) were posted on the <a href="https://health-infobase.canada.ca/alcohol/cpads/" target="_blank">federal government website in January</a>. This survey engaged 31,643 Canadian students aged 17 to 25 enrolled in any program at a university, college or CEGEP. </div><div><br /></div><div>Alcohol remains the most frequent substance consumed (two-thirds of students in the past month), with Cannabis coming second (29% past month use, 8% daily use), vaping third (17% past month use, 8% daily use) followed by smoking (8% past month use, 2% daily use). Gender differences in vaping and smoking were not observed.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYD7iSvF9FNEgaYNkFLZCwxlkuIb1tlWvpKzLT9D7MTbxVLeOSX19zhqlBMVKf51pbSRvR1gw6sm5hesK8rPPuGmJmYUJJ1X11o2FXhxxdTHK0nKK7DG_Y5P2lU-GNyGjweD4tjKGnC9lf7rq4Uo24PRHjP2C0q6MjKX-iuInJ-zu_iaNNisBhOijgXE8/s1091/cpads.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="587" data-original-width="1091" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYD7iSvF9FNEgaYNkFLZCwxlkuIb1tlWvpKzLT9D7MTbxVLeOSX19zhqlBMVKf51pbSRvR1gw6sm5hesK8rPPuGmJmYUJJ1X11o2FXhxxdTHK0nKK7DG_Y5P2lU-GNyGjweD4tjKGnC9lf7rq4Uo24PRHjP2C0q6MjKX-iuInJ-zu_iaNNisBhOijgXE8/w400-h215/cpads.png" width="400" /></a></div><br /><div><b>New trademark registrations may signal new products</b></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEGubQkEbyeb68UU0DTlMv1nS48PYwfGYr7dpHxiplkQPKuVXu2m0rIPlf9ygqstpg-bvewIA49bdgzN0-LGXULAIEfWItDf5WgxFP0NaTc1rPz_cBw8zP31q4-ekXsADgIrls0KFFzFvfUEeTHf17aNf-FGjdruhG_RNHej9c-G4t8F7yoAyW3rXH-1A/s945/veev%20ultra.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="945" data-original-width="250" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEGubQkEbyeb68UU0DTlMv1nS48PYwfGYr7dpHxiplkQPKuVXu2m0rIPlf9ygqstpg-bvewIA49bdgzN0-LGXULAIEfWItDf5WgxFP0NaTc1rPz_cBw8zP31q4-ekXsADgIrls0KFFzFvfUEeTHf17aNf-FGjdruhG_RNHej9c-G4t8F7yoAyW3rXH-1A/s320/veev%20ultra.png" width="85" /></a></div><br />In January, Corporations Canada reported new trademark filings by Philip Morris for:</div><div>* vaping products (<a href="https://ised-isde.canada.ca/cipo/trademark-search/2306417?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">VEEV CLEAR TASTE</a>, <a href="https://ised-isde.canada.ca/cipo/trademark-search/2297948?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">VEEV NOW ULTRA V</a>);</div><div>* snus (<a href="https://ised-isde.canada.ca/cipo/trademark-search/2306060?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">ADVANCE FIFTEEN</a>, <a href="https://ised-isde.canada.ca/cipo/trademark-search/2306057?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">ADVANCE NINE</a>), </div><div>* heated tobacco (<a href="https://ised-isde.canada.ca/cipo/trademark-search/2300586?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">RIVIERA PEARL</a>, <a href="https://ised-isde.canada.ca/cipo/trademark-search/2300585?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">TEREA STARLING PEARL</a>, <a href="https://ised-isde.canada.ca/cipo/trademark-search/2299251?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">TE</a><a href="https://ised-isde.canada.ca/cipo/trademark-search/2299251?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">REA BLACK SUNSHINE</a>)</div><div>* PR campaigns (<a href="https://ised-isde.canada.ca/cipo/trademark-search/2299939?lang=eng&payload=%7B%22domIntlFilter%22%3A%221%22%2C%22searchfield1%22%3A%22all%22%2C%22textfield1%22%3A%22philip+morris%22%2C%22display%22%3A%22list%22%2C%22maxReturn%22%3A%22500%22%2C%22nicetextfield1%22%3Anull%2C%22cipotextfield1%22%3Anull%7D&pageNum=0&pageLen=50&pageOrder=%257B%2522id%2522%253A%2522SortByAppNumber%2522%252C%2522order%2522%253A%2522descending%2522%257D">STAY CURIOUS</a>)</div><div><br /></div><div>From these it seems reasonable to assume that:</div><div>* Philip Morris is f<a href="https://smoke-free-canada.blogspot.com/2023/07/bat-shoehorns-its-nicotine-pouches-onto.html" target="_blank">ollowing the path laid by British American Tobacco</a> in seeking authorization to market their Zyn/Velo nicotine pouches in Canada, but to use a different brand name (Advance/Zonnic) in doing so.</div><div>* PMI is introducing a fourth version of its vaping product to Canada (in addition to the capsule <a href="https://www.180smoke.ca/veev-one-closed-pod-device" target="_blank">Veev One</a>, and the disposables <a href="https://www.180smoke.ca/veev-disposable-vapes" target="_blank">Veev NOW 2ml and Veev NOW 5 ml</a>)</div><div><br /></div><div><br /></div><div><b>Changing surveillance tools </b></div><div><br /></div><div>Although it has not made an announcement to this effect, Health Canada has terminated its support for the <a href="https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5305" target="_blank">Canadian Tobacco and Nicotine Survey</a>, making the winter of 2022-23 the last period in which this survey was conducted. </div><div><br /></div><div>The <a href="https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=1532313#qb1532610" target="_blank">2024 questionnaire of the Canadian Community Health Survey</a> contains 8 questions on vaping, and the <a href="https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=1533124" target="_blank">Rapid Response Module</a> (a smaller sample component of the survey) has one question on quit intention, one question on "other" tobacco products and two questions on nicotine pouches. These were released in late December 2023. </div><div><br /></div>In January, Health Canada <a href="https://canadabuys.canada.ca/en/tender-opportunities/tender-notice/cb-875-40086363">issued an Advanced Contract Award Notice</a> for a $700,000 contract with the University of Waterloo for a "Evaluating and understanding cigarette smoking, nicotine vaping, and policies on both products among adults in Canada in the international context" The contract appears to be for an additional wave of the ITC study of smokers and former smokers, with increased sampling in each province.<br /><div><br /></div><div><b>I Quit for Me</b></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSkKqTF-4g_AYJPmpyWXQVtVRoJvgGlIaHR-V4ooetC8d3Mcv0tPIzb3DVANLPm_wi9Wmuxnea5b15VH56lTyNQBEQjB749eshu7LNOtW9VDN5Ar93U2imJh5XZCi_thIEfLLYSFjGE7Lz8HcfDf_VjgAEfVa0_eElBqDUM5LOP-LEK15lOUWmrBevv2A/s496/i-quit-for-me-recruitment-poster.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="496" data-original-width="320" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSkKqTF-4g_AYJPmpyWXQVtVRoJvgGlIaHR-V4ooetC8d3Mcv0tPIzb3DVANLPm_wi9Wmuxnea5b15VH56lTyNQBEQjB749eshu7LNOtW9VDN5Ar93U2imJh5XZCi_thIEfLLYSFjGE7Lz8HcfDf_VjgAEfVa0_eElBqDUM5LOP-LEK15lOUWmrBevv2A/s320/i-quit-for-me-recruitment-poster.png" width="206" /></a></div><b><br /></b></div><div>Health Canada has updated and re-branded its Quit4Life resources. The new resources <a href="https://www.canada.ca/en/health-canada/services/publications/healthy-living/i-quit-for-me-guide-youth.html" target="_blank">became available on the web-site</a> in January. The website also asks young people to answer a long survey on smoking and vaping and their feelings of addiction (including 8 options for gender!). Those who participate are invited to contact Health Canada for a follow-up survey.</div><div><br /></div><div><b>Administrative modifications to the federal Vaping Products Tax</b></div><div><br /></div><div>Canada has imposed a tax on vaping liquids at retail <a href="https://www.smoke-free.ca/SUAP/2020/e-cigarette-tax.pdf">since January 2023</a> and a number of provinces have indicated that they will be partnering in this tax (with a rumoured start date of July 2024).</div><div><br /></div><div>Amendments to the Excise Act on how this tax will be administered are the subject of a <a href="https://www.parl.ca/DocumentViewer/en/44-1/bill/C-59/first-reading" target="_blank">bill currently before Parliament</a>. </div><div><br /></div><div>In <a href="https://www.canada.ca/en/revenue-agency/services/forms-publications/publications/edn89/general-information-legislative-amendments-with-respect-to-vaping-products.html" target="_blank">January the Finance Department provided an explanation on the impact of these changes</a>. (They shift the point at which manufacturers must remit taxes.) </div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-72555903526668110012024-01-15T06:05:00.000-08:002024-01-15T06:44:27.978-08:00Updated data sheets on tobacco taxes and cigarette consumption in Canada<div class="separator">This post provides links to updated data sheets on tobacco tax revenues, industry earnings, cigarette sales and smoking rates. Some highlights are provided below. </div><div class="separator"><br /></div><div class="separator">Appreciation goes to those working in the government agencies which have collected this information and made it available.</div><a href="https://www.smoke-free.ca/pdf_1/taxrates.pdf "></a><ul style="text-align: left;"><a href="https://www.smoke-free.ca/pdf_1/taxrates.pdf "></a><li><a href="https://www.smoke-free.ca/pdf_1/taxrates.pdf "></a><a href="https://www.smoke-free.ca/pdf_1/taxrates.pdf ">Taxes on cigarettes in Canadian jurisdictions</a></li><li><a href="https://www.smoke-free.ca/SUAP/2020/totaltax.pdf">Tax revenues from tobacco sales, 1990 to 2022</a></li><li><a href="https://www.smoke-free.ca/pdf_1/2022/sales%20taxes%20and%20revenues.pdf">Manufacturers’ and federal tax revenues from cigarette sales.</a></li><li><a href="https://smoke-free.ca/SUAP/2020/Taxrevenues%20per%20smoker.pdf">Tobacco tax revenues per smoker, Canada 2011 to 2022</a></li><li><a href="https://www.smoke-free.ca/pdf_1/2022/cigarettes%20per%20smoker.pdf">Provincial cigarette and fine-cut sales per smoker</a></li></ul><div class="separator"><span style="color: white;"> </span></div><div><div style="font-weight: bold;"><b>1</b>) <b>The average Canadian cigarette smoker provided governments with $1,862 in tobacco-specific taxes in 2022</b></div><div style="font-weight: bold;"><b><br /></b></div><div>Almost all (90%) of the federal tobacco tax is collected on manufactured cigarettes, with taxes on cigars and loose tobacco totalling about 340 million. Provincial governments do not provide detail on revenues from different types of tobacco. </div><div><br /></div><div>These revenues represents an average of $1,685 in tobacco taxes collected from each of Canada’s 3.8 million cigarette smokers – with the federal government reporting $779 in tobacco tax revenue per smoker and provincial governments reporting between $616 and $1,311 per smoker during the year. </div><div><br /></div><div>Almost two-thirds (63%) of Canada’s smokers live in Quebec and Ontario, where where tobacco taxes are lowest.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZDT8nJPieX6b2xS8W0hd04nJD_H1MJDG-7o57ztBuP_PGbMk3V6u8VxP3-NLrKyoY9lNIdjADYDrSqX3Rt-6gQTYExdBicbITxgyCUjNkMiH5BveiyCR-A1nuV5v-HjsTFl2W-CgyFUS7yXvYXpgeDerzRGHWknnGGbAXkwGKmTEyLJOS_OtxCDN3mds/s702/tax%20per%20smoker.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="286" data-original-width="702" height="163" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZDT8nJPieX6b2xS8W0hd04nJD_H1MJDG-7o57ztBuP_PGbMk3V6u8VxP3-NLrKyoY9lNIdjADYDrSqX3Rt-6gQTYExdBicbITxgyCUjNkMiH5BveiyCR-A1nuV5v-HjsTFl2W-CgyFUS7yXvYXpgeDerzRGHWknnGGbAXkwGKmTEyLJOS_OtxCDN3mds/w400-h163/tax%20per%20smoker.png" width="400" /></a></div><div class="separator" style="clear: both; font-weight: bold; text-align: center;"><br /></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div style="font-weight: bold; text-align: left;"><i>Related data sheets: </i></div></div></blockquote><div style="text-align: left;"><div style="font-weight: bold;"><ul><ul><li><a href="https://www.smoke-free.ca/pdf_1/taxrates.pdf " target="_blank"><i>Taxes on cigarettes in Canadian jurisdictions</i></a></li><li><a href="https://smoke-free.ca/SUAP/2020/Taxrevenues%20per%20smoker.pdf"><i>Tobacco tax revenues per smoker, Canada 2011 to 2022</i></a></li></ul></ul></div></div><b>2) Total tobacco tax revenues in Canada fell by 10% year over year.</b><div><div><br /></div><div>Overall, tobacco tax revenues across Canada fell by 10% in 2022-2023 compared with the previous fiscal year. </div><div><br /></div><div>Federal revenues from tobacco excise taxes fell by $217 million, from $3.18 billion to $2.96 billion (-7%). All of the provinces experienced a decline in tobacco tax revenues, from a provincial total of $3.93 billion in 2021-22 to $3.4 billion in 2022-2023. The drop was greatest in British Columbia (-25%), Newfoundland (-23%), Alberta (-17%), New Brunswick (-16%) and Nova Scotia (-15%) and Manitoba (-14%). It was smallest in Prince Edward Island (-0.2%), Ontario (-7%), Saskatchewan (-9%) and Quebec.</div><div><br /></div><div>Total provincial tobacco tax receipts have dropped by one-quarter (24%) over the past two years, and by almost one-third (31%) once inflation has been taken into account.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXWGd9OCIELZoImINjXZEqtIYH0S8uu1imWzpzRwn-CzyUrGu0xS3vthK7xoIZuaqPg0MvVFs2jp3LjVzCfUmit8f_CJXcGXYTxXmEVgyA2NW3_ZY3Z9cHXa3JFnUKxQ-MudjjurGlbbSHzJQ2Ze7fUikzpZJFGY4aLuHNxAKjaoh5yLJQgzgDhyphenhyphencntzA/s856/tax%20revenues%20to%202023.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="442" data-original-width="856" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXWGd9OCIELZoImINjXZEqtIYH0S8uu1imWzpzRwn-CzyUrGu0xS3vthK7xoIZuaqPg0MvVFs2jp3LjVzCfUmit8f_CJXcGXYTxXmEVgyA2NW3_ZY3Z9cHXa3JFnUKxQ-MudjjurGlbbSHzJQ2Ze7fUikzpZJFGY4aLuHNxAKjaoh5yLJQgzgDhyphenhyphencntzA/w400-h206/tax%20revenues%20to%202023.png" width="400" /></a></div><div><span style="font-weight: 700;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><i><span style="font-weight: 700;">Related data sheets:</span><span style="font-weight: 700;"> </span></i></div></div></blockquote><div><div style="text-align: left;"><ul style="font-weight: 700;"><ul><li><a href="https://www.smoke-free.ca/SUAP/2020/totaltax.pdf"><i>Tax revenues from tobacco sales, 1990 to 2022</i></a></li></ul></ul></div><div><br /></div><div><b>3) Industry revenues from cigarette sales are falling -- but are keeping up with inflation better than federal tobacco tax revenues.</b></div><div><br />Tobacco manufacturers are required to report to Health Canada the number cigarettes they sell, and also to report on their wholesale revenues (including federal taxes) from these sales. This data is periodically released by Health Canada in an aggregate form for each calendar year.<br /><br />From this data a comparison with the revenues to manufacturers and the federal government from cigarette sales during the calendar year can be made. Before 2014, government and industry generated equivalent gross revenues from cigarette sales and taxes. Since 2014, industry revenue has been significantly higher than federal tax revenues from cigarette sales.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfdCIb9QBmNA5Umux4Ybe3tsfMkNXoypAF5OBohyphenhyphen740AyvaA4cembOKS1uY71nnnCyI9SVUER5mIcmF9XWX2LJDmWCfjnRyqdrMeciBFhCmScf42IPfY6dbaFz_QtWfqWpJ17j84cpMjwRN1GxJbOyWvhnlpEmjyhBsfwGox37OSYqa8nSrhaKP6fQmYA/s741/profits%20and%20taxes.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="442" data-original-width="741" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfdCIb9QBmNA5Umux4Ybe3tsfMkNXoypAF5OBohyphenhyphen740AyvaA4cembOKS1uY71nnnCyI9SVUER5mIcmF9XWX2LJDmWCfjnRyqdrMeciBFhCmScf42IPfY6dbaFz_QtWfqWpJ17j84cpMjwRN1GxJbOyWvhnlpEmjyhBsfwGox37OSYqa8nSrhaKP6fQmYA/w400-h239/profits%20and%20taxes.png" width="400" /></a></div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><i><span style="font-weight: 700;">Related data sheets:</span><span style="font-weight: 700;"> </span></i></div></div></blockquote><div><ul style="text-align: left;"><ul><li><i><a href="https://www.smoke-free.ca/pdf_1/2022/sales%20taxes%20and%20revenues.pdf" target="_blank">Manufacturers’ and federal tax revenues from cigarette sales.</a></i></li></ul></ul><div><br /></div><div><b>4) Tobacco companies report selling 13.4 cigarettes per day per smoker.</b></div><div><br /></div><div>Across Canada, the the number of cigarettes (and fine-cut equivalents) reported sold per smoker ranges from fewer than 10 per day in Newfoundland to 15 per day in Quebec, with a national average of 13.4 per day (4,838 per year). </div><div><br /></div><div>The number of cigarettes sold per smoker has fallen slightly since 2018. Possible reasons for this are explained in the next section. </div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjevzjQDw0eWD4Wsq0r97mTSqH6r5sRyGfHEN4YyoWpdzMnwJQZcLeCKqXtXepB9wmfWvuuEkg03PUsZqEFC-DosgDuE0cKoAoNwW3-FFXZm8nsiNb0Y88kkL-f6YjRPHX1ybJnKC9eFIkuhZ7z5SLaT7FmnJa05fANF2DnKaMwvEjqJegeCV-96-jTquM/s917/cigarettes%20per%20day.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="443" data-original-width="917" height="194" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjevzjQDw0eWD4Wsq0r97mTSqH6r5sRyGfHEN4YyoWpdzMnwJQZcLeCKqXtXepB9wmfWvuuEkg03PUsZqEFC-DosgDuE0cKoAoNwW3-FFXZm8nsiNb0Y88kkL-f6YjRPHX1ybJnKC9eFIkuhZ7z5SLaT7FmnJa05fANF2DnKaMwvEjqJegeCV-96-jTquM/w400-h194/cigarettes%20per%20day.png" width="400" /></a></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><b><i>Related data sheets: </i></b></div></blockquote><div><ul style="text-align: left;"><ul><li><i><a href="https://www.smoke-free.ca/pdf_1/2022/cigarettes%20per%20smoker.pdf" target="_blank">Provincial cigarette and fine-cut sales per smoker</a></i></li></ul></ul><div><br /></div><div><b>5) Smoking surveys and sales statistics tell different stories about reductions in tobacco use.</b></div><div><b><br /></b></div><div>Between 2021 and 2022, estimates of the number of smokers in Canada fell by 1% (from 3.830 million to 3.804 million) and the number of cigarettes reported sold fell by 12% (from 20.9 billion to 18.4 billion). </div><div><br /></div><div>This is not the first time in the past decade that there has been a large difference in the year-over-year estimates of smoking (from Statistics Canada's Canadian Community Health Survey) and reported cigarette salse (from industry reports to Health Canada). A similar difference was found in 2020, when smoking rates fell much more deeply than did cigarette sales (-11% vs -3%). </div><div><br /></div><div>Such discrepancies could result from a number of factors, including:</div>▪ changing patterns of nicotine use (e.g. smokers shifting to or away from e-cigarettes)<br />▪ normal variance in the estimates of smoking behaviours </div><div>▪ changes to survey methods which lower or increase prevalence estimates (<a href="https://smoke-free-canada.blogspot.com/2021/09/do-telephone-interviews-undercount.html" target="_blank">as happened in 2020</a>) </div><div>▪ increases or decreases in unreported illicit cigarette sales <br />▪ incomplete reporting by manufacturers<div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiarQ7kAYsC3s1GIqPk8MJamlUCmR-I42NrR0ysAFnPfgJvMdToPskQZyLllMYSFqvewqBt9rxH5HS9FKEJl_XyPbM3GZMKmBtv2hH19CkT6ShoR3b8TGvxxzCcrNLSerDW5T2tXUdq5cqsfLnp4ytGyb3km6p-6OMdxaugMj_l-oXEm98Fx2rJqIgnvrI/s802/changes%20to%20sales%20and%20prevalence.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="410" data-original-width="802" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiarQ7kAYsC3s1GIqPk8MJamlUCmR-I42NrR0ysAFnPfgJvMdToPskQZyLllMYSFqvewqBt9rxH5HS9FKEJl_XyPbM3GZMKmBtv2hH19CkT6ShoR3b8TGvxxzCcrNLSerDW5T2tXUdq5cqsfLnp4ytGyb3km6p-6OMdxaugMj_l-oXEm98Fx2rJqIgnvrI/w400-h205/changes%20to%20sales%20and%20prevalence.png" width="400" /></a></div><br /></div><div>In 2022, tobacco companies commented on an unexpectedly large reduction in reported sales in 2022, particularly in the western provinces. In <a href="http://cfcanada.fticonsulting.com/ImperialTobacco/docs/Motion%20Record%20(Stay%20Extension)%20-%20Applicants%20-%20Imperial%20Tobacco%20Canada%20Limited%20et%20al.%20-%2020-SEPT-2022.pdf" target="_blank">a submission to the Ontario Court</a>, Imperial Tobacco reported: <i>"A review of the cash flow actuals vs. forecast for the period from February 28, 2022 until </i><i>August 29, 2022 shows a decline of $212 M in collections (equivalent to -8.3%). This is
driven by a lower sales volume than expected for this period. Although the volume decline
is affecting all the regions, it is significantly more severe in the Western provinces.
ITCAN’s belief is that this steep decline is affecting not only ITCAN’s business but the
entire legitimate cigarettes category. ITCAN’s observation is that a significant and
unexpected increase in demand for illicit products is the main cause of the decline."</i></div><div><br /></div><div>Sales data reported to Health Canada confirm that legal tobacco sales fell by a greater percentage in British Columbia in 2022 than the reduction in the number of smokers would account for.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEio82EKzED_ZWtYt8v-Be2PSZ2q20kmwMXxkwy0wNEdW5YfGPVxa4NewlYldqrE6SIXjxS_-aiESYCMZF2TSqAkFXDQVdz5RwplMPzFgOo2Zgacm918h2x-H1LoKqwmeI-pAkMo7rsR36Y4_rm7nozh9VYI6oFWfEPxoVske47B9L5Kk54K73_gdglVJoc/s871/b.c..png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="352" data-original-width="871" height="161" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEio82EKzED_ZWtYt8v-Be2PSZ2q20kmwMXxkwy0wNEdW5YfGPVxa4NewlYldqrE6SIXjxS_-aiESYCMZF2TSqAkFXDQVdz5RwplMPzFgOo2Zgacm918h2x-H1LoKqwmeI-pAkMo7rsR36Y4_rm7nozh9VYI6oFWfEPxoVske47B9L5Kk54K73_gdglVJoc/w400-h161/b.c..png" width="400" /></a></div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><div style="text-align: left;"><b><i>Related data sheets:</i></b></div></div></blockquote><ul style="text-align: left;"><ul><li><a href="https://www.smoke-free.ca/pdf_1/2022/cigarettes%20per%20smoker.pdf" target="_blank"><i>Provincial cigarette and fine-cut sales per smoker</i></a></li></ul></ul> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-68005031347347659232024-01-11T12:10:00.000-08:002024-01-11T12:38:05.488-08:00Statistics Canada sheds light on income disparity in vaping. (There isn't much)<p>In recent weeks, Statistics Canada updated its public data tables to include <a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1310009701" target="_blank">information on the difference in health behaviours in 2022 as related to income and education</a>. </p><p>Significantly, this is the first government data release which provides income and education-related information on the use of electronic nicotine products. </p><p>The Canadian Community Health Survey, from which these tables are constructed, did not include questions on vaping until the 2022 survey year. Of <a href="https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&a=1&&lang=en&Item_Id=1390243#qb1390605" target="_blank">the 9 questions asked about electronic cigarettes and vaping</a>, information on two has been released: whether people have tried using an e-cigarette and whether they have used one in the 30 days prior to responding to the survey.</p><p>These survey results show that the income gradient associated with smoking is not as dramatic with e-cigarettes. Smoking is twice as frequent among the poorest Canadians as the richest, but there is only one (statistically significant) percentage point difference for vaping.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTvC5JKOxCZsVrCq_aJykvEIO2Kh8BwrxMtbtvv3adWHBBqNWZ_wIoPKaxCiH-lqS-6f-R-gXhybYDvssvSj5yoFELuCWMhQpb2N3fBL1bDAowYGmU-Jv9F1JSNSCvSHEGM4GMtZbNSEZEOPckmmA9mr5s3ceJc05kEuZGcKr0kzkTIxALVGH18AwjiRs/s622/cchs-income.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="622" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTvC5JKOxCZsVrCq_aJykvEIO2Kh8BwrxMtbtvv3adWHBBqNWZ_wIoPKaxCiH-lqS-6f-R-gXhybYDvssvSj5yoFELuCWMhQpb2N3fBL1bDAowYGmU-Jv9F1JSNSCvSHEGM4GMtZbNSEZEOPckmmA9mr5s3ceJc05kEuZGcKr0kzkTIxALVGH18AwjiRs/w400-h193/cchs-income.png" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div>With respect to education, Canadians with post-secondary certificates are much less likely to smoke than are those without (9.6% vs. 18.4% for those with only high school and 21.9% for those who never graduated from high school). <div><br /></div><div>The pattern is does not hold for vaping: those with post-secondary certificates are more likely to use e-cigarettes than are those who do not have high school. Statistics Canada does not provide an immediate way to compare income and education-related estimates by age or by sex, although provincial breakdowns are provided.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJEk3uCt-lXI3mqEGe55K3xONKFlnHFKwU87W2-_RHJr-d_ryjdk3ewHDZdJtMAXfiYgF1CtkPXQTSDe5oYmeVrWkbxO9w9Uod9s32AAf1GBl2Umva1xLxHJDHKP6BwKYF-1f9DCdaSSpMunr8NIQJSrN_Ga2o-Qa5PHpSCe5FEzOM5LnFRh1uoVKBjBY/s431/cchs-education.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="431" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJEk3uCt-lXI3mqEGe55K3xONKFlnHFKwU87W2-_RHJr-d_ryjdk3ewHDZdJtMAXfiYgF1CtkPXQTSDe5oYmeVrWkbxO9w9Uod9s32AAf1GBl2Umva1xLxHJDHKP6BwKYF-1f9DCdaSSpMunr8NIQJSrN_Ga2o-Qa5PHpSCe5FEzOM5LnFRh1uoVKBjBY/s320/cchs-education.png" width="320" /></a></div><br /><div><br /></div><div>Age- and sex-disaggregated data is available on a <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009601" target="_blank">different table provided by the agency</a>, although this does not provide information on other socio-demographic factors. As shown below, the age profile of cigarette and e-cigarette use is very different. </div><div><br /></div><div>There are roughly twice as many cigarette smokers as e-cigarette users in Canada (3.8 million vs. 1.9 million), but not so for younger Canadians. Smoking among teenagers is too small to be picked up by this survey - but vaping is not. Among Canadians under 35, for every 10 smokers there are 14 vapers. Among Canadians over 35, for every 10 smokers there are 2 vapers.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdiEbqOElr3sgRFrlxyl7jXOGLzmJIFRWjJNsG-MspAoUUzFZBiibAaCZULmLD_mZR73_7KP93rNZ2m0wSihoM-1gGBXm8d-Ouq2sx7LxeU5SxE-olOLZhSuaqD8k5FTMM3-LcgEcLJ7H2QATKDhBTIJx72KerZl4XdlJ-DcQWwjLFiR7HMQiNVzz9NFo/s507/cchs-age.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="275" data-original-width="507" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdiEbqOElr3sgRFrlxyl7jXOGLzmJIFRWjJNsG-MspAoUUzFZBiibAaCZULmLD_mZR73_7KP93rNZ2m0wSihoM-1gGBXm8d-Ouq2sx7LxeU5SxE-olOLZhSuaqD8k5FTMM3-LcgEcLJ7H2QATKDhBTIJx72KerZl4XdlJ-DcQWwjLFiR7HMQiNVzz9NFo/w400-h217/cchs-age.png" width="400" /></a></div><br /><div><br /></div><div>For the coming year, the CCHS will <a href="https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=1532313#qb1532610" target="_blank">ask 8 questions about e-cigarette use</a> and will also ask a sub-sample about their use of nicotine pouches. (<a href="https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=1533124" target="_blank">Rapid Response</a><a href="https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=1533124"> Tobacco Alternative Products) </a> This will the first time the use of pouches will be surveyed by the federal government. </div><div><p><b>Statistics Canada Tables cited above</b></p><p></p><ul style="text-align: left;"><li><a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009701" style="box-sizing: border-box; outline: 0px;">Table 13-10-0097-01 Health characteristics, annual estimates, by household income quintile and highest level of education</a></li><li><a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009601" style="box-sizing: border-box;">Table 13-10-0096-01 Health characteristics, annual estimates</a></li></ul><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><p></p></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-15322287200419564312024-01-03T06:56:00.000-08:002024-01-03T07:36:51.397-08:00How European governments are regulating nicotine pouches <p><a href="https://smoke-free-canada.blogspot.com/2023/12/why-prescription-status-is-currently.html" target="_blank">Last week's post</a> looked at the options available to Canada's federal health minister to address the recent marketing of Zonnic nicotine pouches. (TLDR?: They should be sold as prescription medications until Canada's tobacco laws include these new products).</p><p>This post reports on a variety of recent actions taken to regulate nicotine pouches in European countries. Of these, the experience in Finland may have the greatest relevance for Canada. There, as here, pouches were only available as licensed medicines. Recognizing that this therapeutic designation was not consistent with how the pouches were being sold or used it decided to regulate them as part of the tobacco and vaping product market.</p><p>Oral tobacco products, like traditional chewing tobacco or snus, are banned in all but one EU countries by a European Union directive. Nicotine pouches, however, do not meet the definition of tobacco products under EU law, and so <a href="https://www.europarl.europa.eu/RegData/etudes/IDAN/2022/740068/IPOL_IDA(2022)740068_EN.pdf" target="_blank">this prohibition does not apply to them</a>. </p><p>The EU is in the process of revising its rules for tobacco, and <a href="https://twitter.com/weimers/status/1708764259365109769?s=20" target="_blank">there are rumours that a ban on non-tobacco nicotine pouches are under consideration.</a> In the meantime, in the absence of a region-wide directive, countries are left on their own to decide how to control this market. </p><p>Within the European region, oral tobacco use (snus) is established and commonplace in the Scandinavian countries. Tobacco-based snus is legal in Sweden because it received an exemption from the EU ban on oral tobacco when it joined the EU and is legal in Norway, which is not a member of the European Union. Although sales of oral tobacco are banned in Finland and Denmark, <a href="https://journals.sagepub.com/doi/full/10.1177/1455072521995704" target="_blank">they are easily imported into these countries and usage is increasing</a>. </p><p>Non-tobacco nicotine pouches <a href="https://www.annualreports.com/HostedData/AnnualReportArchive/s/swedish-match_2014.pdf" target="_blank">were first marketed in 2014 in Sweden</a>. As shown in the table provided by <a href="https://tobaccotactics.org/article/nicotine-pouches/">Tobacco Tactics</a>, sales of these products have increased substantially in the past few years, especially in the United States and Western Europe.</p><p></p><div style="text-align: center;"><i>Sales of nicotine pouches in million units, by region, 2019-2022.</i></div><i><div style="text-align: center;"><i>(Source Euromonitor International)</i></div></i><p></p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://content.tobaccotactics.org/uploads/2023/08/Nic-pouches_regional-markets_bar-chart.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="374" data-original-width="579" height="258" src="https://content.tobaccotactics.org/uploads/2023/08/Nic-pouches_regional-markets_bar-chart.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://tobaccotactics.org/article/nicotine-pouches/" target="_blank">From Tobacco Tactics' review of Nicotine Pouches</a></td></tr></tbody></table><br /><h3 style="text-align: left;"><b>The regulatory response in European countries to nicotine pouches</b></h3><p><b>Belgium</b></p><p>Belgium is the first European country to ban nicotine pouches. The ban came into force at the retail level in October 2023, seven months after it was proclaimed in a Royal Decree (<a href="https://etaamb.openjustice.be/fr/arrete-royal-du-14-mars-2023_n2023041247.html" target="_blank">Arrêté royal relatif à l'interdiction de mise sur le marché de certains produits similaires</a>, March 2023). </p><p>The stated objective of the order was <i>"to prevent known and potential harmful health effects from the use of these new products, to discourage their use by young people and to avoid possible negative consequences on efforts to combat the smoking."</i></p><p>British American Tobacco <a href="https://etaamb.openjustice.be/fr/avis_n2023042883.html" target="_blank">launched a legal challenge to the regulation</a>.</p><p><b>Czechia </b></p><p>In May 2023, <a href="https://www.mzcr.cz/nikotinove-sacky-bez-obsahu-tabaku-vyhlaska-oznamovani-prostrednictvim-eu-ceg/" target="_blank">Czechia passed a decree</a> imposing requirements on the manufacture of nicotine pouches. These included required elements for labelling, restrictions on the additives that could be put in them, minimum packaging of 20 pouches, maximum nicotine of 12 mg per pouch, restrictions on promotional packaging. English and French-language versions of the regulation and background information <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/16379" target="_blank">can be accessed on the EU TRIS site</a>. </p><p><b>Denmark </b></p><p>In Denmark, tobacco-free nicotine pouches became <a href="https://www.retsinformation.dk/eli/lta/2020/2071" target="_blank">regulated under the Tobacco Act as a tobacco surrogate/substitute</a> in 2020. The rules which apply to them include health warnings, restrictions on sales to young people and other labelling and packaging restrictions.</p><p><b>Estonia</b></p><p>Estonia included smokeless tobacco products during its 2020 revisions to its <a href="https://www.riigiteataja.ee/en/eli/ee/503052023002/consolide" target="_blank">Tobacco Act</a>. These extend some of the restrictions on combustible products to nicotine pouches, and provide for a specific health warning. ("This tobacco product damages your health and is addictive").</p><p><b>Finland </b></p><p>The Finnish government is currently transferring the regulation of nicotine pouches from medicinal products to tobacco products in an attempt to control the illicit market. <a href="https://stm.fi/hanke?tunnus=STM029:00/2023" target="_blank">Legislation to accomplish this is expected</a> to be presented to the Finnish legislature within a few weeks.</p><p>In preparation for this change, the Finnish ministry of health prepared both an explanatory <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/24952/text/D/EN" target="_blank">Draft Text</a> with the changes, as well as an <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/24952/text/I/EN" target="_blank">Impact Assessment</a> . These were provided to the <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/24952" target="_blank">European Commission TRIS portal</a> as a routine part of the EU's management of technical barriers to trade. </p><p>The de-medicalization of pouches is being managed in two steps. A stop-gap measure was put in place in June 2023 with an<a href="https://stm.fi/documents/1271139/152515719/Interim+decision+pursuant+to+section+45b,+subsection+3+of+the+Chemicals+Act+restricting+the+placing+on+the+market+of+certain+products+containing+nicotine,%C2%A0the+Finnish+Safety+and+Chemicals+Agency.pdf/8d263a41-6ab0-7796-0ade-09c9a0513e80/Interim+decision+pursuant+to+section+45b,+subsection+3+of+the+Chemicals+Act+restricting+the+placing+on+the+market+of+certain+products+containing+nicotine,%C2%A0the+Finnish+Safety+and+Chemicals+Agency.pdf?t=1688392460585#:~:text=Pursuant%20to%20section%2045b%20subsection,20%20mg%2Fpouch%20or%20more." target="_blank"> order under the Finnish Chemicals Act</a> and increased enforcement activity. The longer-term approach involves amendments to their tobacco law -- scheduled for introduction in February. These would regulate nicotine pouches largely as tobacco and vaping liquids currently are and would establish a maximum nicotine limit of 20 mg and restrictions on flavourings. (The exact flavours to be restricted would be established by regulation).</p><div><p><b>Germany</b></p><p>The report noted that German state authorities currently regulate nicotine pouches as a novel food, rendering the sale of pouches illegal in some states, but not illegal to use by those who privately import them. Germany's national tobacco law (<a href="https://www.gesetze-im-internet.de/tabakerzg/BJNR056910016.html" target="_blank">Tabakerzeugnisgesetz</a>) does not include specific rules for nicotine pouches.</p><p>In 2022, the German Federal Institute for Risk Assessment (Bundesinstitut für Risikobewertung) provided its <a href="https://mobil.bfr.bund.de/cm/349/health-risk-assessment-of-nicotine-pouches.pdf" target="_blank">Health risk assessment of nicotine pouches</a>. Although the agency concluded that pouches were less harmful than cigarette smoking, it noted that they can expose users to tobacco-specific nitrosamines (TSNAs). </p><p>Their assessment found that nicotine pouches could delivery much more nicotine than smoking a cigarette: <i> "at least half of the nicotine in the pouch can be absorbed. Relevant
nicotine blood levels were achieved, i.e. levels were within a range that is comparable with
conventional cigarettes. Use of high-dose products led to significantly higher nicotine levels
than cigarette consumption."</i></p><p><b>Hungary</b></p><p>Outside of Scandinavia, Hungary is a country with higher involvement with nicotine pouches. British American Tobacco opened a large <a href="https://tobaccoreporter.com/2020/09/01/out-of-the-bag/" target="_blank">nicotine pouch manufacturing plan in Hungary in 2020</a>. Over the past year, however, the government has raised concerns about the unregulated market and this summer <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/24361" target="_blank">proposed restrictions</a> on nicotine levels (17 mg per pouch) and other limitations on "nicotine containing smoking substitutes" similar to those in place for tobacco products. </p><p><b>Iceland</b></p><p>Iceland r<a href="https://www.government.is/library/04-Legislation/Act%20on%20electronic%20cigarettes%20and%20refill%20containers%20for%20electronic%20cigarettes%20No%2087%202018%20-%20Copy%20(1).pdf" target="_blank">evised its law in 2022</a> to address nicotine pouches. Restrictions include a ban on advertising, an age limit of 18 years, and prohibitions on using in places where children and young people are present. Although the law permits a ban on flavourings, none are yet in place. Maximum nicotine levels are 20 mg per pouch.</p><p><b>Latvia </b></p><p>Latvia's legislature, the Saeima, is finalizing its review of <a href="https://titania.saeima.lv/LIVS14/saeimalivs14.nsf/webSasaiste?OpenView&restricttocategory=48/Lp14" target="_blank">amendments to its tobacco law</a>. Among the proposed changes are restrictions on tobacco substitutes, a category which includes nicotine pouches. As described <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/23978" target="_blank">in an impact assessment submitted to the EU,</a> these measures include <i>"specific composition requirements for tobacco substitute products to be placed on the Latvian market, including the maximum admissible nicotine concentration of 4 mg per g, restrictions on additives, including a restriction on the added flavourings, with the exception of flavours which produce the odour or taste of tobacco. The draft </i><i>law also foresees a prohibition of sales to minors, including sales by means of </i><i>distance communication, including distance contracts, restrictions on advertising </i><i>and sponsorship, including restrictions on visible placement of tobacco products </i><i>in retail stores. The draft law also requires placement of a mandatory health </i><i>warnings on tobacco substitute products. "</i></p><p><b>Lithuania</b></p><p><a href="https://tobaccointelligence.com/lithuania-works-on-draft-nicotine-pouch-legislation-amid-shadow-market-fears/" target="_blank">Lithuania is reported</a> to be responding to an increase in illegal sales of nicotine pouches by developing a law to regulate their sale.</p><p><b>Netherlands</b></p></div><p>In November 2021, the <a href="https://open.overheid.nl/documenten/ronl-3bc702dc-a37e-4d37-8564-0fb13e97431a/pdf" target="_blank">Netherlands health minister informed the legislature</a> that he would propose legislation to address nicotine pouches and other new nicotine products, but would use food regulations temporarily to block the sale of pouches. The following spring, a declaration that nicotine pouches containing more th an 0.035 mg of nicotine were unsafe and therefore not legal for sale was <a href="https://zoek.officielebekendmakingen.nl/stcrt-2022-10837.html" target="_blank">formally published</a>. This maximum nicotine level was <a href="https://www.rivm.nl/sites/default/files/2021-11/FO_nicotinezakjes%20tox_20211101_def_anon.pdf" target="_blank">calculated by the government's public health agencies</a> by applying the food standard Acute Reference Dose for nicotine as set by the European Food Safety Authority. </p><p>In September 2023, the <a href="https://www.tweedekamer.nl/kamerstukken/wetsvoorstellen/detail?cfg=wetsvoorsteldetails&qry=wetsvoorstel%3A36403" target="_blank">Netherlands legislature was provided with draft amendments</a> to the tobacco law which would expand the law to include non-tobacco nicotine products (and impose similar restrictions to these products as were applied to tobacco products) and which would ban nicotine pouches.</p><p>Following an election in November 2023, there was a change of government in the Netherlands. The new government has not formally been set, and so the impact of this change on tobacco policy is unknown.</p><p><b>Norway</b></p><p>Norway is not a member of the European Union, and oral tobacco (snus) is commonly used by adults and young people. </p><p></p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhapYppEZ5TSnSRN3uh0w4K8k9UrQ9ehiOrGevC1J6h8JYYi8vjYgZ8BLByaO9SAx34GDnAcoSSQqpeCKV9eYj_Ukhn_bjPSHoGxUcwiqcToVX6PpQY1_z2ZbEgUIeButY0_l1TGUbYl1qlQrL4oU0qZy2VG1_C0TANe2vGYT-buv9ckQ5PTRKUXwn3JfY/s1000/Zyn.webp" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="596" data-original-width="1000" height="130" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhapYppEZ5TSnSRN3uh0w4K8k9UrQ9ehiOrGevC1J6h8JYYi8vjYgZ8BLByaO9SAx34GDnAcoSSQqpeCKV9eYj_Ukhn_bjPSHoGxUcwiqcToVX6PpQY1_z2ZbEgUIeButY0_l1TGUbYl1qlQrL4oU0qZy2VG1_C0TANe2vGYT-buv9ckQ5PTRKUXwn3JfY/w217-h130/Zyn.webp" width="217" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><i>In Norway, Zyn contains a small<br />amount of tobacco </i><br /></td></tr></tbody></table>Norwegian law, similar to Canada's, bans the marketing of nicotine pouches, other than those specifically authorized as a medical device. To skirt this regulation, nicotine pouches in Norway are sold with small amounts of tobacco in them. As tobacco products, they must be sold in plain packaging. <p></p><p>For example, the PMI product Zyn is sold in Norway with some tobacco included. (<i>"The all-white appearance of the snus is made possible thanks to a composition of plant fiber and a small proportion of light tobacco. The mixture and the portion provide a soft fit and a long-lasting taste experience."</i> <a href="https://www.snuslageret.no/zyn/" target="_blank">translation</a> from www.snuslageret.no/zyn/)</p><p><b>Sweden</b></p><p>In 2022, <a href="https://www.lexology.com/commentary/healthcare-life-sciences/sweden/westerberg-partners-advokatbyr-ab/swedens-new-legislation-on-non-medicinal-tobacco-free-nicotine-products" target="_blank">Sweden responded to a court ruling </a> which required it to remove e-cigarettes from medicinal regulation. It created a specific law for tobacco-free nicotine products (Act 2022:1257). The law will be <a href="https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/living-conditions-and-lifestyle/andtg/legal-requirements/tobacco-free-nicotine-products" target="_blank">fully in force in 2024</a>. The <a href="https://technical-regulation-information-system.ec.europa.eu/en/notification/17569" target="_blank">regulations</a> include health warnings, labelling requirements, reporting obligations, and premarket notification. Sweden's permissive approach to oral nicotine products is reflected in its expressions of concern about other EU countries banning them.</p><p><b>United Kingdom</b></p><p>The United Kingdom is no longer a member of the EU, but has to date maintained EU-consistent tobacco laws. </p><p>In the UK and Scotland, nicotine pouches are not regulated under the same laws that cover tobacco and vaping products, but under consumer product safety rules. As a result, restrictions on advertising, labelling and minimum age do not apply. Despite c<a href="https://www.theguardian.com/business/2023/jul/30/influencers-and-freebies-big-tobaccos-push-to-sell-nicotine-pouches-in-uk" target="_blank">oncerns raised</a> about the marketing of these products, and <a href="https://www.bbc.com/news/health-63320986" target="_blank">a call for government action</a>, the UK government<a href="https://www.gov.uk/government/news/prime-minister-to-create-smokefree-generation-by-ending-cigarette-sales-to-those-born-on-or-after-1-january-2009#:~:text=Proposed%20new%20legislation%20will%20make,completely%20as%20early%20as%202040." target="_blank"> did not include reference to this</a> in its recent announcements regarding tobacco law reforms.</p> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-47497955746814549062023-12-28T07:41:00.000-08:002023-12-30T06:57:48.361-08:00Why prescription status is the best short-term option to manage nicotine pouches in Canada. <p>A month has now passed <a href="https://smoke-free-canada.blogspot.com/2023/11/mark-holland-on-zonnic-and-update-on.html" target="_blank">since Health Minister Mark Holland expressed his frustrations</a> with the marketing of British American Tobacco (Imperial Tobacco Canada) Zonnic nicotine pouches. </p><p><i>"I'm mad. I think it is wholly inappropriate," </i>the Minister told CBC reporter Marina von Stackelberg on November 28th<i>. "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."</i></p><div>This post provides a recap of events to date and looks at the actions available to the Minister and Health Canada to "shut down" the loophole that allowed the current marketing of Zonnic-brand nicotine pouches. A subsequent post will report on ways in which other governments are addressing the health risks of these products.</div><div><br /></div><div><b>The story so far: Zonnic nicotine pouches in Canada</b></div><div><br /></div><div>Zonnic nicotine pouches are manufactured by British American Tobacco (BAT) and distributed in Canada by its subsidiary Imperial Tobacco Canada. They are the same as the 4mg version of the company's Velo-brand nicotine pouches sold in other countries.</div><div><br /></div><div>Canadian tobacco control laws do not currently allow the sale of nicotine pouches. BAT was able to overcome this barrier by applying for and receiving authority from Health Canada to sell them as a smoking cessation and craving-control medication. This permission <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80125630" target="_blank">was given in late July 2023</a>, shortly before the Hon. Mark Holland was appointed health minister. They are regulated as a Natural Health Product, subject to the same rules as homeopathic medicines, supplements and herbal remedies. <a href="https://smoke-free-canada.blogspot.com/2023/07/bat-shoehorns-its-nicotine-pouches-onto.html" target="_blank">More background can be read here</a>.</div><div><br /></div><div>Imperial Tobacco began shipping these pouches to retailers in October with supportive digital and retail advertising campaigns. The first observed sales in Ottawa were the week of October 9th. </div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dzAljseOGw4JUYawbUvx3YhDO5TxlOklMPzv8JCtphKW_uvQ5LD_vu88AEMxAE4gKPSF-AF9sf2JXkQIeE6yg' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div><br /><div><br /></div><div><div>Soon after the products appeared for sale, health agencies raised concerns about the risks they posed to children and young adults who could be induced to experiment with this addictive drug. Of particular concern was the absence of federal or provincial laws which prohibited selling these pouches to children.</div><div><br /></div><div>In November, the <a href="https://smoke-free.ca/health-canada-makes-it-legal-for-flavoured-nicotine-products-from-imperial-tobacco-to-be-sold-to-children/" target="_blank">groups called on the Minister of Health</a> to put these products under prescription control until better controls were in place. The Minister's response - cited above - followed those appeals and was echoed by <a href="https://twitter.com/drsdelliscc/status/1730416325632127150" target="_blank">opposition health critics.</a> </div><div><br /></div><div><b>The problems created by the changes to the Prescription Drug List in 2018.</b></div><div><br /></div><div>Health Canada created a loophole for nicotine novelties when it amended the nicotine qualifiers on the Prescription Drug List in 2018.</div><br />In Canada, nicotine that is found in tobacco products or vaping products is regulated by the <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/" target="_blank"><i>Tobacco and Vaping Products Act</i></a>. For these categories of products, manufacturers do not need to permission to sell these products -- or even to notify the government before they put them on the market.</div><div><br /></div><div>Any other kinds of nicotine products are regulated by the federal <i><a href="https://laws-lois.justice.gc.ca/PDF/F-27.pdf" target="_blank">Food and Drug Act</a>)</i>. In these cases, the government must give specific approval to each product before it can be marketed. By default, such products can only be sold under prescription, but there are <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/prescription-drug-list/notices-changes/notice-nicotine-salts.html" target="_blank">5 conditions</a> which allow them to be authorized as natural health products. </div><div><br /></div><div>This list of exemptions was last modified in 2018 when vaping products were legalized in Canada. The language used to describe nicotine inhalers was modified to avoid ambiguity about the status of electronic cigarettes. As shown below, the new wording provided a vague exemption for products <i>"in a form to be administered into the oral cavity by means of a non-active device (one that operates on energy generated by the human body or by gravity) that delivers 4 milligrams or less of nicotine per dose for buccal absorption.” </i></div><div><br /></div><div>This wording also allows oral nicotine products that were not marketed in Canada -- or even those that were not yet invented -- to be authorized as medicines. Even if these are manufactured by tobacco and vaping product companies, once approved as a natural health product they can be marketed without the constraints that are placed on these companies other goods -- advertising restrictions, age limits, taxes, reporting requirements, licensed retailers, etc. This is the loophole that needs to be closed.</div><div><br /></div><div><div class="separator" style="clear: both; font-weight: bold; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYoXoQDBOs63OaCE4kTC0V-RKEzKSVYyUGfpGftvoUUjLgjQS9np45Y1M7s3NE_ve67FON57YRTUUMvzpizxaM67BNyY3fwP1cfrpzkiaM0TSi0d_9H_xTDa-_Mc0b7bUkU2Zm0tqOfmpgcrotiOGBDJX3JLuNbbZVJa08jiur13xfKTxLehs58-YgOjA/s650/pdl.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="490" data-original-width="650" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYoXoQDBOs63OaCE4kTC0V-RKEzKSVYyUGfpGftvoUUjLgjQS9np45Y1M7s3NE_ve67FON57YRTUUMvzpizxaM67BNyY3fwP1cfrpzkiaM0TSi0d_9H_xTDa-_Mc0b7bUkU2Zm0tqOfmpgcrotiOGBDJX3JLuNbbZVJa08jiur13xfKTxLehs58-YgOjA/w400-h301/pdl.png" width="400" /></a></div><div class="separator" style="clear: both; font-weight: bold; text-align: center;"><br /></div><div class="separator" style="clear: both; font-weight: bold; text-align: left;"><br /></div><div class="separator" style="clear: both; font-weight: bold; text-align: left;">The Options available to Minister Holland to "close the loophole"</div><div class="separator" style="clear: both; font-weight: bold; text-align: left;"><br /></div><div class="separator" style="clear: both; font-weight: bold; text-align: left;"><span style="color: red;">The best short-term action: </span><br />Making nicotine pouches a prescription product.</div><div class="separator" style="clear: both; font-weight: bold; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">By restoring the qualifier to the Prescription Drug List to its pre-2018 meaning, Minister Holland can put new nicotine products under prescription controls. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">The "d" category of the exemption list could be reworded from: ... <i>"a non-active device (one that operates on energy generated by the human body or by gravity) that delivers 4 mg of less of nicotine per dose for buccal absorption"</i> ... To: <i>"a form to be administered orally by means of an inhalation device which operates on energy generated by the human body or gravity delivering 4 mg or less of nicotine per dosage unit."</i></div></div><div><br /></div><div>This minor wording adjustment could allow Zonnic to remain on the market but would require a doctor or to prescribe it (provincial governments could allow pharmacist prescriptions). It would take the products off the counters of convenience stores, and would place additional constraints on marketing. Direct-to-consumer advertising for prescription drugs is not banned in Canada, but faces higher constraints than other medications.</div><div><br /></div><div>This approach would be similar to the one adopted in Australia with respect to vaping products. Although the Australian health department does not formally authorize electronic cigarettes or test them for safety or efficacy, it does restrict access to prescription basis.</div><div><br /></div><div>The <a href="https://laws-lois.justice.gc.ca/PDF/F-27.pdf" target="_blank"><i>Food and Drug Act</i></a>, section 29, gives the Minister clear authority to decide which drugs are placed on the <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/prescription-drug-list.html" target="_blank">Prescription Drug List</a>. The <a href="https://laws-lois.justice.gc.ca/PDF/C.R.C.,_c._870.pdf " target="_blank"><i>Food and Drug Regulations</i></a>, section C.01.040.3, list the factors that the Minister must consider in doing so. These include identifying whether practitioner oversight is necessary to monitor the use of the drug and whether the use of the drug can cause <i>"a risk to public health which can be mitigated by a practitioner's supervision."</i></div><div><br /></div><div>Putting nicotine pouches under prescription management will allow an assessment of what role these products should play in the management of nicotine addiction. This is consistent with the historic treatment of pharmaceutical NRT products, which were sold by prescription before they were allowed for sale over the counter. Nicotine Gum was <a href="https://idl-bnc-idrc.dspacedirect.org/server/api/core/bitstreams/c66be2fa-0176-4351-aa25-b211b765f5e8/content">first approved for sale in Canada in 1979</a> as a prescription medication and only after 1992 did the 2mg dosage not require a prescription. The 4 mg gum was under prescription until 1997. The nicotine patch was sold as a prescription drug in Canada between 1992 and 1998, when it became available over-the-counter.</div><div><br /></div><div><b><span style="color: red;">The less-good short-term action: <br /></span></b><span style="font-weight: 700;">Enforcing the Natural Health Product Regulations</span></div><div><br /></div><div>If Health Canada tries to crack down on Imperial Tobacco using regulations designed for vitamin pill companies, it will soon find that this toothpaste will not easily go back in the tube. The enforcement approach is too slow and too unwieldy, and does not address the structural problems within the regulations.</div><div><br /></div><div>The <i><a href="https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/" target="_blank">Natural Health Product Regulations</a> </i>(s. 17 to 19) give the Minister the power to instruct a manufacturer to stop selling a product, and also the power to suspend a license -- BUT there are very narrow conditions under which this can be done. These conditions include problematic packaging and labelling, but do not include unintended use or impact on public health. </div><div><br /></div><div>Health Canada's internal rules for enforcing these regulations as laid out in a <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/compliance-enforcement/information-health-product/natural-health-products/health-products-food-branch-inspectorate-policy-0044.html" target="_blank">compliance and enforcement policy</a> are not well designed for dealing with tobacco companies. The policy is based on principles which include to <i>"work collaboratively with regulated parties ... to achieve compliance and to mitigate risks." </i></div><div><br /></div><div>Other departmental rules also weigh down immediate action. The <a href="https://www.canada.ca/en/health-canada/corporate/about-health-canada/reports-publications/health-products-food-branch/health-canada-decision-making-framework-identifying-assessing-managing-health-risks.html" target="_blank">framework to risk management</a> gives little encouragement for <i>"precautionary approaches" </i>and generally directs officials to find evidence of harm before the department intervenes in the market. Addiction is not one of the risks identified in this operational manual. </div><div><br /></div><div>These operating rules will make it harder for the Minister to <i>"take actions quickly"</i> or <i>"close the loophole".</i></div><div><br /></div><div>They do, however, allow the department to put pressure on Imperial Tobacco to change its marketing, and there are signs that these communications are taking place. Imperial Tobacco has now modified its <a href="http://www.zonnic.ca" target="_blank">Zonnic.ca website</a>, reducing the lifestyle imagery and animations on it. It is reasonable to speculate that changes to labelling have been requested, following reports from retailers that they have ceased receiving shipments of the product and have been told that the company is <i>"fixing a problem before bringing it back." </i></div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEacF3XB1Bkk0NETNwp8oSQLrYXv6AI2vwnbJia5ZsYw2uGpnEiqNEHrU-KuGHQ11TkveVowC3zaO2CulIHBamc7fmRcNfoAvE6e59DZATKRnDScC6-EDimW1Lap_bh4JMOL8e_oT-x0_d_msTO-IPyzMpA_nCPU8q4puDEERdf8MTvkMDuGJshGuzvMY/s1132/zonnic-dec-2023.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="516" data-original-width="1132" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEacF3XB1Bkk0NETNwp8oSQLrYXv6AI2vwnbJia5ZsYw2uGpnEiqNEHrU-KuGHQ11TkveVowC3zaO2CulIHBamc7fmRcNfoAvE6e59DZATKRnDScC6-EDimW1Lap_bh4JMOL8e_oT-x0_d_msTO-IPyzMpA_nCPU8q4puDEERdf8MTvkMDuGJshGuzvMY/w400-h183/zonnic-dec-2023.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><i>Imperial Tobacco has toned down <br />but not stopped showing lifestyle <br />promotions on its revised Zonnic.ca website </i></td></tr></tbody></table><div><br /></div><div>Meanwhile, Imperial Tobacco has increased the youth-facing advertisements in thousands of convenience stores across Canada. </div><div><br /></div><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGRc-TM25snhphvxThPyA5PLr8_9rqm3AL_yVwOIuD1TEse7Zox1jN84do54VK0NIZjTbGB0StTqV1raIdPbxziZ0726y764RDcVwDxvKCuNI3o6UC3sfKftV8gNB4VNpYxqJJ-6NWeWw-9y-GAhJrnXynVN1bJLuFYDRis1naS2LGCZOmBdQ1yhaufq0/s847/circle%20k%20small.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="750" data-original-width="847" height="283" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGRc-TM25snhphvxThPyA5PLr8_9rqm3AL_yVwOIuD1TEse7Zox1jN84do54VK0NIZjTbGB0StTqV1raIdPbxziZ0726y764RDcVwDxvKCuNI3o6UC3sfKftV8gNB4VNpYxqJJ-6NWeWw-9y-GAhJrnXynVN1bJLuFYDRis1naS2LGCZOmBdQ1yhaufq0/s320/circle%20k%20small.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Circle K promotions for Zonnic behind the cash <br />register are visible to all customers <br /><br /></td></tr></tbody></table></div><div><br /></div><div>Fundamentally, the <i>Natural Health Product Regulations</i> are the wrong tool for the job. They lack the provisions necessary to protect children from experimenting with nicotine. They do not ban sales to youth, they do not ban advertising. Re-writing these regulations to make them strong enough to protect children will take months or years.</div><div><br /></div><div><b><span style="color: red;">The necessary short-term fix and long-term plan: </span><br />Tweak the <i><a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/" target="_blank">Tobacco and Vaping Products Act</a></i> (TVPA) and prepare for a new <i>Nicotine Control Act. </i></b></div><div><b><br /></b></div><div>Canada's tobacco laws lag behind the marketing ingenuity of tobacco companies. Nicotine pouches are not the only nicotine innovation the companies have started selling since the law was last amended in 2018. Others on the horizon are products such as heated nicotine sticks (e.g. <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/philip-morris-develops-zero-tobacco-heat-stick-that-may-avoid-regulations-2023-09-28/" target="_blank">Philip Morris' Levia</a> and BAT's <a href="https://tobaccoreporter.com/2023/10/16/bat-uses-rooibos-tea-in-heat-sticks/" target="_blank">VEO</a>), and hybrid heated tobacco/vaping devices (e.g. Philip Morris <a href="https://www.pmi.com/our-business/smoke-free-products/heated-tobacco-products" target="_blank">lil HYBRID</a>). Start-up companies have recently launched other novelties, such as newly-patented <a href="https://www.ic.gc.ca/opic-cipo/cpd/eng/patent/3151691/summary.html" rel="nofollow">sublingual nicotine pearls</a></div><div><br /></div><div><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinnaPkGrbMaoQjq4FEsfxE2wjAGLXK6UCz6P-l4qFDfin3HyozalgZixDE6SAfr5cbtaCh_DRdTCukQHkZCw0CnBd41ykUuF1ytfkGphR-p48zHC8T5Nc-U2VIcYpO4GSixtvuXfZ8vZXeiHEXOt0Z4o6-8fbBq2NJiOThdPftvhE8oQJv77b5199Cw7c/s800/Berries_Nicotine_Pearls_by_Nicopop_8MG_1.jpg" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="534" height="293" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinnaPkGrbMaoQjq4FEsfxE2wjAGLXK6UCz6P-l4qFDfin3HyozalgZixDE6SAfr5cbtaCh_DRdTCukQHkZCw0CnBd41ykUuF1ytfkGphR-p48zHC8T5Nc-U2VIcYpO4GSixtvuXfZ8vZXeiHEXOt0Z4o6-8fbBq2NJiOThdPftvhE8oQJv77b5199Cw7c/w196-h293/Berries_Nicotine_Pearls_by_Nicopop_8MG_1.jpg" width="196" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.ic.gc.ca/opic-cipo/cpd/eng/patent/3151691/summary.html" target="_blank"><span style="color: #0b5394;"><span style="font-size: x-small;">Nicopop patent was filed <br />in Canada in 2020</span><br /></span></a><br /></td></tr></tbody></table>In many cases these products do not fit comfortably under a law that was designed with cigarettes, pipe tobacco, chewing tobacco and vaping products in mind. 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 short, Health Canada has no parliamentary direction on how it should manage the market for new nicotine products.</div><div><br /></div><div>As <a href="https://smoke-free-canada.blogspot.com/2023/11/the-urgent-need-for-new-nicotine.html" target="_blank">discussed here earlier</a>, Health Canada is currently engaged in a review of the administration of this law, and is required by table a report on this legislative review by May 23, 2024. Ideally, this report will include proposals for substantial revisions to the law and expand it to address all tobacco- and nicotine-industry products.</div><div><br /></div><div><b>In the meantime, however, the law can be adjusted to meet short-term needs to put Zonnic and other similar products under appropriate controls. </b></div><div><br /></div><div>Relatively minor adjustments could be made to the law to ensure that some important protective measures are put in place. These include banning the non-prescription sale of any nicotine product to a minor, banning advertisements in places where young people have access, requiring regular reporting on marketing activities and health warning labels. </div><div><br /></div><div><b>One way or another, this issue will likely end up in court</b></div><div><br /></div>Health Canada is no stranger to lawsuits filed by tobacco companies and other regulated industries. Each of the paths identified above carries the likelihood of being challenged in court by Imperial Tobacco and possibly requiring the government to expose its policy response to outside scrutiny. <div><br /></div><div><div>Imperial Tobacco may claim that putting Zonnic under prescription status is a regulatory taking, and seek compensation under investment or trade agreements. It may go to Federal Court to challenge enforcement actions or other administrative decisions of the department. </div><div><br /></div><div>Failing to address the nicotine pouch loophole will, however, expose the department to litigation by other stakeholders. Imperial Tobacco was only one of many companies seeking permission to sell nicotine pouches, and a refusal to issue further licenses can also be challenged in court. (A timely and relevant example is <a href="https://www.canlii.org/en/ca/fct/doc/2023/2023fc1465/2023fc1465.pdf" target="_blank">the department's experience defnding its decision to deny authorization to the Resolve stop smoking aid</a>). </div></div><div><br /></div><div>Some legal battles need to be fought. </div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-62103301384763971032023-12-14T05:36:00.000-08:002023-12-15T06:20:23.764-08:00The World Health Organization's Call to Action on E-cigarettes<div class="separator"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbseeg6MjwtB_nn3aQ8uDS_yANuOrjLyml6JJbGyAlvAadIhN2zdbumGzh9qTEt__Ufyah5WTLUYmxo6vUAIdtDKwwTe1HCJ4j2lcnzDdMRTsGaIJyMbJJKQ1-ISCP7uUuqd09BpVTYCGgrR9Vv18KZAASQ4kXcqxEEj7CTKAcgsmehoIWZWq6DS24XC8/s662/who-call.png" imageanchor="1" style="clear: right; display: inline !important; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="662" data-original-width="482" height="252" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbseeg6MjwtB_nn3aQ8uDS_yANuOrjLyml6JJbGyAlvAadIhN2zdbumGzh9qTEt__Ufyah5WTLUYmxo6vUAIdtDKwwTe1HCJ4j2lcnzDdMRTsGaIJyMbJJKQ1-ISCP7uUuqd09BpVTYCGgrR9Vv18KZAASQ4kXcqxEEj7CTKAcgsmehoIWZWq6DS24XC8/w184-h252/who-call.png" width="184" /></a></div>Today the <a href="https://www.who.int/news/item/14-12-2023-urgent-action-needed-to-protect-children-and-prevent-the-uptake-of-e-cigarettes">World Health Organization issued a press release</a> calling on governments to take "strong decisive action" to protect children from the uptake of e-cigarettes. The release was accompanied by a <a href="https://cdn.who.int/media/docs/default-source/tobacco-hq/regulating-tobacco-products/ends-call-to-action.pdf?sfvrsn=ea4c4fdb_12&download=true">"Call to Action"</a> with specific recommendations and a readable <a href="https://cdn.who.int/media/docs/default-source/tobacco-hq/regulating-tobacco-products/ends-call-to-action-background.pdf?sfvrsn=7dd2856e_11&download=true">Technical Note</a> providing background on these recommendations.<br /><br />WHO's statement today is consistent with the concerns it has previously raised about the threat to public health raised by permissive marketing of these addictive products. WHO reminds governments that "The tobacco industry profits from destroying health and is using these newer products to get a seat at the policy-making table" and that it "funds and promotes false evidence to argue that these products reduce harm."<br /><br />WHO's review of the evidence does not lead it to believe that e-cigarettes when sold as consumer products are effective as cessation support. Instead, the health authority advises "Cessation strategies should be based on the best available evidence of efficacy, to go with other tobacco control measures and subject to monitoring and evaluation. Based on the current evidence, it is not recommended that governments permit sale of e-cigarettes as consumer products in pursuit of a cessation objective."<br /><br />For governments -- like that in Canada, the United Kingdom and New Zealand - which encourage the use of e-cigarettes as a cessation strategy, WHO recommends that the market be strongly regulated to protect the unintended use of e-cigarettes by children: "Any government pursuing a smoking cessation strategy using e-cigarettes should control the conditions under which the products are accessed to ensure appropriate clinical conditions and regulate the products as medicines (including requiring marketing authorization as medicines). The decision to pursue a smoking cessation objective, even in such a controlled form, should be made only after considering national circumstances, along with the risk of uptake and after exhausting other proven cessation strategies."<br /><br /><b>Among the Eight recommendations for e-cigarette regulation identified in WHO's Call to Action, only one is currently in place in Canada.</b><br /><br />The recommendation currently in place across Canada is:<br /><br /><i>– Limiting the concentration and quantity of nicotine, to reduce the risk of dependence<br /></i><br />The recommended regulations that have not been adopted by Health Canada are:<br /><br /><i>– Banning all flavouring agents, including menthol and synthetic menthol analogues<br />– Prohibiting attractive and/or promotional features related to the presentation and packaging of the products, such as colours or colouring properties, attractive descriptors, including names<br />– Regulating features that enable the user to manipulate the product, post-sale<br />– Setting a maximum volume for e-cigarette cartridges, to limit toxicants exposure and use<br />– Setting a maximum battery power, to limit the influence of power on nicotine and toxicant delivery<br />– Prohibiting device features that permit transmission of information to and from third parties (including manufacturers), such as connections to smartphone apps, that could be used to collect personal information, details of use topography, or to remotely control the product<br />– Prohibiting additives that have carcinogenic, mutagenic and reprotoxic properties.<br /></i><br /><b>Three important regulations have dropped from view<br /></b><br />Health Canada's lack of progress in restricting flavours in e-cigarettes <a href="https://smoke-free-canada.blogspot.com/2023/07/will-they-wont-they-health-canada-keeps.html">has been much discussed.</a>, but there are two other regulatory reforms that have also dropped from view. These are<br /><br /><a href="https://www.canada.ca/en/health-canada/corporate/about-health-canada/legislation-guidelines/acts-regulations/forward-regulatory-plan/plan/amendments-tobacco-access-regulations.html">Access Regulations (Age Verification for Online/Distance Sales)</a>. These regulations to require more than a box-tick to access on-line sales were identified on the Forward Regulatory Plan almost three years ago (February 2021), but no apparent action has been taken on them since.<br /><br /><a href="https://frp.policygeek.ca/HC/2021-04-07/plan/regulations-amending-vaping-products-promotion-regulations.html">Vaping Products Promotion Regulations (Package and Design Features)</a>. This regulation was intended to "place certain limits on what promotional elements can appear on vaping product packages. They would also impose restrictions on design features that are appealing to youth to prevent their use in the manufacture of vaping products." It was identified in the Forward Regulatory Plan in early 2021, but dropped in the revision to the list the following year.<br /> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-60096864694013498902023-12-13T07:50:00.000-08:002023-12-13T08:24:06.029-08:00Australia's new tobacco law and what Canada can learn from it<p> Last week both houses of Australia's Parliament gave approval to an updated tobacco law. The <i><a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r7083" target="_blank">Public Health (Tobacco and Other Products) Bill 2023</a> </i>was introduced in mid-September 2023, and was approved by both the lower and upper chambers on December 7th. </p><p>Australia has long been considered a fore-runner of tobacco regulation. In modernizing its tobacco law, it has set an example for countries (including Canada!) on raising the bar for health protection. This post identifies 5 measures adopted in Australia that Canadian governments might want to copy.</p><p><b>1) A modernized and broad purpose.</b></p><p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmSSo2jQmJlenGeBBhyphenhyphen5-6pWImgzSGS25F7wX_IbhXCrmDWwoyy0KLPx2W7P-pLCkz_Ja8hqLfwHPzZ9w0cUwES0Vqq0APD17-63jZi-0dpH_kgxT98O0mr14hhn88HqQXJi3XsT9ewBineuv5zhxfhFipNj6cqJStiqFxknqFWkKfJH-LsczcmI1TQtg/s798/australia-purpose.png" style="clear: right; display: inline; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="798" data-original-width="795" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmSSo2jQmJlenGeBBhyphenhyphen5-6pWImgzSGS25F7wX_IbhXCrmDWwoyy0KLPx2W7P-pLCkz_Ja8hqLfwHPzZ9w0cUwES0Vqq0APD17-63jZi-0dpH_kgxT98O0mr14hhn88HqQXJi3XsT9ewBineuv5zhxfhFipNj6cqJStiqFxknqFWkKfJH-LsczcmI1TQtg/w257-h258/australia-purpose.png" width="257" /></a>The new Australian law has 3 objectives and identifies 12 means of obtaining them. </p><p>The objectives are (1) to improve public health by discouraging smoking and the use of
regulated tobacco items, and encouraging people to give up smoking and to stop using
regulated tobacco items; (2) to give effect to certain obligations that Australia has as a party to
the WHO FCTC; and (3) to address public health risks posed by vaping and e-cigarette products. The 13 means include discouraging people who have given up smoking or vaping from relapsing, preventing and reducing nicotine addiction, reducing exposure to second hand smoke, reducing environmental risks of tobacco products, limiting innovations by tobacco manufacturers and increasing public knowledge about the tobacco industry. </p><p>By contrast, the purpose of the Canadian <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/page-1.html#h-449204" target="_blank">Tobacco and Vaping Products Act</a> is vague and the specific objectives (similar to the 'means' in Australia) are narrow. The overall purpose of the law is <i>"to provide a legislative response to a national public health problem of substantial and pressing concern and to protect the health of Canadians in light of conclusive evidence implicating tobacco use in the incidence of numerous debilitating and fatal diseases." </i>The four specific objectives are removing inducements to initiate use, restricting access to young people, preventing misleading or deceptive messaging, and enhancing knowledge of health risks. These objectives were drafted in the mid-1980s (and mapped onto vaping products in 2018), but have not been substantially revisited in 35 years. </p><p>Adopting a broader scope, as Australia has done, would permit warnings about environmental damage, and would give Health Canada cover for more ambitious programming. Until then, there is no statutory obligation for the department to actually prevent youth uptake, or to facilitate or achieve cessation, and no mandate to reduce addiction to nicotine. Without legislation to back it up, the goal of "less than 5% by 2035" is more of a campaign slogan than an accountability framework. </p><p>Australia's example is particularly relevant to Canada given the recent introduction of a cost-recovery system for tobacco regulation. The <a href="https://www.parl.ca/DocumentViewer/en/44-1/bill/C-59/first-reading#ID0E0NG0AA" target="_blank">legislation which proposes this regulatory charge</a> limits the use of these funds to those <i>"in relation to the carrying out of the purpose of this Act, including regulations." </i>If a purpose similar to that of Australia's were in place, tobacco companies could be assessed for the costs of media campaigns to encourage quitting, for research, for environmental clean-up.</p><p><b>2) A belt and suspenders approach to regulating nicotine </b></p><p>In Australia, vaping products are not permitted as consumer goods, although they are available as prescription cessation aids for smokers. Their <a href="https://www.tga.gov.au/products/nicotine-vaping-products-hub" target="_blank">Therapeutic Goods Administration regulates the supply of electronic cigarettes</a> through a system that does not require the same type of review and approval or licensing that is applied to some other medications. </p>In the revisions to its tobacco law, Australia's health regulators recognized that the drug-regulatory system permitted more advertising than was appropriate for e-cigarettes. As <a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/bills/r7083_aspassed/toc_pdf/23115b01.pdf;fileType=application%2Fpdf" target="_blank">the legislative proposal explained</a>:<i> "In order to limit the risk of e-cigarette products becoming a gateway into smoking, and to address the health risks of vaping, this Act includes similar prohibitions [for advertising and sponsorships] in relation to e-cigarette products." </i><div><i><br /></i></div><div>If Canada followed Australia's example, restrictions on marketing of nicotine pouches or e-cigarettes could be imposed (including minimum age for sale) independent of their authorization as cessation products. This would, for example, address many of <a href="https://smoke-free.ca/health-canada-makes-it-legal-for-flavoured-nicotine-products-from-imperial-tobacco-to-be-sold-to-children/" target="_blank">the concerns with Zonnic</a>. <p><b>3) Accelerated work on regulations</b></p><p>In Canada, the Tobacco and Vaping Products Act was before Parliament for 18 months before it was adopted in May 2018. Despite this long gestation, very few regulations under the act were ready to be put in place when the law was proclaimed. It took more than a year for <a href="https://laws-lois.justice.gc.ca/eng/regulations/SOR-2019-353/index.html" target="_blank">warnings on vaping products</a> to be regulated (December 2019) and two years before <a href="https://gazette.gc.ca/rp-pr/p2/2020/2020-07-08/html/sor-dors143-eng.html" target="_blank">promotional restrictions on vaping products were in place</a> (July 2020). A <a href="https://laws-lois.justice.gc.ca/eng/regulations/SOR-2021-123/page-1.html#:~:text=4%20(1)%20For%20the%20purposes,of%20nicotine%2C%20propylene%20glycol%20and" target="_blank">maximum level of nicotine in vaping liquids</a> was not imposed for three years after the law was changed (June 2021), and basic <a href="https://laws-lois.justice.gc.ca/eng/regulations/SOR-2023-123/FullText.html" target="_blank">reporting requirements on vaping manufacturers</a> were not finalized for 5 years (June 2023). </p><p>Australia has avoided some of these delays by <a href="https://consultations.health.gov.au/phd-tobacco/public-health-tobacco-and-other-products-regulatio/" target="_blank">releasing draft regulations for consultation</a> only days after its new law was passed by parliament and before it is in force. </p><p><b>4) Greater transparency and protection from tobacco industry interference</b></p><div>Australia is among the many countries which have included proactive disclosure of regulatory submissions part of their transparency initiative, enhancing this principle by invoking Article 5.3 of the Framework Convention on Tobacco Control. </div><div><br /></div><div>Submission made to government during the consultation process on new regulations will <a href="https://consultations.health.gov.au/phd-tobacco/public-health-tobacco-and-other-products-regulatio/supporting_documents/Supplementary%20Consultation%20Paper%20%20Regulations%20%20FINAL.pdf" target="_blank">generally be made public proactively</a> (with exceptions for those submissions considered to "contain offensive or defamatory comments").</div><div><br /></div><div>Unlike Canada, the Australian government considers that its obligation to protect public health from tobacco industry interference <a href="https://consultations.health.gov.au/phd-tobacco/public-health-tobacco-and-other-products-regulatio/supporting_documents/Supplementary%20Consultation%20Paper%20%20Regulations%20%20FINAL.pdf" target="_blank">"also extends to the e-cigarette industry.</a>" It will impose a conflict of interest screen on submissions from those associated with either. <a href="https://consultations.health.gov.au/phd-tobacco/public-health-tobacco-and-other-products-regulatio/supporting_documents/Supplementary%20Consultation%20Paper%20%20Regulations%20%20FINAL.pdf" target="_blank">"Written
submissions received from individuals or organisations associated with the tobacco or
e-cigarette industry will be deemed to have a conflict of interest (whether actual or
perceived)."</a></div><div> </div><div><b>5) Stronger controls on product names</b></div><div><b><br /></b></div><div>Australia has introduced new restrictions on the words that can be used by tobacco manufacturers. No longer will they be able to use words that suggest reduced harm or other positive qualities, use the names of colours or filter terms, or use terms like "additive-free."</div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2nQ6Ha6D93VTFqM6IsQPKqMx1oeB1Vu29LBnWH9eF-Cjvi7b83MbvLUD8ATfbtGYf7mBecmZVktsq2e3rr_uQMmwrr7BSneVndUgOlqbHCmWhLJdYKYKceQtHtPLuIv_BP_l5vrpVCtgmKaTF1dGgmjpda78f7AG4W6HfSESHvFDZpOt0Geeu-8r38xo/s685/australia-prohibited%20terms.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="595" data-original-width="685" height="348" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2nQ6Ha6D93VTFqM6IsQPKqMx1oeB1Vu29LBnWH9eF-Cjvi7b83MbvLUD8ATfbtGYf7mBecmZVktsq2e3rr_uQMmwrr7BSneVndUgOlqbHCmWhLJdYKYKceQtHtPLuIv_BP_l5vrpVCtgmKaTF1dGgmjpda78f7AG4W6HfSESHvFDZpOt0Geeu-8r38xo/w400-h348/australia-prohibited%20terms.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;"><b>Australia <br /></b><a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/bills/r7083_first-reps/toc_pdf/23115b01.PDF;fileType=application%2Fpdf#search=%22legislation/bills/r7083_first-reps/0000%22" target="_blank"><span style="font-size: x-small; text-align: start;"><b>Public Health (Tobacco and Other</b></span> </a></span><b style="color: #0000ee; text-align: start; text-decoration-line: underline;"><a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/bills/r7083_first-reps/toc_pdf/23115b01.PDF;fileType=application%2Fpdf#search=%22legislation/bills/r7083_first-reps/0000%22" target="_blank"><span style="font-size: x-small;">Products) Bill 2023</span></a><br /><br /></b></td><td class="tr-caption"><br /></td><td class="tr-caption"><br /></td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvKdbVAGIREz8EjW57a4g_A-NGNPuTf2EZ0y67cVve_f5Yk8AaJiyevz1389IrHfH1PYEAuwbdHbtJW018qYnI8rflPPzzTGyVvyIE99if3XlG1YEAREvYYVu8RBeQb6spclgx29z-dPsuwG0rVOejp97QBVzgIQPiYCCy2ZUm39Boslf8nzZ3f55TtTM/s781/northfield.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="781" data-original-width="514" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvKdbVAGIREz8EjW57a4g_A-NGNPuTf2EZ0y67cVve_f5Yk8AaJiyevz1389IrHfH1PYEAuwbdHbtJW018qYnI8rflPPzzTGyVvyIE99if3XlG1YEAREvYYVu8RBeQb6spclgx29z-dPsuwG0rVOejp97QBVzgIQPiYCCy2ZUm39Boslf8nzZ3f55TtTM/w146-h222/northfield.png" width="146" /></a></div><br />Canada also imposes restrictions on brand names. In 2011 the terms <a href="https://laws-lois.justice.gc.ca/PDF/SOR-2011-178.pdf" target="_blank">"light" and "mild"</a> were prohibited and in 2019 <a href="https://laws-lois.justice.gc.ca/PDF/SOR-2019-107.pdf" target="_blank">as part of plain packaging regulations</a> a ban was placed on brand names that "<i>evoke a colour or a characteristic of a filter." </i>Terms that imply positive health effects - like "organic" - and terms which convoke positive qualities - like "smooth", are still permitted. <br /></div><div><br /></div><div><div>Australia's new law provides an example of an approach which anticipates new marketing tactics and implements preventive measures against them.</div></div><div><br /></div><div><br /></div></div></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-78858045103841263792023-11-28T13:19:00.000-08:002023-11-28T13:22:40.411-08:00The 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. <br /><br /><b>Minister Holland expresses anger over the marketing of Zonnic.</b><div><br /><div>Parliament was not sitting last week, when <a href="https://www.cbc.ca/news/politics/restrictions-nicotine-pouches-1.7028297" target="_blank">health groups called on Minister of Health Mark Holland to suspend the sale of Zonnic</a>, the nicotine pouch authorized by his department this summer as a smoking-cessation aid.</div><div><br /></div><div>With the House back in session, journalists were able to question the Minister about his response. The <a href="https://www.cpac.ca/episode?id=84ae7a28-b3ea-49d7-b7b8-deff4f086b7b" target="_blank">full scrum is available on CPAC</a> (starting at 54:32) -- with some highlights from Minister Holland's comments pasted below.</div><i><br />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. <br /><br />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. <br /><br />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. <br /><br />We are looking at what actions we can take and to take those actions quickly. We want to shut down this loophole. <br /><br />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. <br /><br />The way that this [product] was presented was that it was for the purposes of cessation. We were duped. <br /><br />The true intent appears to have been concealed. Obviously if we knew their intention, we would never have allowed the product. <br /><br />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.</i></div><div><i><br /></i><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsLxPPcgm0E94MIGBj2HucPohv18NUThyphenhyphenx1dGTKWUo5c4UL1xEGcCy7EoV2eOJRTlpP9njeWuJ_hHUOENsAVWQyMqysv-EhQdwp_C0uNNNwrWw0QdHoWZjEx7beE_0mou7ob1wOF5Arld6A3hUJVS4T-eQmwwlK9TBu_xfD3lAH-F-NIjUedT4qzxoWxA/s1357/holland.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="782" data-original-width="1357" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsLxPPcgm0E94MIGBj2HucPohv18NUThyphenhyphenx1dGTKWUo5c4UL1xEGcCy7EoV2eOJRTlpP9njeWuJ_hHUOENsAVWQyMqysv-EhQdwp_C0uNNNwrWw0QdHoWZjEx7beE_0mou7ob1wOF5Arld6A3hUJVS4T-eQmwwlK9TBu_xfD3lAH-F-NIjUedT4qzxoWxA/w400-h230/holland.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.cpac.ca/episode?id=84ae7a28-b3ea-49d7-b7b8-deff4f086b7b" target="_blank">Minister Holland responds to questions about Zonnic <br />(54:32 - 103:40)</a></td></tr></tbody></table><br /><span><a name='more'></a></span><i><br /></i></div><div style="text-align: left;"><b>Selected global developments</b></div><div style="text-align: left;"><br /></div>This month a number of governments have made decisions to advance or retreat on tobacco- and vaping-related policies - some of the more significant actions are mentioned below.<div><div><div><br /></div><div><b>Australia</b></div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_jPIF0Ov-fKIcLAQzlNZByiNu4wuWQX0RCUWG1MsDuf2w_f8KL4BCdKXA4NDfvTMPdxHK8Zx-LvdXMt1HxsDb8Az0y1PPoUEsVkCQGK0jZ0NxQc0oGrWU7an532cI7nrcEcd56v5zW6OMkLaUUQ6Qt1buNNynJ4jPwhtOU4rOBMO8rDZs_R8eRc5V6lY/s481/Butler%20-%20tweet.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="481" data-original-width="445" height="246" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_jPIF0Ov-fKIcLAQzlNZByiNu4wuWQX0RCUWG1MsDuf2w_f8KL4BCdKXA4NDfvTMPdxHK8Zx-LvdXMt1HxsDb8Az0y1PPoUEsVkCQGK0jZ0NxQc0oGrWU7an532cI7nrcEcd56v5zW6OMkLaUUQ6Qt1buNNynJ4jPwhtOU4rOBMO8rDZs_R8eRc5V6lY/w228-h246/Butler%20-%20tweet.png" width="228" /></a></div>In May this year, Australia's health minister,<a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-national-press-club-2-may-2023?language=en" target="_blank"> Mark Butler, announced the government's plans</a> to curb the sale of vaping products by restricting sales to pharmacies and ending the legal sale of disposable and flavoured vapes. This week he <a href="https://twitter.com/Mark_Butler_MP/status/1729386610431857120" target="_blank">issued a social media post</a> announcing an agreement among state health ministers to end the sale of disposables by January 1, 2024.</div><div><br /></div><div><b>New Zealand</b></div><div><b><br /></b></div><div>Two years ago (December 9, 2021), the<a href="https://www.health.govt.nz/publication/smokefree-aotearoa-2025-action-plan-auahi-kore-aotearoa-mahere-rautaki-2025" target="_blank"> New Zealand Health Minister announced a suite of pioneering measures</a> aimed at ending the harm caused by tobacco, Among the measures <a href="https://www.health.govt.nz/system/files/documents/publications/proposals_for_regulation_-_smokefree_environments_and_regulated_products_act_1990_22_dec_final.pdf" target="_blank">later detailed in a consultation paper</a> and <a href="https://www.legislation.govt.nz/act/public/2022/0079/latest/LMS708154.html" target="_blank">legislation</a> was banning the sale of tobacco to anyone born after January 2009, a 90% reduction in the number of tobacco retailers (from 6000 to 600) the allowable amount of nicotine in combustible tobacco (scheduled for April 2025).</div><div><br /></div><div>Six weeks ago <a href="https://en.wikipedia.org/wiki/2023_New_Zealand_general_election" target="_blank">an election resulted in a change of government in New Zealand</a>. At the beginning of this week a new coalition government was sworn in. During <a href="https://www.rnz.co.nz/news/national/503342/smokefree-legislation-would-have-driven-cigarette-black-market-christopher-luxon" target="_blank">media interviews, the new prime minister</a> announced the intention to repeal these new measures. The reasons cited included workability of restricting sales to middle-aged people and concerns of a loss of tax revenues if retail restrictions fuelled an illicit market.</div><div><br /></div><div><b>England and Wales</b></div><div><b><br /></b></div><div>During the opening of the British Parliament on , <a href="https://assets.publishing.service.gov.uk/media/654a21952f045e001214dcd7/The_King_s_Speech_background_briefing_notes.pdf" target="_blank">the King's Speech</a> included the government's intention to introduce a law to ban the sale of tobacco products to anyone in England or Wales born after January 1, 2029. If this law is passed (and the New Zealand government rescinds its measure), England and Wales will be the first jurisdictions to implement the smoke-free generation law. </div><div><br /></div><div><b>France </b></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHuj49xvm8ReBqme6b0ZeAMDGNbkLu2hdxtFrOFauVTQgo1TPnptiI49PYuEzwHYNJ4FI8UBToExAa4B8hhpuvS4HZTOAC-gndNPWsJJvkUG4-q5WqJWz8y4JsPVgpEHCoMeTHs_9Xr939PriPQeQ2YweF00vUtPOXXoWdYL6MQnl7_XwHLiNLBcPho8k/s845/france.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="845" data-original-width="605" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHuj49xvm8ReBqme6b0ZeAMDGNbkLu2hdxtFrOFauVTQgo1TPnptiI49PYuEzwHYNJ4FI8UBToExAa4B8hhpuvS4HZTOAC-gndNPWsJJvkUG4-q5WqJWz8y4JsPVgpEHCoMeTHs_9Xr939PriPQeQ2YweF00vUtPOXXoWdYL6MQnl7_XwHLiNLBcPho8k/w181-h253/france.png" width="181" /></a></div><br />This week the government of <a href="https://sante.gouv.fr/actualites/actualites-du-ministere/article/un-nouveau-programme-national-de-lutte-contre-le-tabagisme-2023-2027" target="_blank">France announced a new four-year tobacco control plan</a>. Among the specific measures announced in the plan are to:</div><div>* ban disposable vaping products</div><div>* implement plain packaging for vaping products (already in place for tobacco)</div><div>* expand smoke-free areas (including beaches and parks)</div><div>* increase the price of a package of cigarettes to 13 euros ($19) by 2027</div><div>* strengthen and systematize smoking-cessation treatments</div><div>* establish a roadmap to regulate new forms of nicotine, such as nicotine pouches</div><div><br /></div><div><b>Denmark</b></div><div><br /></div><div>In mid-November, an all-party health agreement was made public for a Danish plan to <a href="https://sum.dk/nyheder/2023/november/politisk-aftale-om-ny-forebyggelsesplan-skal-nedsaette-boern-og-unges-forbrug-af-alkohol-nikotinprodukter-og-tobak" target="_blank">Reduce Children's and Young People's Consumption of Alcohol, Nicotine Products and Tobacco</a>. New enforcement measures include strengthening border controls and on line age-verification systems. The agreement also includes measures to make tobacco and tobacco substitutes (vaping, pouches) less attractive by banning some flavourings, restricting some ingredients and requiring standardized packaging and appearance.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh57kIWWwQYpBFxFck231O1XSUe0x-1l02e8H4FbIpXQRJ4PhuvZAuVnqvPFN4zwN3_X-Baaow1y6_tWR7cfXClEC1sn-V-nKTOcJRENMkZUiDa41oLVhRPUxWEBnCQqBzvU4rg7uGY0NFRcxWVu0MUtKpMNv9nleu7G4SS1TLQETYe0ClgO3qD91N3vmo/s1288/denmark.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="732" data-original-width="1288" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh57kIWWwQYpBFxFck231O1XSUe0x-1l02e8H4FbIpXQRJ4PhuvZAuVnqvPFN4zwN3_X-Baaow1y6_tWR7cfXClEC1sn-V-nKTOcJRENMkZUiDa41oLVhRPUxWEBnCQqBzvU4rg7uGY0NFRcxWVu0MUtKpMNv9nleu7G4SS1TLQETYe0ClgO3qD91N3vmo/w400-h228/denmark.png" width="400" /></a></div><br /><div><br /></div><div><b>Ireland</b></div><div><b><br /></b></div>Ireland issued a consultation paper on <a href="https://www.gov.ie/en/consultation/a6f8f-public-consultation-on-further-regulation-of-tobacco-and-nicotine-inhaling-products/" target="_blank">Further Regulation of Tobacco and Nicotine Inhaling Products</a>. Proposals on which the government is seeking feedback include restrictions on the retail display, appearance, flavours, taxation and use of e-cigarettes. The consultation paper also seeks views on raising the minimum age (currently set at 18).</div><div><br /></div><div><br /></div><div><div style="background-color: white; color: #222222; font-family: Calibri; font-size: 13.2px;"><div><br /></div><div><br /></div></div></div></div></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-54657316041338512652023-11-23T07:01:00.000-08:002023-11-23T11:45:34.018-08:00Updates on smoking behaviours from the Canadian Community Health Survey 2022 <p>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 (<a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1310009601" target="_blank">Health Characteristics annual estimates)</a>, Health Canada's website and the <a href="https://www.smoke-free.ca/2023/CCHS%202022%20Data%20Dictionary%20Provinces%20(rounded%20frequencies).pdf" target="_blank">Data Dictionary for the survey</a> which was provided to us by Statistics Canada. A <a href="https://www.smoke-free.ca/2023/CCHS%20Smoking%20Data%202001-2023.pdf">downloadable data sheet </a> which relates to some of the figures is available.</p><p><b>Background: Canada's national surveys on smoking behaviour</b></p><p>With 65,300 participants, the Canadian Community Health Survey is the largest health survey in Canada, but it is not the only one. </p><p>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 <a href="https://smoke-free-canada.blogspot.com/2021/09/do-telephone-interviews-undercount.html">reported here earlier</a>, 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. </p><p>On behalf of Health Canada, since late 2019 Statistics Canada also conducts the <a href="https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey/2022-summary.html" target="_blank">Canadian Tobacco and Nicotine Survey</a>, (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 <a href="https://www.canada.ca/en/health-canada/services/canadian-alcohol-drugs-survey.html" target="_blank">Canadian Tobacco Alcohol and Drug Survey</a> (2013-2017). The CTNS collects information on-line, and the previous surveys used telephone interviews.</p><div><b>Figure 1: the gaps between survey estimates are closing</b></div><p>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. </p><p>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. </p><p>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%. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9vfkdaOBHPaGHsofnYXNboJgQvgbsnhrHjlqckVSiqc89J716x6htwiSzC2cP6s7_uL_RNocpwl6XTk3vQXc9choo3tnFVrTJDn_TTPk6hxgWHlbfnsKW-Sft-IRiXzMHGEYncTxxh1xzOaLNQp1i2tzG2swF-KdROglyS-InsEVDn1VbcU1yAERBn10/s811/cchs-ctns.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="492" data-original-width="811" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9vfkdaOBHPaGHsofnYXNboJgQvgbsnhrHjlqckVSiqc89J716x6htwiSzC2cP6s7_uL_RNocpwl6XTk3vQXc9choo3tnFVrTJDn_TTPk6hxgWHlbfnsKW-Sft-IRiXzMHGEYncTxxh1xzOaLNQp1i2tzG2swF-KdROglyS-InsEVDn1VbcU1yAERBn10/w400-h243/cchs-ctns.png" width="400" /></a></div><div><br /></div><div><b>Figure 2 : More provincial variation in smoking rates than in vaping rates</b></div><div><br /></div><div>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. </div><div><br /></div><div>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. </div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVY4wZs7d4pQbomKf7ZeiDpm_unKJnPkKmhEqvfE1Bb0HQE-u0dTB-MsD1nVjhqiPQFVPNsFJ4Pb-mZXSe5Is0QTkVdLRotbdvLeEBaHZ9XTtaUXxB5pVzrovtuIRAjFTn_q6yK-VuhyUV3wlIMmvPSz74LXV1oczHVcfJ8M9CLFLg3SeIT38e_hNUntw/s680/cchs2022.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="337" data-original-width="680" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVY4wZs7d4pQbomKf7ZeiDpm_unKJnPkKmhEqvfE1Bb0HQE-u0dTB-MsD1nVjhqiPQFVPNsFJ4Pb-mZXSe5Is0QTkVdLRotbdvLeEBaHZ9XTtaUXxB5pVzrovtuIRAjFTn_q6yK-VuhyUV3wlIMmvPSz74LXV1oczHVcfJ8M9CLFLg3SeIT38e_hNUntw/w400-h199/cchs2022.png" width="400" /></a></div><br /><div><br /></div><p><b>Figures 3a and 3b: Prevention can take the credit for driving smoking rates down.</b></p><p>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.</p><p>The <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000801" target="_blank">population growth in Canada during that period</a> 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. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgl84Q8HnIlwgPY8oIPol0xx7o3BmAlmn7IJ4Ay-HQmhqAIjhsmNfjnVmyUiT7jj43yV6rGSj5tmpDGGZDhq7ZfsJ_VpuZTLgLoKJNQnS3soBGy00PSnAkauGKV-xO2ybK_YXlimPK0o4IHRWkPs-R4J5uiy2SdNSOvrYpVeRN9aBCsgk32NZ41Vbs4774/s780/prevalence-cchs.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="470" data-original-width="780" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgl84Q8HnIlwgPY8oIPol0xx7o3BmAlmn7IJ4Ay-HQmhqAIjhsmNfjnVmyUiT7jj43yV6rGSj5tmpDGGZDhq7ZfsJ_VpuZTLgLoKJNQnS3soBGy00PSnAkauGKV-xO2ybK_YXlimPK0o4IHRWkPs-R4J5uiy2SdNSOvrYpVeRN9aBCsgk32NZ41Vbs4774/w400-h241/prevalence-cchs.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div>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.</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRPUC6ca5qzeB0lyu7xoam_MvadXNLxYSVTTkO_CTi5C94QVTaGiMyc4aMEa_Ziv1aKs_i74JKK6e0y6YGafvoTPfofKehsOcW2wlCiEsozplo9oKaHB0u-6DbIg7r2CjYq4qCaBf3iAhox_TrKMo2A-oPQNEgzFpLuW_yBLBguOJ88EoJJ0Y9xvF7Emo/s997/populationchange.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="997" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRPUC6ca5qzeB0lyu7xoam_MvadXNLxYSVTTkO_CTi5C94QVTaGiMyc4aMEa_Ziv1aKs_i74JKK6e0y6YGafvoTPfofKehsOcW2wlCiEsozplo9oKaHB0u-6DbIg7r2CjYq4qCaBf3iAhox_TrKMo2A-oPQNEgzFpLuW_yBLBguOJ88EoJJ0Y9xvF7Emo/w400-h193/populationchange.png" width="400" /></a></div><div><b><br /></b></div><div><b><br /></b></div><div><b>Figure 4: Cannabis now rivals tobacco for number of users</b></div><div><br /></div><div>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). </div><div><br /></div><div>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).</div><div> </div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKooDUvxBG5rfv4mGDkFloTHtq6yRDg9CRFdAAtjOw0HLTWfhcBj6frlpYrakrj3011Zc292Rzbmr1SYdbexbeDDRm2mdafSUqqFTYGYbn5kcXEHHUG8ou4JXZgI-JSkbkHZCwA4xiaJI5mr9x-D6rHtI3QRyiV9eqpy2EEdS8OCAtjZU9bSQyITLtLo4/s517/ctns-cchs-daily%20.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="296" data-original-width="517" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKooDUvxBG5rfv4mGDkFloTHtq6yRDg9CRFdAAtjOw0HLTWfhcBj6frlpYrakrj3011Zc292Rzbmr1SYdbexbeDDRm2mdafSUqqFTYGYbn5kcXEHHUG8ou4JXZgI-JSkbkHZCwA4xiaJI5mr9x-D6rHtI3QRyiV9eqpy2EEdS8OCAtjZU9bSQyITLtLo4/w400-h229/ctns-cchs-daily%20.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /><br /></div><b>Figure 5: January is a key month for quitting.</b></div><div><b><br /></b></div><div>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. </div><div><br /></div><div>January was most frequently cited as the month in which a smoker quit (19%) followed by June (11%) and September (9%).</div><div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjonqTJxMh6_ev9AKXpjiMB2uHErmGfM5PqS4kM0-ei7zmtafetsnomkBxWI_G3j2ZR3EAvEnuLAq6vftfVXCLddGjwj6JhOZdBo8htOx1F1lg_QWgzLD65CNrAJ8Zn0JOySmjhnlWnyV_pKQ8xsZVM4T7A5xtEbICqvZxZdSVTbb2nufc5NY5BHvFTBcI/s840/whenquit.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="567" data-original-width="840" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjonqTJxMh6_ev9AKXpjiMB2uHErmGfM5PqS4kM0-ei7zmtafetsnomkBxWI_G3j2ZR3EAvEnuLAq6vftfVXCLddGjwj6JhOZdBo8htOx1F1lg_QWgzLD65CNrAJ8Zn0JOySmjhnlWnyV_pKQ8xsZVM4T7A5xtEbICqvZxZdSVTbb2nufc5NY5BHvFTBcI/w400-h270/whenquit.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><p style="text-align: left;"><br /></p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-46167765329702693722023-11-16T15:24:00.000-08:002023-11-17T09:15:33.032-08:00The urgent need for a new nicotine regulatory framework<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgu3e72ljzR276YFfZtvCLDIA5XFgev9d1FKqiTE6JLL3C5kKXIxc5Fj0hljdKeY2pOUwJTkkdkRDwUZ2OBhMO1eH-zhagUpbu-04HljKP859VCHuNu0ZnyoD6ogZfxslShsjKFaz9kIZJA6O_vR4v4iE8HJnHB2vYDHQDmHmjw_F3niv94TXCVDIFD4o8/s577/discussion%20paper.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="577" data-original-width="307" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgu3e72ljzR276YFfZtvCLDIA5XFgev9d1FKqiTE6JLL3C5kKXIxc5Fj0hljdKeY2pOUwJTkkdkRDwUZ2OBhMO1eH-zhagUpbu-04HljKP859VCHuNu0ZnyoD6ogZfxslShsjKFaz9kIZJA6O_vR4v4iE8HJnHB2vYDHQDmHmjw_F3niv94TXCVDIFD4o8/s320/discussion%20paper.png" width="170" /></a></div><p>Today (November 17th) is the deadline for contributions to<a href="https://www.canada.ca/en/health-canada/programs/consultation-second-legislative-review-tobacco-vaping-products-act/document.html"> Health Canada's legislative review of the federal tobacco law.</a> The Minister is required by law to table a biennial report on the <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/page-7.html#h-450023">“provisions and operations” of the law</a> no later than May 23, 2024.<br /><br />This post reports on the key recommendations contained in <a href="https://www.smoke-free.ca/pdf_1/2023/LegislativeReview-2023-PSC-Response.pdf">the PSC response to the discussion paper</a>. Our submission includes 49 additional recommendations aligned with their 19 consultation questions.<br /><br /><b><span style="color: #cc0000;"><span style="font-size: large;">Key Recommendation A:</span></span></b></p><p><b>Health Canada should seize this opportunity to modernize its tobacco/nicotine strategy</b></p><p>• 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.</p><p>• Although Health Canada has adopted <a href="https://www.canada.ca/en/health-canada/services/publications/healthy-living/canada-tobacco-strategy.html" target="_blank">the goal of reducing tobacco use to “under 5% prevalence by 2035”</a> this objective is not legislated, and is not supported by an accountability framework for government or industry.</p><p>• 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.</p><p>• 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.</p><p><span style="background-color: #ffe599;"><b>• 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.</b></span></p><p><span style="background-color: #ffe599;"><span></span><span></span></span></p><a name='more'></a><b><br /></b><p></p><p><b><span style="color: #cc0000;"><span style="font-size: large;">Key Recommendation B:</span><br /></span>Health Canada should transparently report the challenges it has faced in implementing the TVPA.</b></p><p>• Over the past five years, Health Canada has faced a number of challenges in administering the TVPA, including <a href="https://smoke-free.ca/pdf_1/2022/Evaluation-A-2021-000914.pdf" target="_blank">6 identified by its internal evaluators</a> which were originally presented as: </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="text-align: left;"><i>1. The absence of workplans which “set out a clear path, including interim targets in the short- and medium-term, for reaching the long-term goal of less than 5% tobacco use by 2035 and for addressing the issue of youth vaping.”</i></p><p style="text-align: left;"><i>2. Technology systems that are “outdated” or “non-existent”, and which prevent the collection and analysis of needed information.</i></p><p style="text-align: left;"><i>3.Robbing-Peter-to-Pay Paul, and shifting financial and human resources from tobacco to vaping-related activities, risking losing ground on tobacco-related issues</i></p><p style="text-align: left;"><i>4.Time-intensive regulatory processes.</i></p><p style="text-align: left;"><i>5.Public communications which are not informed by updated scientific assessments, and which make questionable therapeutic claims for un-licensed products</i></p><p style="text-align: left;"><i>6.Inconsistent performance measurement and limited systematic knowledge exchange.</i></p></blockquote><p>• These are in addition to the long-standing systemic barriers noted by ourselves and others, including the absence of efficient enforcement systems (e.g. administrative monetary penalties) and a reluctance to prosecute offenders, the absence of a mechanism for a rapid regulatory response (e.g. interim orders) and the loss of surveillance tools during key periods.</p><p>• The TVPA is administered in isolation of other federal and provincial programs and regulatory systems which influence tobacco use. </p><p><span style="background-color: #ffe599;"><b>The Legislative Review is an opportunity for Health Canada to be transparent with the challenges it has faced in using the TVPA to reduce smoking.</b></span></p><p><span style="background-color: #ffe599;"><span></span></span></p><!--more--><b><br /></b><p></p><p><span style="color: #cc0000;"><span style="font-size: large;"><b>Key Recommendation C:<br /></b></span></span><b>Health Canada should go beyond the 20th century demand-side approach and impose controls on suppliers aimed at phasing-out tobacco use and nicotine addiction.</b></p><p>• A variety of “end game” and other regulatory innovations have been proposed to modernize tobacco control strategies, among which some have been chosen for implementation in other countries.</p><p>• Tobacco companies in Canada are currently operating under the protection of federal insolvency law, and are negotiating their future operations with provincial governments. This provides a unique opportunity to establish a forward path for this industry that is aimed at eliminating tobacco use and nicotine addiction.</p><p><b style="background-color: #ffe599;">The Legislative Review is an opportunity for Health Canada to propose more ambitious, innovative supply-side regulations.</b></p><p><br /></p> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-49036061903244530262023-10-31T11:14:00.003-07:002023-10-31T11:36:13.733-07:00This Hallowe'en, Quebec kids get better protection from candy-flavoured nicotine. <p></p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5ZOuAydJdpDBhrzlJ_rIpH4pw3F7wtWdpbaRuSIFPSO-NXV5mlb2JaZ0sTLgEf1ookt_3SCTjoo5Y4wl5vne3eTB-8c9c3AyeXdOd_ruwIJXdwIDBePzZKFePtwesupGve7Hj7oMl_w2F6hXHheGQntY5TFw9mYw_lNnhETHRh8itj3xhPre7sVMI2pM/s803/kergbbk.png" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="803" data-original-width="565" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5ZOuAydJdpDBhrzlJ_rIpH4pw3F7wtWdpbaRuSIFPSO-NXV5mlb2JaZ0sTLgEf1ookt_3SCTjoo5Y4wl5vne3eTB-8c9c3AyeXdOd_ruwIJXdwIDBePzZKFePtwesupGve7Hj7oMl_w2F6hXHheGQntY5TFw9mYw_lNnhETHRh8itj3xhPre7sVMI2pM/s320/kergbbk.png" width="225" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="color: #0b5394;"><b><a href="https://www.vapesshops.ca/product/kerg-bbk-strawberry-bear-disposable-8000-puffs-grape/" target="_blank">Flavoured and Toy-shaped <br />vapes are now illegal in Quebec</a>, <br />although they remain offered <br />for sale on e-stores.</b></span></td></tr></tbody></table>On October 31, 2023 new measures to restrict e-cigarette sales come into effect in Quebec. On this day the revisions to the province's <a href="https://www.legisquebec.gouv.qc.ca/en/document/cr/L-6.2,%20r.%201" target="_blank">Regulation under the Tobacco Control Act</a> come into force - ninety days after they were<a href="https://www.publicationsduquebec.gouv.qc.ca/fileadmin/gazette/pdf_encrypte/lois_reglements/2023A/106401.pdf" target="_blank"> published in the province's Gazette</a>. <p></p><p>From this day on, e-cigarettes are included under the law's prohibition on the sale (<a href="https://www.legisquebec.gouv.qc.ca/en/document/cs/L-6.2?langCont=en#se:29_2" target="_blank">s. 29.2</a>) of <i>"a tobacco product that has a flavour or aroma other than that of tobacco, including a menthol, fruit, chocolate, vanilla, honey, candy or cocoa flavour or aroma, or whose packaging suggests it is such a product." </i>(The Quebec law includes e-cigarettes in the definition of tobacco product, but had exempted them from this provision until the regulatory change this year).</p><p>Quebec's new regulation also sets new labelling requirements for e-cigarette packaging and:</p><p></p><ul style="text-align: left;"><li>prohibits the sale of disposable or capsule products with more than 2 ml of liquid (30 ml for refill containers)</li><li>prohibits the sale of devices that resemble toys or for which the use can be concealed.</li></ul><div>This post looks at the challenges for Quebec and other provinces to protect young people from flavours and other youth-oriented marketing without the support from the federal government.</div><p><b>In the absence of federal measures, six Canadian provinces have banned vaping flavours </b></p><p>As of today, six eastern Canadian jurisdictions have banned all flavours in e-cigarettes. In order of implementation, they are Nova Scotia (April 2020), Prince Edward Island (March 2021), New Brunswick (Sept 2021), Northwest Territories (March 2022), Nunavut (May 2023) and Quebec (October 2023). </p><p>These <a href="https://smoke-free.ca/SUAP/2021/e-cigarette-flavour%20restrictions.pdf" target="_blank">provinces join six other countries</a> (Finland, Hungary, Netherlands, Ukraine, Lithuania, China) and five U.S. states (Massachussets, New Jersey, New York, Rhode Island and California) which have also banned all flavours other than tobacco. Australia has banned flavourings in its prescription-based system for e-cigarettes and many other countries (shown in black in the figure below) ban all e-cigarettes.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmQuX8awKQg3cg1CbQxsYWbnqNeZd9_ey2FAoBYw382izbE0ZZMPVQMDyEGbvV3W3-cb6QLdQllFbxFmO2NaWOpi_X-RhI-8xhmwRxsWnvT8havu5A0ro5_JhlNUav091LnMEfQIWgycVPhp6GchjHVm2ULgenxW6X8iMijZM-txcQ_vK7pJYfRpNhWEQ/s736/flavourmap.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="371" data-original-width="736" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmQuX8awKQg3cg1CbQxsYWbnqNeZd9_ey2FAoBYw382izbE0ZZMPVQMDyEGbvV3W3-cb6QLdQllFbxFmO2NaWOpi_X-RhI-8xhmwRxsWnvT8havu5A0ro5_JhlNUav091LnMEfQIWgycVPhp6GchjHVm2ULgenxW6X8iMijZM-txcQ_vK7pJYfRpNhWEQ/w400-h201/flavourmap.png" width="400" /></a></div><p>Three other Canadian provinces have adopted regulations to restrict the sale of flavoured vaping liquids to specialty vape shops where children are not permitted to enter. British Columbia (September 2021), Ontario (July 2020) and Saskatchewan (September 2021). Ontario and Saskatchewan also allow menthol and mint to be sold outside of these specialty shops.</p><p><b>But the federal government has stalled at the starting gate.</b></p><p>Federal regulation currently <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/page-9.html#docCont" target="_blank">prohibits the use of some non-flavouring ingredients</a> in vaping liquids, and <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/page-10.html#docCont" target="_blank">does not allow for labels</a> to suggest that the aerosols taste like confectionary, deserts, soft drinks, energy drinks or cannabis. </p><p>In May 2021, Health Canada initiated regulations to restrict vaping flavours, but has not moved forward on these since then. The government <a href="https://smoke-free-canada.blogspot.com/2023/07/will-they-wont-they-health-canada-keeps.html" target="_blank">will neither confirm nor deny that the proposal has been suspended.</a> </p><p>Questions raised in parliament this fall received the same non-response that had been given in the spring. When Senator Judith Seidman asked earlier this month <a href="https://sencanada.ca/en/content/sen/chamber/441/debates/150db_2023-10-19-e" target="_blank"><i>"When does the federal government plan to ban flavours in vaping products?"</i></a> - the response from the government representative was a telling <i>"I do not know, and I am not in a position to predict what the government’s plan is." </i></p><p><b>The Prime Ministers' office has not endorsed the measure.</b></p><p>In 2019, <a href="https://www.pm.gc.ca/en/mandate-letters/2019/12/13/archived-minister-health-mandate-letter" target="_blank">Prime Minister Trudeau directed incoming Health Minister Patty Hajdu</a> to <i>"address the rapid rise in youth vaping. This should start with regulations to reduce the promotion and appeal of vaping products to young people and public education to create awareness of health risks. You are encouraged to explore additional measures." </i>It was under Minister Hajdu that draft regulations to restrict flavours <a href="https://gazette.gc.ca/rp-pr/p1/2021/2021-06-19/html/reg2-eng.html" target="_blank">were formally published in June 2021</a>.</p><p>This minister was not reappointed to the health portfolio after the 2021 general election. A new cabinet position was created, under which tobacco regulation was placed. In his instructions to the inaugural Minister of Mental Health and Addictions, the <a href="https://www.pm.gc.ca/en/mandate-letters/2021/12/16/minister-mental-health-and-addictions-and-associate-minister-health" target="_blank">Prime Minister's mandate letter </a>contained no reference to the flavour restrictions that had been proposed only six months earlier.</p><p>New mandate letters have not been issued since the July 2023 cabinet shuffle. The newly-appointed Minister of Addictions and Mental Health (Ya'ara Saks) has not said anything about flavours in her new role. There are indications that she has not yet discussed this topic with departmental staff.</p><p><b>A national approach is needed to make provincial laws enforceable.</b></p><p>Provincial governments which have banned flavours are limited in their ability to control the import of products from web-sites which operate from other provinces, and are not able to lay charges against businesses which ship flavoured products across provincial borders. (Some <a href="https://www.eastcoastvape.ca/product-p/allo7000-fai.htm" target="_blank">vape stores located in these provinces also continue to offer illegal flavours,</a> without apparent provincial capacity to shut these sales down).</p><div>Without effective enforcement, provincial governments have not been able to fully protect children from these products being available. This is reflected in the results of the 2021-2022 Canadian Student Tobacco, Alcohol and Drug Survey (<a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey.html" target="_blank">currently pulled off of Health Canada's website</a>), which show continued use of flavours by youth in the three provinces where flavour bans were in place at the time of the survey. </div><div><br /></div><div>Tobacco companies are assisting the informal market and social sources through which young people acquire flavoured vaping products. They offer deep discounts for volume sales, allowing an individual to purchase products at a wholesale price. Philip Morris on-line stores sells the disposable Veev-Now for $11 each, b<a href="https://www.veev-vape.com/ca/en/webshop/veev/veev-now/vape-bundles-en" target="_blank">ut cuts the price to only $6 per unit when purchased in quantities of 9 or more</a>, and occasionally offers even deeper discounts. This rewards re-sellers who wish to import products into markets where flavoured products are not legal for sale.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd9lrbD7KGswwuQRB1p-WRLNqMA-RZUQ8LjKf5Wu-BF4C0qjRYBGLIxXx2svzTFXk6Rg346gM7vdqiTiNPzw_NZREB6WNrnLRtFxWjA6U1Xw4f2PyD3wTvT6IBUi6oFvQe15SB9FjTt6TTdTjRsQgbUp17Y2t-EMDBnvmETIrAB-ueberk_A4KjAb3grQ/s1062/veev%20bundles.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="678" data-original-width="1062" height="255" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd9lrbD7KGswwuQRB1p-WRLNqMA-RZUQ8LjKf5Wu-BF4C0qjRYBGLIxXx2svzTFXk6Rg346gM7vdqiTiNPzw_NZREB6WNrnLRtFxWjA6U1Xw4f2PyD3wTvT6IBUi6oFvQe15SB9FjTt6TTdTjRsQgbUp17Y2t-EMDBnvmETIrAB-ueberk_A4KjAb3grQ/w400-h255/veev%20bundles.png" width="400" /></a></div><div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i><span style="color: #3d85c6;"><b>By reducing the price of VEEV-NOW to $6 from $11, <br />PMI creates an incentive for re-sellers.</b></span></i></div><div style="text-align: center;"><b><br /></b></div><b><div><b><br /></b></div>National health recommendations are being ignored.</b></div><div><br /></div><div>Almost four years have elapsed <a href="https://www.canada.ca/en/public-health/news/2020/01/statement-from-the-council-of-chief-medical-officers-of-health-on-nicotine-vaping-in-canada.html" target="_blank">since Canada's provincial and federal chief medical officers of health recommended</a> that governments <i>"Ban all flavoured vaping products and then provide regulatory exemptions or market authorizations for a minimum set of flavours to support smokers who choose to use vaping to end or reduce their use of nicotine-containing products."</i></div><div><br /></div><div>Canada's major health organizations have all called for a ban on flavours - as have their international counterparts. (<a href="https://www.smoke-free.ca/2023/Health%20organization%20positions-flavour.pdf" target="_blank">A list or such organizations is available here</a>). </div><div><br /></div><div><div><b><span style="color: #0b5394;">Six of Canada's fourteen jurisdictions have taken steps towards implementing that recommendation -- but their efforts are being undermined by the failure of other governments to do so. National action -- preferably headed by the federal government -- is needed.</span></b></div></div><div><br /></div><div><br /></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-42928292229590026902023-10-23T06:03:00.009-07:002023-10-24T06:23:24.045-07:00Trends in overall nicotine use in Canada. <p>For many decades, health regulators have focused on cigarette smoking as their indicator of tobacco and nicotine use. Around the world, statistical agencies ask variations of the questions "do you smoke cigarettes?" "when did you start smoking cigarettes?" "how many cigarettes do you smoke?" and use the answers to assess the success or failure of their tobacco control efforts.</p><p>This same approach has been grafted onto monitoring of vaping behaviour. Soon after these products appeared on the market (and long before they were legalized for sale), Health Canada included questions on e-cigarette use on its tobacco surveys. </p><p>Information on the use of many other nicotine products - like cigarillos, cigars, chewing tobacco/snuff, pipes and waterpipes - is also collected in Canada. For some other products - notably heated tobacco sticks - there is still no monitoring instrument in effect.</p><p>This post (and <a href="https://smoke-free.ca/2023/CTNS-CTADS%20-%20Any%20Nicotine%20Use.pdf" target="_blank">the accompanying data sheet</a>) use data from recent tobacco surveys to show how including information on any form of tobacco or nicotine use provides additional insights on the health behaviour of Canadians.</p><p><b>Measuring the use of any nicotine product in Canada.</b></p><p>Over the past decade, the <a href="https://www.canada.ca/en/health-canada/services/canadian-alcohol-drugs-survey.html" target="_blank">Canadian Tobacco, Alcohol and Drug Survey</a> (2013, 2015 and 2017) and its replacement, the <a href="https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey.html" target="_blank">Canadian Tobacco and Nicotine Survey</a> (annually in the late winters of 2019, 2020, 2021 and 2022) have produced estimates of the number of Canadians who report past-month use of 7 categories of nicotine products: cigarettes, little cigars, cigars, traditional pipe, oral tobacco/snuff, water-pipe, and electronic cigarettes. In addition to the tables provided on government web-sites, the survey results are also available in Public Use Microdata Files (PUMF).</p><p>These PUMF files allow the identification of survey respondents who reported using any of the 7 products identified above during the month before they were surveyed. (It also identifies those who use pharmaceutical nicotine, such as patches or gum and those who used tobacco when they were smoking cannabis, but these were not included in the results shown below).</p><p>The survey is not currently constructed to establish a measure of how many people use a nicotine-bearing product every day, although they do ask about daily use of cigarettes, e-cigarettes and some other products. Someone who uses either e-cigarettes or traditional cigarettes every day but who does not use either product on each day could not be identified as a "daily" user from the survey as it is now designed.</p><p><b>Ten years of changed nicotine use, but not much progress against it.</b></p><p><span style="text-indent: -18pt;"><b>The number of Canadians using nicotine is as high in 2023 as it was in 2013. </b></span><span style="text-indent: -18pt;">A decade ago, 5.18 m</span><span style="text-indent: -18pt;">illion Canadians reported that the used either cigarettes, other tobacco products or vaping products in the
past month. In 2023, the estimate was slightly higher (5.22 million Canadians). </span></p><p><b>Overall patterns of use have changed.</b> In 2013, four in five (82%) of nicotine users reported using cigarettes, but this past winter only two-thirds did (67%). (In both cases, they may also have used other products). The number of nicotine users who were identified as never smokers (they had smoked fewer than 100 cigarettes in their lifetime) more than doubled - from 478,800 to 1,001,100 Canadians. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkR3Ihys9aKfK7HJdZGR5Dm05mg5KM9vU9klq9A3CCmia1o05a_arEcOLcC3qKz40iIhmLBI0PWNrpfYC7OrJu4-hlDMLZwhDxDV1l0QdiD55yJ4H_nd0uzy7n0JGxpFMOmEOVP5a18TuJCFHxhT5Gkh8E-es3-_2qQCEkGUfGJ-_lb_z4ZoOj8VmZ7Nw/s691/by%20smoking%20status.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="288" data-original-width="691" height="166" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkR3Ihys9aKfK7HJdZGR5Dm05mg5KM9vU9klq9A3CCmia1o05a_arEcOLcC3qKz40iIhmLBI0PWNrpfYC7OrJu4-hlDMLZwhDxDV1l0QdiD55yJ4H_nd0uzy7n0JGxpFMOmEOVP5a18TuJCFHxhT5Gkh8E-es3-_2qQCEkGUfGJ-_lb_z4ZoOj8VmZ7Nw/w400-h166/by%20smoking%20status.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;">(click to enlarge, or <a href="https://smoke-free.ca/2023/CTNS-CTADS%20-%20Any%20Nicotine%20Use.pdf" target="_blank">download data sheet</a>)</div><p><b>Young people make up the same proportion of nicotine users today as they did a decade ago.</b> In 2013, about 1 in 5 nicotine users (18%) was under 25 years of age. In 2023 the proportion was almost the same (17%).</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqSyNP0KD0_QCX0D7Es1dFVyjBq4uPabZwXdwwNTp8_DKL5fVTwsseuOMpfY88EOLZG3-rld8HFccZ16OSm5CY199PNBcEUtjoc8rKRkEYhO8btLhB0moV-03NwjNBmtrlkk-qPHDCb6OKOS-HYzUYLqzXcDQcEPONZIzo7BQYvEKplIk6VVWNzoKMxac/s677/total%20nicotinei%201.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="297" data-original-width="677" height="175" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqSyNP0KD0_QCX0D7Es1dFVyjBq4uPabZwXdwwNTp8_DKL5fVTwsseuOMpfY88EOLZG3-rld8HFccZ16OSm5CY199PNBcEUtjoc8rKRkEYhO8btLhB0moV-03NwjNBmtrlkk-qPHDCb6OKOS-HYzUYLqzXcDQcEPONZIzo7BQYvEKplIk6VVWNzoKMxac/w400-h175/total%20nicotinei%201.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;">(click to enlarge, or <a href="https://smoke-free.ca/2023/CTNS-CTADS%20-%20Any%20Nicotine%20Use.pdf" target="_blank">download data sheet</a>)</div><p><span style="text-indent: -18pt;"><b>Because of population growth, there has been a slight decrease in the percentage of Canadians who use nicotine. </b></span><span style="text-indent: -18pt;">The prevalence of Canadians using
nicotine products in the past month dropped from 18% in 2013 to 16% in 2023. (No statistical test has been performed on these estimates).</span></p><p></p><ul style="text-align: left;"><li><span style="text-indent: -18pt;">The lowest estimates in the number and percentage
of Canadians using any nicotine product coincided with the first winter of
COVID (December 2020 to January 2021).</span></li><li>Many more men than women used these nicotine products in 2013 (21% vs 15%), and the gender gap remained a decade later (20% vs 13%).</li><li>The decrease in cigarette use in younger age groups has been largely offsets by increased use of other nicotine products. </li><ul><li>In comparison with 2013, there was a small drop in the percentage of teenagers (aged 15 to 19) who used nicotine in 2023 (15% in 2023 vs 17% in 2023) </li><li>Roughly one-quarter of young adults (aged 20 to 24) used in nicotine in 2013 (24%), as do their younger cousins a decade later (24% in 2023). </li></ul></ul><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA6nRWzwMS42KEfFqcsNar3yAgHR9VTUPYXhqTfOOVX7xXDVVfi3kWcGTk5u267Bo1PYAH7T7igjxglRIXQwQRWVwAdEsYYeb3FDwljWeBw4J4pea0AnDVZWtl3Fg5xTxaam6NMdxpzlVnq4RXdQmmMloVoe0yQ56LP_TujB-Lv5RZxwIBJxe0Owb85n4/s1201/any%20nicotine%20all%20ages.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="683" data-original-width="1201" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA6nRWzwMS42KEfFqcsNar3yAgHR9VTUPYXhqTfOOVX7xXDVVfi3kWcGTk5u267Bo1PYAH7T7igjxglRIXQwQRWVwAdEsYYeb3FDwljWeBw4J4pea0AnDVZWtl3Fg5xTxaam6NMdxpzlVnq4RXdQmmMloVoe0yQ56LP_TujB-Lv5RZxwIBJxe0Owb85n4/w400-h228/any%20nicotine%20all%20ages.png" width="400" /></a></div><div><div style="text-align: center;">(click to enlarge, or <a href="https://smoke-free.ca/2023/CTNS-CTADS%20-%20Any%20Nicotine%20Use.pdf" target="_blank">download data sheet</a>)</div><div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><p style="text-align: left;"><b>Implications for public health</b></p><p style="text-align: left;">Tobacco companies are steadily expanding the range of nicotine products they market. Over the past month alone, <a href="https://www.zonnic.ca/">BAT began selling tobacco-less nicotine pouches</a> in convenience stores in all provinces but Quebec. In other countries <a href="https://tobaccoreporter.com/2023/10/16/bat-uses-rooibos-tea-in-heat-sticks/" target="_blank">both BAT</a> and <a href="https://tobaccoreporter.com/2023/10/02/pmi-launches-tobacco-free-heat-stick/" target="_blank">Philip Morris</a> have launched tobacco-less nicotine sticks intended for use in their heated tobacco devices. </p><p style="text-align: left;">Using cigarette smoking as a measure of tobacco use is out-dated. Using tobacco use as a measure of nicotine addiction is also out-dated. </p><p style="text-align: left;">It's time for health authorities to establish an indicator for nicotine use that can be used as a yardstick to measure the impact of changes in the nicotine market and also progress against nicotine use (a precursor to nicotine addiction, for which a separate indicator is likely also needed). </p><p style="text-align: left;">Tobacco surveys should collect information on the complete range of nicotine products on the market, and the summary tables produced from these surveys should provide information on the emerging patterns of use and co-use of products. </p><p style="text-align: left;"><br /></p><p style="text-align: left;"><b>Data Sheet:</b> <a href="https://smoke-free.ca/2023/CTNS-CTADS%20-%20Any%20Nicotine%20Use.pdf" target="_blank">Nicotine Users in Canada 2013 – 2023</a></p><div style="text-align: left;"><br /></div></div><div><div><p></p></div></div></div></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-40868066088337915272023-10-04T10:31:00.000-07:002023-10-04T10:31:57.707-07:00Heads up! A peek at new nicotine products on the horizon .... <p>This post reports on recent actions by tobacco companies which signal new products or activities in Canada.</p><p><b>Philip Morris International plans to sell "tobacco free" heat not burn </b></p><p>On Thursday, September 28 one of the world's two largest tobacco companies made a series of presentations to investors, the slides from which are <a href="https://www.pmi.com/investor-relations/press-releases-and-events/investor-day-2023?EventId=26551" target="_blank">available on their website</a>. Within this series of presentations was an explanation of their new "LEVIA" heat sticks.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDYFEa7RSCeiYWn56-4ZUcnQR2IPRzgI6r3jclfU34XLVVq8o_zumrPCJkm8HM1mFAA_U9S7X-_rMTWPeMtWFUcFsZgZDiqf3Iy_ve0Qz0p32cpanDeoFAc7BrMV2BMCx4t3q8ZU5ZfMCjKNK958_OBcrt6Dz-ZNeh-X1xVAj2UNIZYCi7G46ijegSAXo/s1116/presentation%202%20slide%2034.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="637" data-original-width="1116" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDYFEa7RSCeiYWn56-4ZUcnQR2IPRzgI6r3jclfU34XLVVq8o_zumrPCJkm8HM1mFAA_U9S7X-_rMTWPeMtWFUcFsZgZDiqf3Iy_ve0Qz0p32cpanDeoFAc7BrMV2BMCx4t3q8ZU5ZfMCjKNK958_OBcrt6Dz-ZNeh-X1xVAj2UNIZYCi7G46ijegSAXo/w400-h229/presentation%202%20slide%2034.jpg" width="400" /></a></div><p>This heat stick is designed to work with the fourth generation of IQOS heat-not-burn electronic devices, ILUMA. This device uses a somewhat different heating system which does not pierce the heat stick and the tobacco (TEREA) or tobacco-free (LEVIA) sticks sold for it are not compatible with other sticks. ILUMA is not yet sold in Canada, but is intended to be present in 50 markets by the end of this year. (<a href="https://www.pmi.com/resources/docs/default-source/investor-day-2023/2023-pmi-investor-day---stefano-volpetti.pdf?sfvrsn=675340c9_2" target="_blank">slide 8</a>) (Lat month it became available <a href="https://www.betterretailing.com/br/product-news/pml-launches-next-gen-iqos-iluma-device-into-uk-market" target="_blank">for sale in the UK</a>).</p><p>Conceptually, the LEVIA sticks are similar to those <a href="https://tobaccoreporter.com/2022/01/01/making-its-mark/" target="_blank">developed in Canada by PODA</a> before the <a href="https://tobaccoreporter.com/2022/05/16/altria-buys-poda-holdings-assets-and-properties/" target="_blank">intellectual property for the novel nicotine delivery system was sold to ALTRIA last year</a>. (Altria is a partner with PMI in IQOS distribution in the United States). </p><p></p>Earlier this year, PMI advanced the registration of trademarks for <a href="https://ised-isde.canada.ca/cipo/trademark-search/2271854?" target="_blank">ILUMA</a>, <a href="https://ised-isde.canada.ca/cipo/trademark-search/2264386" target="_blank">TEREA</a> and <a href="https://ised-isde.canada.ca/cipo/trademark-search/2242838" target="_blank">LEVIA</a> in Canada. There is no requirement for the company to provide regulators of advance notice of their intention to sell these products. Because they are made with tobacco, the TEREA sticks would be taxed federally as <a href="https://www.smoke-free.ca/SUAP/2020/taxrates-heatnotburn.pdf" target="_blank">manufactured tobacco sticks,</a> at a per unit rate lower than cigarettes and would be subject to provincial restrictions on tobacco flavourings. Because LEVIA produces a nicotine aerosol, it would likely be regulated as a vaping product in Canada, <a href="https://www.smoke-free.ca/SUAP/2020/e-cigarette-tax.pdf" target="_blank">taxed accordingly</a>, and subject to provincial flavour restrictions. <div><div><br /></div><div><p><b>"POP TUCK FEEL"</b></p><p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-3VPGAaVE7uJyYB9h0a95CV0z6xjUSxWXYh15ClOIDqTPSZPzyuOz2f51Sd59619ZXEUHpzqgMS9WFCEnWfsKMHr2dem84xho0oe9sRBGbEYzhm6eAmBhFIX5dqbDCuqJ-WPQhO0kAkhEO5CQEln9ALSfBP9SZbd6y1Ras63VFBZPPFYo0gYs9jVOlUw/s630/zonnic%20packs.jpg" imageanchor="1" style="clear: right; display: inline !important; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="630" data-original-width="406" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-3VPGAaVE7uJyYB9h0a95CV0z6xjUSxWXYh15ClOIDqTPSZPzyuOz2f51Sd59619ZXEUHpzqgMS9WFCEnWfsKMHr2dem84xho0oe9sRBGbEYzhm6eAmBhFIX5dqbDCuqJ-WPQhO0kAkhEO5CQEln9ALSfBP9SZbd6y1Ras63VFBZPPFYo0gYs9jVOlUw/s320/zonnic%20packs.jpg" width="206" /></a>In late September, the auditing firm engaged in Imperial Tobacco Canada Ltd insolvency proceedings <a href="http://cfcanada.fticonsulting.com/ImperialTobacco/docs/Sixteenth%20Monitor%20Report%20-%20FTI%20-%2020-SEP-2023.pdf" target="_blank">reported to an Ontario court that</a> <i>"Imperial anticipates launching Zonnic in Canada in the fourth quarter of 2023." </i></p><p>Zonnic is the brand name for the first nicotine pouches to be authorized for sale in Canada by Health Canada. A sneak-peek at the packaging is available on the<a href="https://www.zonnic.ca/ca/en/stay-tuned" target="_blank"> Zonnic Website</a>, which encourages visitors to "stay tuned".</p><p><a href="https://smoke-free-canada.blogspot.com/2023/07/bat-shoehorns-its-nicotine-pouches-onto.html" target="_blank">As described here earlier,</a> there will be few regulatory restrictions on the 5 permitted flavours of the 4 mg pouches. These products do not fall under laws which establish minimum age for sales, taxes, mandatory warnings, restrictions on television, billboard advertising or in-store displays.</p><p>A marketing slogan filed with the trademark office last spring: <a href="https://ised-isde.canada.ca/cipo/trademark-search/2261324" target="_blank">"POP, TUCK, FEEL"</a> seems likely to be intended for these nicotine pouches - it is the same slogan <a href="https://www.velo.com/gb/en/how-to-velo" target="_blank">BAT uses to sell its VELO brand nicotine pouches in the UK. </a></p><p>Noting the way <a href="https://www.bnnbloomberg.ca/big-tobacco-pushes-nicotine-pouches-as-vaping-hit-by-curbs-1.1908060" target="_blank">BAT markets Velo and PMI markets Zyn</a>, other countries have moved to tighten laws and prevent nicotine pouches from becoming a starter product for nicotine addiction. The Netherlands government responded to the sale of these products by commissioning research from its public health researchers, f<a href="https://www.nvwa.nl/onderwerpen/roken-en-tabak/verbod-op-nicotinezakjes-snus-zonder-tabak" target="_blank">ollowing which it banned the sale of pouches with 0,035 milligrams or more nicotine per pouch</a> in November 2021. Belgium similarly imposed regulations which ban their sale (<a href="https://www.ejustice.just.fgov.be/eli/arrete/2023/03/14/2023041247/moniteur" target="_blank">in March 2023</a>).</p><p><b>Renewed "contraband" campaigns on the way?</b></p><p>Last week a series of press releases were issued to raise alarm about contraband cigarette sales. Tehse included the release of a report prepared by EY and commissioned by the Convenience Industry Council of Canada. <a href="https://www.globenewswire.com/news-release/2023/09/20/2746301/0/en/Canadians-Losing-Billions-to-Organized-Crime.html" target="_blank">"Canadians losing billions to organized crime"</a>. This was soon followed by a <a href="https://www.newswire.ca/news-releases/warning-signs-of-growing-illegal-tobacco-problem-in-saskatchewan-850543425.html" target="_blank">report from Imperial Tobacco on contraband in the prairies</a>. </p><p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_lbiM3IQYdQRYDrUgtXfaQcVqQLxJwOopO8vhFaeWzYh7d7PXlkq82v99LOK0zajQ2Ppd4Ka_gaqDl3PjvuWnG2_JnvhY3heIezQM8L8M-acDCNvY7Ip-rrovb_QLm7iApxHKuOxW5wkaEp7LgLM5fJHWU8U33pk3N6HQVEERMlgNGseJfCgXZT3zbNo/s181/2273882-contraband-.png" imageanchor="1" style="clear: left; display: inline !important; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="178" data-original-width="181" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_lbiM3IQYdQRYDrUgtXfaQcVqQLxJwOopO8vhFaeWzYh7d7PXlkq82v99LOK0zajQ2Ppd4Ka_gaqDl3PjvuWnG2_JnvhY3heIezQM8L8M-acDCNvY7Ip-rrovb_QLm7iApxHKuOxW5wkaEp7LgLM5fJHWU8U33pk3N6HQVEERMlgNGseJfCgXZT3zbNo/s1600/2273882-contraband-.png" width="181" /></a>This activity echoes <a href="https://www.smoke-free.ca/eng_home/2016/Cora-Slides-Annotated.pdf" target="_blank">previous collaborations</a> between the convenience industry and tobacco companies to amplify concerns about contraband in order to pre-empt tax increases or regulation. And recent trademark registrations suggest a new campaign is on its way.</p><p>This summer Philip Morris International tried to registered not one but two designs for <a href="https://ised-isde.canada.ca/cipo/trademark-search/2273882" target="_blank">"Fight Contraband. Fight Together"</a> in connection with proposed "Illicit Trade awareness programmes". The last record on the trademark office's database is that the trademark regulators considered this<i> "Goods or Services Not Acceptable" </i></p><p>Cheap cigarettes - whether they result from contraband sales, low tax rates or discount pricing - undermine public health because affordability is a major driver of continued smoking. </p><p>In contrast to the cries of alarm from tobacco companies, Revenue Canada has produced its own estimates of the underground economy, with the most recent update for the 2014-2018 period. <a href="https://www.canada.ca/en/revenue-agency/corporate/about-canada-revenue-agency-cra/tax-canada-a-conceptual-study/tax-gap-brief-overview/overall-federal-tax-gap-report.html" target="_blank">The CRA report</a> attributes illegal and untaxed tobacco to be responsible for a tax loss of about $400 million, representing 4% of the excise tax revenue. By contrast, personal under-reporting of income (i.e. construction jobs done "under the table") and under-reporting and under-payment of corporate income tax is estimated to cost $5.1 billion to $8.3 billion in lost tax revenue.</p></div></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-57694791521392323182023-09-11T08:28:00.010-07:002023-09-11T11:58:42.117-07:00Delays and missing details from the 4th wave of the Canadian Tobacco and Nicotine Survey. <p> Today Statistics Canada r<a href="https://www150.statcan.gc.ca/n1/daily-quotidien/230911/dq230911a-eng.htm" target="_blank">eleased a few results of the fourth wave of the Canadian Tobacco and Nicotine Survey</a>. This release confirms that without any new constraints on vaping marketing the youth vaping problem continues. </p><p><b>What we know</b></p><p><b>The patterns of nicotine use are stable over the past 4 years. </b>As shown in Statistics Canada's Infographic from the release, over the past 4 years, nicotine continues to capture new cohorts of teenagers. As these teenagers age into their twenties, young adult vaping continues to climb while smoking rates fall. Once blended into the larger population of Canadians, however, the use both products has not diminished. </p><p>Overall, an additional 1% of Canadians are using vaping products in early 2023 than in late 2019 and 1% fewer Canadians reported smoking over the same period. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzGdQs8eTjiXb-9kp74_U_YodvVFvfQEeQanErT4v5kKkFkonxkGYC2pY1lpPe0hZ2H48sLQFI4XZnZZBS-p6CWhlXyqpfIakpI7IcrLP6rTb8YTv37blIfYk49ZvX-Q7mDwXznRgZ3VRuauOhasYEEMTAoAzvYjtzzfMyiHyTzSNsTRSowTurOkNsojk/s675/CTNS=g230911a001-eng.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="336" data-original-width="675" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzGdQs8eTjiXb-9kp74_U_YodvVFvfQEeQanErT4v5kKkFkonxkGYC2pY1lpPe0hZ2H48sLQFI4XZnZZBS-p6CWhlXyqpfIakpI7IcrLP6rTb8YTv37blIfYk49ZvX-Q7mDwXznRgZ3VRuauOhasYEEMTAoAzvYjtzzfMyiHyTzSNsTRSowTurOkNsojk/w400-h199/CTNS=g230911a001-eng.png" width="400" /></a></div><p><b><br /></b></p><p><b>The impact of policy change is imposed on youth. </b>This survey was implemented after the federal government legalized the vaping market with the intention of providing adult smokers with access to vaping products while protecting youth from vaping.</p><p>When compared with data from the period before the change of law in May 2018, the failure to achieve those goals is made clearer. Over the 5 years period, adult use of vaping products has changed little, but youth use rose quickly and has stabilized at a high level.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSPtR2rA34S5FbkwPVFwSkeW9qPPVmUUYWqh_5eGM4fGcO7Fb0inawoR8pNPXhwRJ4W4_OX-nTUebONegAd-ich83x9CWx9UIDLtKZag3wSTwhEywVS5Uzfr-0q3KuSSzD4raqSzirZaJCpek4XMgzYSmfcbLCQdD9pLgqR1KiwXcffguA_mxUdS9UPXU/s791/ctns2023.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="287" data-original-width="791" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSPtR2rA34S5FbkwPVFwSkeW9qPPVmUUYWqh_5eGM4fGcO7Fb0inawoR8pNPXhwRJ4W4_OX-nTUebONegAd-ich83x9CWx9UIDLtKZag3wSTwhEywVS5Uzfr-0q3KuSSzD4raqSzirZaJCpek4XMgzYSmfcbLCQdD9pLgqR1KiwXcffguA_mxUdS9UPXU/w400-h145/ctns2023.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p><b>More than 1 in 5 teenagers who tries a vaping product ends up using them every day. </b>The probability of becoming a daily user of vaping products is high. One fifth of young people who had ever tried vaping products were doing so daily at the time of survey. Even among adults over 25, one-seventh of ever-vapers were vaping daily. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzyGO-PMDF3NK5wCn0eNZYEDuUMc8lHLWmeZSxLnc5E5iHQBFNWp0j9oxtDzKGKSjcTyXrxFrOpCiVBbc_A_swXMrI6FkOtC0FOnWm-0RNVizYQVqED12wGhygZgtSwuj_JpARlMGMGewGxxlEht5aAxTww0dfyJ2VovjuPA9vuurL2Eqv3hNyeuDCAZM/s357/ctns20232.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="357" data-original-width="257" height="273" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzyGO-PMDF3NK5wCn0eNZYEDuUMc8lHLWmeZSxLnc5E5iHQBFNWp0j9oxtDzKGKSjcTyXrxFrOpCiVBbc_A_swXMrI6FkOtC0FOnWm-0RNVizYQVqED12wGhygZgtSwuj_JpARlMGMGewGxxlEht5aAxTww0dfyJ2VovjuPA9vuurL2Eqv3hNyeuDCAZM/w196-h273/ctns20232.jpg" width="196" /></a></div><p></p><p><b>Sexual orientation is associated with higher vaping rates. </b>Vaping rates are twice as high among non-heterosexual Canadians as among those who identify as heterosexual (11.5% vs 5.5%). The pattern for cigarettes is less pronounced (12.4% vs 10.8%). </p><p><b>What we still don't know</b></p><p>Frustratingly, very few results from the CTNS were released today. The survey questionnaire covers a wide range of issues related to tobacco and nicotine use. </p><p>Among the data from the survey which is not yet available is that which will allow us to know:</p><p></p><ul style="text-align: left;"><li>the smoking status of Canadian vapers (e.g. how many are former smokers?)</li><li>rates of use of other tobacco products (e.g. chewing tobacco) and cannabis</li><li>patterns of co-use of tobacco, vaping and cannabis, and progression of use (e.g. which products are used first?)</li><li>relationship of indigeneity and other racial identity to the use of these products (e.g. which groups appear more vulnerable?).</li><li>use of flavourings in vaping products (e.g. who is using candy and fruit flavourings and why?)</li><li>source of supply of vaping and tobacco products (e.g. where do young people get their nicotine products from?)</li><li>the reasons that Canadians say they use vaping products (e.g. are these to help stop smoking, to reduce stress or to satisfy curiosity?) </li><li>changes in the use of these substances in different regions of Canada. (e.g. are people in provinces with taxes or flavour restrictions or retail constraints less likely to use these products?)</li><li>the use of stop-smoking aids (e.g. what products are smokers using in their quit attempts - and which are associated with success?)</li><li>beliefs about the harmfulness of e-cigarettes (e.g. do these beliefs seem to influence use?)</li></ul><p></p><p>This information will only be available once results of an analysis are made available by federal government agencies, or once the data is made available to independent researchers.</p><p><b>Delaying data release</b></p>An important story from today's release is that it took so long to receive so little information. This survey should and could have been released in the spring, as it was in previous years. By arranging for a delay of the data release, Health Canada was able to defer this bad news story. <p></p><p>In 2020 and 2021 - despite the pressures of COVID - Statistics Canada released the data in March and made the PUMF file available at the same time. In 2022, the data was released in May, with the PUMF made available August. </p><p>In each of those years, Health Canada made its analysis a<a href="https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey.html" target="_blank">vailable many months later</a>. But because the raw data was available to researchers and other levels of government, the impact of this delay was lessened.</p><p>The Health Ministry appears to have objected to Statistics Canada's decision to make the data available to the public in advance of that department. In a memo to the Minister in July 2020, Health Canada officials complained <i>"The Tobacco Control Directorate (TCD) was not aware that the data set was being made available to the public by Statistics Canada until after the fact." </i></p><p>It appears that this year the intention was for both government departments to release information on the same date. In response to inquiries on the release, Statistics Canada officials informed us this summer that: <i>"The CTNS master file release date for the 2022 reference year is currently planned for September 11, 2023. This is when the data become available to the public. This differs from previous cycles of CTNS, whose master files were released in the spring. <b>Additionally, Health Canada will be releasing web summary tables on September 11. </b>The PUMF for CTNS 2022 is tentatively planned to be released later in October." </i>(emphasis added)</p><p>As it turns out, Health Canada does not seem have met this deadline. The <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/230911/dq230911a-eng.htm" target="_blank">last line in today's release</a> notes that <i>"Health Canada will also be releasing a detailed report from the latest cycle of the CTNS in September 2023."</i></p><p><i><br /></i></p><p><i><br /></i></p> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-35403096388609057232023-09-07T07:55:00.004-07:002023-09-07T07:55:16.412-07:00Heart & Stroke takes its message to the streets: "Ban Vape Flavours"<p>When parliamentarians return to Ottawa mid-month, they will be greeted with graphic reminders of the need for regulatory action to end the sale of flavoured vaping liquids.</p><p>Heart & Stroke has commissioned the placement of small billboards on the perimeter of the parliamentary precinct and sandwiching the Prime Ministers Office. </p><p>The campaign is simple and graphic. Each of the three executions of the campaign features flavourings in the context of the damage they can do to the cardio-vascular system. <i><a href="http://www.smoke-free.ca/2023/heart.jpg">"Berry Blast can increase the risk of heart disease"</a>, "<a href="http://www.smoke-free.ca/2023/brain.jpg">Mango Crush can increase the risk of stroke"</a>, <a href="http://www.smoke-free.ca/2023/lung.jpg">"Cool Mint can damage blood vessels.</a>"</i></p><p>The posters also appear in transit stops near Health Canada's headquarters. The campaign is also being delivered to decision-makers through news-services popular with political staff, like the Hill Times.</p><p>This is not the first advertising campaign by health organizations calling for federal action on flavours, but it is the most extensive to date. </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIW4qcfo90l3MI9EbDikh5O0gFA14JMibc4iGxwxUJRSVWbkYLGW-Cnm8QHv8kPLT-pdyUpaKE3PXTa1gpqsBhcrk3JgC8m3qKaF8S0wMEbPNh9JC6XXL62mxK2zYTTJQElRQ196zK40XtC5f5cRxnVsNV7qrKwBw5UXafdVRGOJqw9WkoRohqKIs-xKk/s1920/heart.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1920" data-original-width="1440" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIW4qcfo90l3MI9EbDikh5O0gFA14JMibc4iGxwxUJRSVWbkYLGW-Cnm8QHv8kPLT-pdyUpaKE3PXTa1gpqsBhcrk3JgC8m3qKaF8S0wMEbPNh9JC6XXL62mxK2zYTTJQElRQ196zK40XtC5f5cRxnVsNV7qrKwBw5UXafdVRGOJqw9WkoRohqKIs-xKk/w300-h400/heart.jpg" width="300" /></a></div><table border="0" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-insideh: none; mso-border-insidev: none; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
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</tbody></table><div class="separator" style="clear: both; text-align: center;"><br /></div><p>Through other communications, Heart & Stroke provides the public with advice and the health system with policy recommendations. These resources include:</p><p></p><ul style="text-align: left;"><li>Plain-language description of the problem: <a href="https://www.heartandstroke.ca/articles/vaping-what-you-need-to-know" target="_blank">"Vaping: What you need to know"</a></li><li>Position statement: <a href="https://www.heartandstroke.ca/articles/vaping-what-you-need-to-know" target="_blank">Protecting youth from the vaping crisis. </a></li></ul><p></p><p>They are calling on governments to implement comprehensive measures to protect youth, in<a href="https://www.heartandstroke.ca/articles/vaping-what-you-need-to-know#:~:text=Vaping%20is%20less%20harmful%20than,doctor%20or%20other%20health%20practitioner." target="_blank">cluding the following recommendations:</a></p><p></p><ul style="text-align: left;"><li><i>eliminate flavours, which appeal to young people, including mint/menthol,</i></li><li><i>mandate plain and standardized packaging for all vaping products, </i></li><li><i>add graphic and impactful health warnings to educate consumers on the risks of vaping, </i></li><li><i>prohibit sales to those under 21 years of age.</i></li></ul><p></p><p>This year, Heart & Stroke commissioned a public opinion poll <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2022-policy-statements/vaping-crisis-position-statement-2022.pdf?rev=ff18662847d2415e9aa39e3f13859fd7" target="_blank">of almost 4,000 Canadians</a> which demonstrated very high levels of public support for such policies: 84% supported restrictions on flavourings, 84% supported plain packaging for vape products, 86% supported raising the minimum age for sale to 21.</p><p><br /></p><p><br /></p><p><br /></p><p><br /></p> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-68215712151969769702023-08-31T07:34:00.002-07:002023-08-31T07:34:30.731-07:00ICYMI: Tobacco control developments in Canada - Summer 2023<p>For those distracted by wildfires, day-camp schedules, beach days or other seasonal events, this post provides a summary of notable tobacco-control developments since the summer kick-off on July 1st.</p><h3 style="text-align: left;"><b>Health Canada</b></h3><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWpglVXsXVlOI_NqMnVeJqSkdOdU8mYrXi9W4jAsafrs9BRzvMeEDT2zBLpBxi5HKV04HQF8YUXhdC4E0d7Gpe7Y6seDVgfmeXmVTQgYUYoGPwft2oYuskmmcbNrPrEi1xg9h0OIUxEF_9M6mjiw26hc1gBhqoezABdOECTflB1TKPPkkthKTs_2B9XzA/s313/ministers.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="278" data-original-width="313" height="251" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWpglVXsXVlOI_NqMnVeJqSkdOdU8mYrXi9W4jAsafrs9BRzvMeEDT2zBLpBxi5HKV04HQF8YUXhdC4E0d7Gpe7Y6seDVgfmeXmVTQgYUYoGPwft2oYuskmmcbNrPrEi1xg9h0OIUxEF_9M6mjiw26hc1gBhqoezABdOECTflB1TKPPkkthKTs_2B9XzA/w282-h251/ministers.jpg" width="282" /></a></div><b>New hands at the helm:</b> A late July cabinet shuffle appointed new cabinet responsibilities for health. Both <a href="https://www.ourcommons.ca/Members/en/mark-holland(25508)/roles" target="_blank">Mark Holland</a> (Minister of Health) and <a href="https://www.ourcommons.ca/Members/en/yaara-saks(107099)" target="_blank">Ya'ara Saks</a> (Associate Minister of Health/Minister of Mental Health and Addiction) are newcomers to cabinet. Their priorities for the file are still not known: neither has yet made public comments related to tobacco issues, and the mandate letters from the Prime Minister's office are not yet public.<p></p><p><b>A plan without timelines: </b> In mid-July, Health Canada published its Forward Regulatory Plan, forecasting 3 regulatory changes: (1) <a href="https://www.canada.ca/en/health-canada/corporate/about-health-canada/legislation-guidelines/acts-regulations/forward-regulatory-plan/plan/ammendments-tobacco-reporting-regulations-bill-s-5.html">updates to the Tobacco Reporting Regulations</a>; (2) <a href="https://www.canada.ca/en/health-canada/corporate/about-health-canada/legislation-guidelines/acts-regulations/forward-regulatory-plan/plan/restrictions-flavours-vaping-products.html">restrictions on flavourings</a>, and (3) <a href="https://www.canada.ca/en/health-canada/corporate/about-health-canada/legislation-guidelines/acts-regulations/forward-regulatory-plan/plan/amendments-tobacco-access-regulations.html">rules for age-gating e-sales of tobacco and vaping products</a>. As <a href="https://smoke-free-canada.blogspot.com/2023/07/will-they-wont-they-health-canada-keeps.html" target="_blank">discussed here earlier</a>, no timeframe is given for either flavour restrictions or age-gating - nor are these identified in this year's <a href="https://www.canada.ca/en/health-canada/corporate/transparency/corporate-management-reporting/report-plans-priorities/2023-2024-departmental-plan.html" target="_blank">departmental workplan.</a> </p><p><b></b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimPSCTQynDLx701mOhLVsxAOodbrQDy7xLX9Buxu8S2mQmoZGSt8NvgbaWU9a7mesVN6XHSUDy-4euoDioQVHpeIz9zD_urJ9HfGRo1PEAdRb6mLppjXwtlO1I1j34P__iXgxdPhDVJS4iIacskCOS62wg_gRUv9XkAN0-GRTdmiaoAMoJFzh5xlwJFtk/s827/zonnic-2112129.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="525" data-original-width="827" height="129" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimPSCTQynDLx701mOhLVsxAOodbrQDy7xLX9Buxu8S2mQmoZGSt8NvgbaWU9a7mesVN6XHSUDy-4euoDioQVHpeIz9zD_urJ9HfGRo1PEAdRb6mLppjXwtlO1I1j34P__iXgxdPhDVJS4iIacskCOS62wg_gRUv9XkAN0-GRTdmiaoAMoJFzh5xlwJFtk/w204-h129/zonnic-2112129.png" width="204" /></a></b></div><b>A green-light for BAT's pouches: </b>As <a href="https://smoke-free-canada.blogspot.com/2023/07/bat-shoehorns-its-nicotine-pouches-onto.html" target="_blank">previously reported</a>, Health Canada authorized British American Tobacco to sell Zonnic-brand nicotine pouches as stop-smoking medications. These products do not yet appear to be on the market, although t<a href="https://ised-isde.canada.ca/cipo/trademark-search/2112129" target="_blank">rademarks are being put in place to support marketing</a>.<p></p><p><b>Young people unimpressed by vape-to-quit messages: </b>Health Canada paid for on-line focus group tests with young people to assess their reaction to potential advertisements which encouraged smokers to switch to vaping products. (The advertisement is not in use at this time).</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8piWS6u8r_MZLrUYfyD37ol5xPfl5e873YY1JNkeDXv0mRX56fKjTOj7BgKYNCNQtEfDoJEEcCnnHjNhRD56rZS5NzAJPrS3l9-TjvSAT4kQrIAx2uAHbQA9J2OKOunp_ETirjFU4yM31B04rNnhpxQN6L-4lyAdukUHIWGwwHWHJ2bcizYheXjSJZsU/s633/vapeadd.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="361" data-original-width="633" height="159" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8piWS6u8r_MZLrUYfyD37ol5xPfl5e873YY1JNkeDXv0mRX56fKjTOj7BgKYNCNQtEfDoJEEcCnnHjNhRD56rZS5NzAJPrS3l9-TjvSAT4kQrIAx2uAHbQA9J2OKOunp_ETirjFU4yM31B04rNnhpxQN6L-4lyAdukUHIWGwwHWHJ2bcizYheXjSJZsU/w280-h159/vapeadd.jpg" width="280" /></a></div>The results of this opinion research were released this summer (<a href="https://epe.bac-lac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/health/2023/031-22-e/report.pdf" target="_blank">POR 031-22</a>). The ads got a thumbs down from this group: <i>"Many participants, particularly the older ones, expressed the opinion that the ad
communicated that vaping is a preferable alternative to smoking (although not necessarily healthier); a
few even thinking that the ad was “promoting” vaping. Many participants expressed their view that
they felt this was not a good message to communicate, with a few participants questioning the
appropriateness of the Government of Canada logo at the end."</i><p></p><p></p><p style="text-align: center;"><b style="background-color: #6fa8dc;">====================================================</b></p><h3 style="text-align: left;"><b>Provincial actions</b></h3><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE4TPRFgUU8627kfg7QiXLoEVz87xJbtPgUWKqVZ5ogJqSeReMXFMIxb0hZbLdA4_QURD0Y9Ab7WA9g6JzGrdHREn1bsZfw0lzdPsP8Ltqa2oZ9rgEQBdBv94O6xZyn9yJICo6h0WU7ohUrPQwFeeqNxFpx8ZAcI-1R-094ypdUh6QBW8JNEMnLY3c5b8/s861/gazette.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="861" data-original-width="621" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE4TPRFgUU8627kfg7QiXLoEVz87xJbtPgUWKqVZ5ogJqSeReMXFMIxb0hZbLdA4_QURD0Y9Ab7WA9g6JzGrdHREn1bsZfw0lzdPsP8Ltqa2oZ9rgEQBdBv94O6xZyn9yJICo6h0WU7ohUrPQwFeeqNxFpx8ZAcI-1R-094ypdUh6QBW8JNEMnLY3c5b8/s320/gazette.jpg" width="231" /></a></div><b>Flavour restrictions. </b>On August 2nd, the Quebec government <a href="https://www.publicationsduquebec.gouv.qc.ca/fileadmin/gazette/pdf_encrypte/lois_reglements/2023A/106401.pdf" target="_blank">finalized its regulatory prohibition</a> on the sale of vaping liquids which had a taste other than tobacco-flavour. The measure was <a href="https://www.publicationsduquebec.gouv.qc.ca/fileadmin/gazette/pdf_encrypte/lois_reglements/2023A/106216.pdf" target="_blank">first proposed in April</a> and will take effect on October 31, 2023.<p></p><p>Of Canada’s 13 provincial and territorial governments, 6 have adopted legislation or regulations to ban the sale of any e-cigarette liquid other than tobacco flavour: Nova Scotia, Prince Edward Island, New Brunswick, Northwest Territories, Nunavut and Quebec. (See updated fact sheets on <a href="https://smoke-free.ca/SUAP/2021/e-cigarette-flavour%20restrictions.pdf" target="_blank">E-cigarette flavour bans</a> and <a href="https://www.smoke-free.ca/SUAP/2020/Provincial%20regulations%20on%20vaping%20promotions.pdf" target="_blank">provincial regulations on vaping products</a>).</p><p><b>Tightening promotional rules.</b> The Saskatchewan government launched a<a href="https://www.saskatchewan.ca/government/public-consultations/proposed-amendments-to-the-tobacco-and-vapour-products-control-act" target="_blank"> public consultation on proposed changes to its </a><i><a href="https://www.saskatchewan.ca/government/public-consultations/proposed-amendments-to-the-tobacco-and-vapour-products-control-act" target="_blank">Tobacco and Vapour Products Control Act.</a> </i>In addition to raising the minimum age from 18 to 19, the government would strengthen restrictions on advertising with new legal definitions for advertising and promotion. </p><p><b>Litigation talks poised to drag on. </b>At the end of July, <a href="http://cfcanada.fticonsulting.com/ImperialTobacco/updates.htm" target="_blank">representatives for Imperial Tobacco Canada indicated that they would be seeking a further extension for their protection from lawsuits</a>. A hearing is scheduled for September 27. If allowed, this would extend litigation protection to all tobacco companies past the 54 month mark. <b> </b></p><p style="text-align: center;"> <b style="background-color: #6fa8dc; text-align: center;">====================================================</b></p><h3 style="text-align: left;">Selected publications on tobacco and vaping - Summer 2023</h3><p style="text-align: left;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10379233/pdf/ijerph-20-06353.pdf" target="_blank">Cole AG, Gohari MR, Leatherdale ST. Evaluating the One-Year Impact of School e-Cigarette Use Interventions among Current Youth e-Cigarette Users in the COMPASS Study, 2017/18-2018/19. Int J Environ Res Public Health. 2023 Jul 13;20(14):6353. </a></p><p>This study used survey results from 90 schools in the Canadian longitudinal school study (COMPASS) to assess whether school-based prevention and cessation programs had an impact on the vaping behaviour of children who were already using e-cigarettes one year later. They didn't.</p><p><a href="https://www.ajpmonline.org/article/S0749-3797(23)00313-6/fulltext" target="_blank">Reiter A, Hébert-Losier A, Mylocopos G, Filion KB, Windle SB, O'Loughlin JL, Grad R, Eisenberg MJ. Regulatory Strategies for Preventing and Reducing Nicotine Vaping Among Youth: A Systematic Review. Am J Prev Med. 2023 Aug 6:S0749-3797(23)00313-6.</a></p><p>These researchers systematically reviewed 30 studies on the impact of regulations on youth vaping. They found <i>"insufficient evidence to recommend age restrictions (n=16), restrictions on location of use (n=1), and mixed/combined regulations (n=3). Flavor bans (n=4), sales licenses (n=2), and taxation (n=2) were generally shown to be associated with decreased rates of youth vaping. Warning labels (n=2) were associated with a decreased desire to initiate vaping." </i></p><p><a href="https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntad144/7237864?login=false" target="_blank">Simonavičius E, East K, Taylor E, Nottage M, Reid JL, Arnott D, Bunce L, McNeill A, Hammond D. Impact of e-liquid packaging on vaping product perceptions among youth in England, Canada, and the United States; a randomised online experiment. Nicotine Tob Res. 2023 Aug 5</a></p><p>This on-line study provided young people with different pictures of vaping liquid packaging and asked them about their interest in trying such products and their views on the health harms of using them. Young people were less likely to say they wanted to try liquids that were displayed in plain packaging.</p><p><a href="https://link.springer.com/article/10.17269/s41997-023-00792-3" target="_blank">Levy DT, Cadham CJ, Yuan Z, Li Y, Gravely S, Cummings KM. Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model. Can J Public Health. 2023 Aug 4. doi: 10.17269/s41997-023-00792-3. </a></p><p>This paper compared earlier predictions of smoking patterns in Canada derived from the SIMSMOKE model with the actual changes in behaviour. <i>"Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking." </i></p><p>(NB: a similar study was undertaken by the same author <a href="https://buyandsell.gc.ca/cds/public/2021/05/03/b02fb6dc4b1a0d816e7017c4f2827d05/1000230021_-_acan_-_simsmoke_english.pdf" target="_blank">under contract with Health Canada</a>, but has not yet been released).</p><p><a href="https://link.springer.com/article/10.1007/s00345-023-04546-1" target="_blank">Bandara NA, Zhou XR, Alhamam A, Black PC, St-Laurent MP. The genitourinary impacts of electronic cigarette use: a systematic review of the literature. World J Urol. 2023 Jul 31. doi: 10.1007/s00345-023-04546-1.</a> </p><p>These Vancouver-based researchers reviewed 28 research articles which looked at the impact of e-cigarettes on bladder cancer and other genitourinary conditions. While identifying the need for more research, they concluded <i>"E-cig use was associated with an increased risk of bladder cancer, increased exposure to carcinogenic compounds, mixed evidence on CKD, increased risk of reproductive disorders and burns to the GU system." </i></p><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10382621/" target="_blank">Struik L, Christianson K, Khan S, Yang Y, Werstuik ST, Dow-Fleisner S, Ben-David S. Factors that influence decision-making among youth who vape and youth who don't vape. Addict Behav Rep. 2023 Jul 17;18:100509. </a></p><p>These researchers interviewed 25 young British Columbians and assessed their approaches to e-cigarette use against a theoretical framework. They found that young peoples' decisions to vape are based on multiple and intersecting factors, and that the school environment encourages vaping in many different ways.</p><p><a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2023/07/11/tc-2023-057932.full.pdf?with-ds=yes" target="_blank">Block AC, Schneller LM, Leigh NJ, Heo J, Goniewicz ML, O'Connor RJ. Heavy metals in ENDS: a comparison of open versus closed systems purchased from the USA, England, Canada and Australia. Tob Control. 2023 Jul 12:tc-2023-057932. </a></p><p>This analysis of certain heavy metals in vaping liquids purchased in Canada in 2017-18 found measurable amounts of Nickel in JUUL products.</p><p><a href="https://link.springer.com/article/10.17269/s41997-023-00790-5" target="_blank">Courtemanche Y, Poliakova N, Muckle G, Bélanger RE. Smoking cessation attempts and successes among Nunavimmiut. Can J Public Health. 2023 Jul 6. </a></p><p>This article reports on the results of a survey of smoking cessation among Nunavimmiut (Inuit community at Ungava bay) </p><p><a href="https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntad167/7256099" target="_blank">Bitar S, Collonnaz M, O'Loughlin J, Kestens Y, Ricci L, Martini H, Agrinier N, Minary L. A systematic review of qualitative studies on factors associated with smoking cessation among adolescents and young adults. Nicotine Tob Res. 2023 Aug 30</a></p><p>This study reviewed 20 years of qualitative research on adolescent smoking cessation, identifying both environmental factors and individual attributes which influence behaviour.</p><p><a href="https://academic.oup.com/eurpub/advance-article/doi/10.1093/eurpub/ckad112/7231930" target="_blank">Watson LK, Weldon I, Lin GO, Nanyangwe-Moyo T, Hoffman SJ, Poirier MJP. Beyond MPOWER: a systematic review of population-level factors that affect European tobacco smoking rates. Eur J Public Health. 2023 Jul 27</a></p><p>This Canadian research team looked at studies of European smoking outcomes to assess both MPOWER and other interventions on population-level smoking. Tobacco interventions that are not identified in the MPOWER framework (like levels of expenditure) and other public policies (like gender equality) were also found to have a positive impact on smoking reduction.</p><p style="text-align: center;"> <b style="background-color: #6fa8dc;">====================================================</b></p><h3 style="text-align: left;"><b style="background-color: white;">Resources</b></h3><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgn01vdWcBw8gQC45pzonKvs24WateViCtxqSzbacRA0F1jKIYqSwha8CBGM5FOhiSNk86O3QkYmJGNdeIqHlpHcUVT41H3o8XvlyWYGD69wie8y5v1sSoIiDD5jft4uygmvMpu8FP9IN0xFXoPLkKrTomxWK_dcZZfUEroveVVJzpThv3q6U4D1YlvVK4/s615/public%20health.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="615" data-original-width="408" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgn01vdWcBw8gQC45pzonKvs24WateViCtxqSzbacRA0F1jKIYqSwha8CBGM5FOhiSNk86O3QkYmJGNdeIqHlpHcUVT41H3o8XvlyWYGD69wie8y5v1sSoIiDD5jft4uygmvMpu8FP9IN0xFXoPLkKrTomxWK_dcZZfUEroveVVJzpThv3q6U4D1YlvVK4/s320/public%20health.jpg" width="212" /></a></div>Public Health Ontario has captured information on <a href="https://www.publichealthontario.ca/-/media/Documents/Y/2021/youth-health-trends-vaping.PDF?rev=9fe6d23a4c9c4be5ac82c12551e9e525&sc_lang=en" target="_blank">youth vaping in an infographic.</a> <div><br /></div><div>It has also compiled a summary o<a href="https://www.publichealthontario.ca/-/media/Documents/O/2020/ontario-tobacco-vaping-cannabis-by-law.pdf?rev=310611df11724440bbe0c4c050cb40aa&sc_lang=en" target="_blank">f Ontario Tobacco, Vaping & Cannabis By-laws. </a><div><br /><p><br /></p><p><br /></p><p><br /></p></div></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-28560616581426034842023-08-17T07:08:00.003-07:002023-08-17T09:10:35.637-07:00Updated estimates of the costs of substance use in Canada (including tobacco)<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH6HUj582b98y49ehlkKTl3BX03dILU0dLkNvExBA8i4ZS4oKWi6VN8ZvXsCmkLIWU7g5GmxI791tdS7xFmJ7gevupitQgbSeVU0YJyfqXUrbWBdmFYaU0UHtjwh0hSk6N3Nd_9YogpwemD-jOuPWG6ZmfzA4W6ixpNS93Y71xIZIM0y1oSTesnDqlQ6s/s441/COSTSANDHARMS.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="441" data-original-width="340" height="279" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH6HUj582b98y49ehlkKTl3BX03dILU0dLkNvExBA8i4ZS4oKWi6VN8ZvXsCmkLIWU7g5GmxI791tdS7xFmJ7gevupitQgbSeVU0YJyfqXUrbWBdmFYaU0UHtjwh0hSk6N3Nd_9YogpwemD-jOuPWG6ZmfzA4W6ixpNS93Y71xIZIM0y1oSTesnDqlQ6s/w215-h279/COSTSANDHARMS.jpg" width="215" /></a></div>In early spring this year updated calculations on the costs of substance use were released by the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institute for Substance Use Research (CISUR). <p></p><p>This post highlights key findings on tobacco-related costs from their report <a href="https://csuch.ca/documents/reports/english/Canadian-Substance-Use-Costs-and-Harms-Report-2023-en.pdf" target="_blank">"Canadian Substance Use Costs and Harms 2007-2020"</a>. </p><p><b>1. Tobacco is responsible for almost one-quarter (22.7%) of the measured costs of substance use in Canada.</b></p><p>In 2020, the health care, lost productivity and other measured costs from tobacco use were estimated to be $11.2 billion. The total for all substance use was estimated to be $49 billion. The only substance with greater overall costs than tobacco was alcohol ($19.7 billion). Opioids came third, with total costs of $7.1 billion.</p><p>Virtually all of the costs of tobacco use were related to healthcare costs ($5.4 billion in 2020), made up of costs for physician time (36%), prescription drugs (34%) and hospitalization (24%). Premature death was responsible for half of the $5.25 billion costs of lost productivity associated with tobacco. </p><p>Healthcare and lost productivity costs include both costs incurred by the individual and those paid by government. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj83CU0Jb8Sw0qEl2FyQX7wBYhm9YsmdlHWBbuqztukJNaPZTG5TRHPso0GzCFJb5JPzxKsYnDrc4V32s4KOAIN6uIkz8G7waQ1dgnOjrXl-HRNXSW4aoSepNTzSLXO6gGiECC9U4FwOutYPcJ2yfV1aWJulAbeBvB4dQfXEbgH0SxoJynjpSaX5uBQ_NM/s842/costs%20of%20substance%20use.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="556" data-original-width="842" height="264" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj83CU0Jb8Sw0qEl2FyQX7wBYhm9YsmdlHWBbuqztukJNaPZTG5TRHPso0GzCFJb5JPzxKsYnDrc4V32s4KOAIN6uIkz8G7waQ1dgnOjrXl-HRNXSW4aoSepNTzSLXO6gGiECC9U4FwOutYPcJ2yfV1aWJulAbeBvB4dQfXEbgH0SxoJynjpSaX5uBQ_NM/w400-h264/costs%20of%20substance%20use.jpg" width="400" /></a></div><br /><p><b>2. Tobacco control efforts have reduced the economic burden of tobacco.</b></p><p>This analysis found that the total (inflation-adjusted) costs of tobacco use are trending down. The per-capita costs had fallen by one-fifth (20%) between 2007 and 2020 - from $365 per person in 2007 to $294 per person in 2020. This reduction was attributed to fewer hospitalizations and deaths. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyf-PmPkMsoZJn27KJqqwdPVxiQEI75xXipG5FMRcxgTejhIjUmY-Z3wCI0zw2OC35psmmiYhD6GNSlVuSyitcRQgIvmZ8mltg6Pp0-GV4LsW0qxhbFOK_fzQoTLisJ-0pSOIlEhy2nx-U0as3ONB84etKTxq3V_iSofh5YmNBbzItbJp-rKOu1y6PcV0/s852/costs%20over%20time.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="336" data-original-width="852" height="158" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyf-PmPkMsoZJn27KJqqwdPVxiQEI75xXipG5FMRcxgTejhIjUmY-Z3wCI0zw2OC35psmmiYhD6GNSlVuSyitcRQgIvmZ8mltg6Pp0-GV4LsW0qxhbFOK_fzQoTLisJ-0pSOIlEhy2nx-U0as3ONB84etKTxq3V_iSofh5YmNBbzItbJp-rKOu1y6PcV0/w400-h158/costs%20over%20time.jpg" width="400" /></a></div><div><br /></div>By contrast, the total costs associated with alcohol increased during this period by one fifth (21%). The analysts attribute the difference to the success of tobacco control policies and programs. <i>"The diverging costs of alcohol and tobacco use may be explained by the presence of strong public health policies designed to curb tobacco use. Examples include package warning labels, increased taxation and advertising restrictions. Fewer equivalent, recently updated policies exist for alcohol." </i><div><p><b>3. Tobacco causes most substance-related deaths</b></p><p>This analysis estimates that 73,994 deaths from substance use occurred in Canada in 2020. Nearly two in three of these deaths were caused by tobacco products (46,366 or 63%), one-quarter by alcohol (17,098 or 23%) and under one-tenth by opioids (6491 or 9%). Only 336 deaths were attributed to cannabis.</p><p>Estimates for overall mortality from tobacco has not varied much over the period of this study, while deaths from alcohol, opioids, cocaine and other CNS stimulants have increased. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggVMmmtCEb5DU0Fk-RjFdxMdayIrJRbGJaxFwOnaioPkFjtpYOl1KvopcTP1MWuNudQa_1SvRnq2eGi79nHREIVBKy5F3uv6CEbncw1XmQcMJJ-ee8a6HO48xzwFwipdhMNIENXNBSUVnQ-ph7Z5iQkY-VIWKgJ2FwTf3hz-MoP1EYJkDJv0jQzTGIdaA/s960/deaths.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="598" data-original-width="960" height="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggVMmmtCEb5DU0Fk-RjFdxMdayIrJRbGJaxFwOnaioPkFjtpYOl1KvopcTP1MWuNudQa_1SvRnq2eGi79nHREIVBKy5F3uv6CEbncw1XmQcMJJ-ee8a6HO48xzwFwipdhMNIENXNBSUVnQ-ph7Z5iQkY-VIWKgJ2FwTf3hz-MoP1EYJkDJv0jQzTGIdaA/w400-h249/deaths.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div>Although the total deaths from tobacco have remained steady over this period, evidence of the impact of tobacco control policy can be seen in the death rates from tobacco, which have fallen significantly. According to the <a href="https://csuch.ca/explore-the-data/" target="_blank">data made available from this study</a>, the actual death rate from tobacco use in Canada has fallen from 144 deaths per 100,000 people in 2007 to 123 in 2020. Eliminating the impact of an aging population by standardizing the death rates shows a decline from 89 to 57 deaths per 100,000 people over the same period of time.</div><div><p><b>4. Because they cause younger deaths, alcohol and opioids cause a greater loss of productive life-years than tobacco.</b></p><p>The success of tobacco control and reduced smoking rates is reflected in the steadily decreasing quantity of life-years lost as a result of early death. This study based its measure of potential years of productive life lost (PYPLL) on the number of deaths occurring up to 65 years of age. (This indicator "<a href="https://data.oecd.org/healthstat/potential-years-of-life-lost.htm" target="_blank">is an explicit way of weighting deaths occurring at younger ages which may be preventable</a>"). One-third of substance use deaths (24,346) occurred before the age of 65, resulting in 345,091 PYPLLs. </p><p>Following the methods used in this study, opioids have recently surpassed alcohol as the substance causing the greatest potential years of productive life lost. Early deaths from the use of these substances was estimated to result in the loss of 104 million years of potential productive life lost for alcohol and 112 million for opioids. For tobacco the estimate was the third greatest loss at 53 million years.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-OlsTg-bV0mBwMzmP_JirrUelzzoSNwlyN9Kw4y1jGpgyd9oDXRhhoguIhkPE6hdnaQivQNK2ZegGDZ28wXHlrrFdy1EV-NpXBPms1UeDo9x4y1lXdHvUPlo8OAYbfomUVPIX5u5ClNb1dA5wlqZMO8iAGLZSkRCoDG-sRggOIDt-LyPn--anWB0OsuA/s925/lifeyears.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="521" data-original-width="925" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-OlsTg-bV0mBwMzmP_JirrUelzzoSNwlyN9Kw4y1jGpgyd9oDXRhhoguIhkPE6hdnaQivQNK2ZegGDZ28wXHlrrFdy1EV-NpXBPms1UeDo9x4y1lXdHvUPlo8OAYbfomUVPIX5u5ClNb1dA5wlqZMO8iAGLZSkRCoDG-sRggOIDt-LyPn--anWB0OsuA/w400-h225/lifeyears.jpg" width="400" /></a></div><br /><b><br />5. Provincial estimates are available</b></div><div><p>Data from the report is online in an interactive form at <a href="https://csuch.ca/explore-the-data/)">https://csuch.ca/explore-the-data/</a>. From this source, estimates for total provincial costs for healthcare and lost productivity are shown to range from $12.7 million (Yukon) to $4 billion (Ontario). Importantly, the analysts were unable to provide estimates for in-patient hospitalizations, day surgeries, emergency department visits or paramedic services in Quebec, which results in a known underestimation of costs for that province. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBECcG8Gh2qJwBEWajKhMHpCYIyQcgFMi_ECW7qlqH5i3TzQZ1HYJd6uBdwoE6vzQxvyFojXFvEsPN1XaLXl_SUQhN1qFpJ_KeuWj0eFxtLepw6SvFoTudjp7V6UlRaesB934kXQjXc19pgYRL25Ao8ldPN2vLfhXmtVLHewjeXIu_pk6Hde75GZSUbFw/s647/provincial.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="353" data-original-width="647" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBECcG8Gh2qJwBEWajKhMHpCYIyQcgFMi_ECW7qlqH5i3TzQZ1HYJd6uBdwoE6vzQxvyFojXFvEsPN1XaLXl_SUQhN1qFpJ_KeuWj0eFxtLepw6SvFoTudjp7V6UlRaesB934kXQjXc19pgYRL25Ao8ldPN2vLfhXmtVLHewjeXIu_pk6Hde75GZSUbFw/w400-h219/provincial.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">Provincial-level estimates of tobacco-caused deaths show, as expected, that most populous provinces have the greatest number of deaths. However, the death rate per 100,000 individuals varied across the country- with the highest rate in Newfoundland (193 deaths per 100,000 people) and the lowest in Alberta (100 deaths per 100,000). </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">When standardized for age, death rates were lowest in British Columbia and Ontario (51 and 53 deaths per 100,000) and highest in the territories (168 in Nunavut and 127 in Northwest Territories per 100,000).</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcpc-9xsbuhkRhWiUNGDYMg-A27Y0mCzudUKvLI02GoGsdTsLeA_VG2GDglxEhhIIImT64iNFuobZvJxQSlbMoco-AP_bjZf-Ief9VVgCqnF-7pxrF8FfrMAjJat6WbgyM1q37KREtjOnyCrdi6Pgb8-6S707B9mlxAHu8IkP9YF2lelzPSohHObAQM3k/s442/deaths2.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="413" data-original-width="442" height="374" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcpc-9xsbuhkRhWiUNGDYMg-A27Y0mCzudUKvLI02GoGsdTsLeA_VG2GDglxEhhIIImT64iNFuobZvJxQSlbMoco-AP_bjZf-Ief9VVgCqnF-7pxrF8FfrMAjJat6WbgyM1q37KREtjOnyCrdi6Pgb8-6S707B9mlxAHu8IkP9YF2lelzPSohHObAQM3k/w400-h374/deaths2.jpg" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">The <a href="https://www.ccsa.ca/" target="_blank">Canadian Centre on Substance Use and Addiction</a> provides extensive information on the methods they used as well as data tables on request. </div><p><br /></p></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-8518499451319025342023-08-01T08:23:00.004-07:002023-08-01T14:06:44.831-07:00Canada performs well, but has not yet reached podium status in WHO's ranking of global tobacco control efforts<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFZ4I1u6UuilAnr6NXAF58FV_mQgVB5lSFFIzOrtm30P9bJQd1HuBdUrD9CAvlQ5Igv53GA4mj7B4dc4I9TneaJkOR0ajQW2zOPHcjNksrmQdtsHDBk7TSkPgrHR5YU4opdiXm3NgjYBIaa9V9CUHPOWx7iM02CMiGTcAgxRmMyrZRZKF4m2BFsL_2W4M/s860/mpowercover.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="860" data-original-width="607" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFZ4I1u6UuilAnr6NXAF58FV_mQgVB5lSFFIzOrtm30P9bJQd1HuBdUrD9CAvlQ5Igv53GA4mj7B4dc4I9TneaJkOR0ajQW2zOPHcjNksrmQdtsHDBk7TSkPgrHR5YU4opdiXm3NgjYBIaa9V9CUHPOWx7iM02CMiGTcAgxRmMyrZRZKF4m2BFsL_2W4M/s320/mpowercover.jpg" width="226" /></a></div><br />This week the World Health Organization and Bloomberg Philanthropies <a href="https://www.who.int/publications/i/item/9789240077164">issued their biennial report card</a> on progress towards the MPOWER tobacco-control goals. <div><br /></div><div>This post highlights findings from the 248-page report that are of particular relevance to Canada.</div><div><br /></div><div><b>The MPOWER measures<br /></b><p></p><p>The MPOWER model was implemented by WHO and the Bloomberg Philanthropies as a way to track the global tobacco epidemic and the impact of measures intended to address it. </p><p>The first report was <a href="https://www.who.int/publications/i/item/9789241596282" target="_blank">made public in 2008,</a> with subsequent reports in <a href="https://www.who.int/publications/i/item/9789241563918" target="_blank">2009</a>, <a href="https://www.who.int/publications/i/item/9789244564264" target="_blank">2011</a>, <a href="https://www.who.int/publications/i/item/9789241505871" target="_blank">2013</a>, <a href="https://www.who.int/publications/i/item/9789241509121" target="_blank">2015</a>, <a href="https://www.who.int/publications/i/item/9789241512824" target="_blank">2017</a>, <a href="https://www.who.int/publications/i/item/9789241516204" target="_blank">2019</a> and <a href="https://www.who.int/publications/i/item/9789240032095" target="_blank">2021</a></p><p>MPOWER focuses on core tobacco control measures that are complementary to, but a subset of, the obligations in the Framework Convention on Tobacco Control. They are:</p><p><i><b><span style="color: #3d85c6;">M - </span></b>MONITOR tobacco use and prevention policies<br /><b><span style="color: #3d85c6;">P - </span></b>PROTECT people from tobacco smoke<br /><b><span style="color: #3d85c6;">O - </span></b>OFFER help to quit tobacco <br /><b><span style="color: #3d85c6;">W - </span></b>WARN about the dangers of tobacco (assessed for pack warnings and mass media)<br /><span style="color: #3d85c6;"><b>E - </b></span>ENFORCE bans on tobacco advertising, promotion and sponsorship<br /><span style="color: #3d85c6;"><b>R - </b></span>RAISE taxes on tobacco.</i></p><p><b>Canada has a high level of achievement in 3</b>½<span face="-apple-system, BlinkMacSystemFont, "Segoe UI Adjusted", "Segoe UI", "Liberation Sans", sans-serif" style="background-color: white; color: #232629; font-size: 15px;"> </span><b>of the MPOWER measures</b></p><p>The World Health Organization ranks Canada among the countries with highest level of implementation for:</p><p></p><ul style="text-align: left;"><li><b>M </b>Monitoring tobacco use (along with 73 other countries)</li><li><b>P </b>Smoke-free environments (along with 73 other countries)</li><li><b>O </b>cessation programs (along with 31 other countries)</li><li><b>W </b>pack warnings (with 102 other countries). </li></ul><p></p><p>Canada was considered to be at the second implementation level for the other objectives:</p><p></p><ul style="text-align: left;"><li><b>W </b>mass media (36 countries do better)</li><li><b>E </b>advertising bans (65 countries do better)</li><li><b>R</b> taxation (41 countries do better)</li></ul><p></p><p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVDHzrokW-1fk3nwKr0iVQBpBLfzBJ13QFFawbH8lgWVcI___o8-ZQKcYwbw1F7bpLfKXcFmb4YMONEumNlNo051UTzi3crCv7KdgV6na-WsVIs-FIhgfY9HOP9NDGSBNeVMLHUpLq3DnRGMt84SxMzCkXZgprcaFJRo5ehgI_WTH3X0ul4qJqV26kvUI/s1192/canada.png" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="291" data-original-width="1192" height="98" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVDHzrokW-1fk3nwKr0iVQBpBLfzBJ13QFFawbH8lgWVcI___o8-ZQKcYwbw1F7bpLfKXcFmb4YMONEumNlNo051UTzi3crCv7KdgV6na-WsVIs-FIhgfY9HOP9NDGSBNeVMLHUpLq3DnRGMt84SxMzCkXZgprcaFJRo5ehgI_WTH3X0ul4qJqV26kvUI/w400-h98/canada.png" width="400" /></a></p><p>Four countries were ranked with highest level achievement in all six measures (Brazil, Turkiye, Netherlands, Mauritius). Other countries with higher overall levels of implementation than Canada are Ethiopia, Iran, Ireland, Jordan, Madagascar, Mexico, New Zealand and Spain.</p><p>This year's report also provided information on related measures. Canada was identified among the 58 countries with highest-level achievement in implementing a national level tobacco control program and among the 87 countries which have regulated electronic nicotine delivery systems (ENDS or e-cigarettes). </p><p>Canada's progress towards the MPOWER goals appears to have stalled over the past 15 years. Compiling score from all nine reports shows that Canada has increased its level of achievement in only one area (mass media) in the past decade, and has failed to implement policies on taxation or public education at the MPOWER standard. Nonetheless, age-standardized adult prevalence as measured by WHO has continued to fall.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzAoEW4C1dudJlrB-j9kRBK1a3paCBc8cbbTRvSUapGCmbj6poFgf42jqgt6qFRNUsnw5g3J_VQhjuZ_NSL99wadjt1bZpzklDZkCQooUo0RJB3aXBU8H05Uw74wBaK1OpBap6cU80xgqVqQLEe_WUuXN29d49W1MbkqqlsWht97tET88uHrOTwUMWgJo/s1292/mpoerhistoric.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="427" data-original-width="1292" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzAoEW4C1dudJlrB-j9kRBK1a3paCBc8cbbTRvSUapGCmbj6poFgf42jqgt6qFRNUsnw5g3J_VQhjuZ_NSL99wadjt1bZpzklDZkCQooUo0RJB3aXBU8H05Uw74wBaK1OpBap6cU80xgqVqQLEe_WUuXN29d49W1MbkqqlsWht97tET88uHrOTwUMWgJo/w400-h133/mpoerhistoric.jpg" width="400" /></a></div><br /><p></p><p><b>Canada's taxes on tobacco are lower than in most other OECD countries.</b></p><p>The World Health Organization recommends that 75% of the purchase price of tobacco products be composed of taxes. Its assessment of tobacco taxes in Canada took note of the varying tax rates across the country, but found that overall taxes represented only 63.3% of purchase price. </p><p>Among the 38 countries with developed economies that are members of the OECD, 23 countries exceeded this target. Canada did not. Canada ranked sixth from the bottom among these countries. (see our Figure using WHO data below)</p><p><b>Canada's daily smoking rate is lower than in most OECD countries</b></p><p>To compare smoking rates across countries, the WHO team made adjustments to account for differences in age distribution and survey methods. </p><p>Traditionally, Canada measures smoking rates by considering only cigarette smoking (and not cigars, pipes, hookah or other forms of smoked tobacco. Smoking rates in Canada are usually stated as 'current smoking', meaning people who smoke on a daily or occasional basis. </p><p>The WHO team found that the age-standardized daily tobacco smoking prevalence in 2022 among people aged 15 or older for Canada was 9%. By way of comparison, <a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1310009601" target="_blank">Statistics Canada estimates</a> are very similar, suggesting 8.4% of Canadians over 12 years of age smoked cigarettes daily in 2021. </p><p>Among the 38 OECD countries, Canada had the fifth lowest smoking rate - as shown below.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoCtt9vKCvxp_jtotsBikZGTzDp8FteYSgr_mtkWEcQsSVHz7ux8vvYjwjF_rFjWyOV44TOY-WMhy10QwSgVUeDNOAHxGAxvD4gp8vSamoEg2cRQV_dqlQlekCcULy94Gu_F_L4k7kC_V3_yieBsIaVB_XJBqP1QItMHe2CKbugMivBs-t80IXlRokRZY/s828/canada.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="828" data-original-width="527" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoCtt9vKCvxp_jtotsBikZGTzDp8FteYSgr_mtkWEcQsSVHz7ux8vvYjwjF_rFjWyOV44TOY-WMhy10QwSgVUeDNOAHxGAxvD4gp8vSamoEg2cRQV_dqlQlekCcULy94Gu_F_L4k7kC_V3_yieBsIaVB_XJBqP1QItMHe2CKbugMivBs-t80IXlRokRZY/w255-h400/canada.png" width="255" /></a></div><br /><p><b>Canada has implemented many - but not all - of the measures WHO recommends for regulating e-cigarettes.</b></p><p>The World Health Organization is increasingly concerned about the marketing of electronic nicotine devices (ENDS) to children, an issue not foreseen when the MPOWER model and the FCTC were first developed. </p><p>In this year's report, for example, the WHO warns that "ENDS are addictive and harmful, particularly for young people", and that "ENDS undermine tobacco control progress and threaten smoke-free environments. The report notes that 121 countries have adopted measures to address these products, with 34 banning the sale of ENDS and 87 countries permitting a regulated market. </p><p> </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQaQnD2D8zwhExTIvKUBepgJRtrhHWtXugqzOmn682PligmJqWKXEo22PQwTriLrMr0QbOHmpwUVNG45AFRhmsHrdkc0VTyO28N79EBJObG87xY8ZbesVFQkSkW6rKTNZvx8cjOnKn85O4rER3BMeheejonDSjwi0822oH5HWSNGUym4BMQn6zdCTZ7AQ/s1167/ends%20ban.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="583" data-original-width="1167" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQaQnD2D8zwhExTIvKUBepgJRtrhHWtXugqzOmn682PligmJqWKXEo22PQwTriLrMr0QbOHmpwUVNG45AFRhmsHrdkc0VTyO28N79EBJObG87xY8ZbesVFQkSkW6rKTNZvx8cjOnKn85O4rER3BMeheejonDSjwi0822oH5HWSNGUym4BMQn6zdCTZ7AQ/w400-h200/ends%20ban.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">From MPOWER report 2023<br />Measures to Regulate ENDS 2022</td></tr></tbody></table><br />Some of the ENDS regulations recommended by the WHO have been implemented in Canada - including bans on using them in public indoor places, workplaces and public transport, requirements for warning labels, bans on sale to minors and taxation. One WHO recommendation that has not yet been implemented across Canada is a ban on flavours.<p></p><p><br /><br /><br /></p></div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.comtag:blogger.com,1999:blog-6472722075252776734.post-83361450316899691952023-07-21T12:32:00.026-07:002023-07-22T07:24:01.303-07:00BAT shoehorns its nicotine pouches onto the Canadian market<p>On Tuesday this week, Health Canada made public its decision to issue a natural health food license to a subsidiary of British American Tobacco. As a result, British American Tobacco has become the first manufacturer to be <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80125630" target="_blank">authorized to market nicotine pouches</a> in Canada.</p><p>This federal license, issued on July 18, 2023, allows BAT/Nicoventures authority to market five flavours of a 4mg nicotine pouch. It also allows the company to advertise these pouches as a way to quit smoking (<i>"help you quit smoking by delivering nicotine to your body, temporarily relieving cravings and nicotine withdrawal symptoms"</i>) and a way for smokers to cope where smoking is banned ("<i>used when you need to temporarily refrain from smoking, for example, around others, in smoke-free areas, airplanes, or in other situations when you wish to avoid smoking."</i>) It permits the pouches to be sold to children (although it advises people under 18 not to use it). </p><p>This post highlights how this development reveals vulnerabilities in Canada's health regulatory approach, and how BAT has been able to use <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/legislation-guidelines/guidance-documents/pathway-licensing-making-modern-health-claims.html" target="_blank">regulatory pathways intended for health product</a>s as a route to market for its addictive consumer products. Although Health Canada has adopted a harm reduction approach to tobacco, it has failed to established a legal framework for this strategy or to be transparent about how nicotine pouches fit into this strategy. Whatever benefits nicotine pouches might offer for public health, allowing British American Tobacco free rein on advertising them is unlikely to achieve a public benefit.</p><p><b style="background-color: #cfe2f3;">Summary</b></p><p>Canadian law does not currently allow for the sale of nicotine pouches, other than as regulated medicines. Over the past five years, BAT and other tobacco companies have launched "modern oral" products as a way to expand their range of nicotine products to overcome reduced cigarette use. Their nicotine pouch is sold under the brand name VELO and is currently available in at least 22 countries. BAT is hoping to expand the market for modern oral tobacco beyond the Nordic countries, including in North America. </p><p>BAT can use its ownership of NRT companies to gain access to therapeutic channels to sell nicotine. BAT acquired Niconovum, which pioneered nicotine pouches for sale as a form of NRT, branded as ZONNIC. Scandinavian countries have authorized ZONNIC as NRT. However, the product authorization issued by Health Canada shows that the ingredients and flavourings in the Scandinavian ZONNIC are different from the product that BAT will sell in Canada. Based on the ingredient list and flavourings, the product approved by Health Canada this week is almost certainly the 4 mg version of their VELO nicotine pouch.</p><p>BAT will face very few restrictions on how it can market ZONNIC nicotine pouches in Canada, other than with respect to how it represents the therapeutic benefits of the product. Under federal law, advertisements will be allowed in all media, and there are no restrictions on the use of lifestyle imagery. Based on historical marketing practices of BAT, we can expect that the product and promotional material will be available in convenience store outlets in most provinces. Provincial governments have the authority to set restrictions on where the product can be sold and how it can be promoted, but few have such measures currently in place.</p><p>Other companies are positioned to start selling nicotine pouches in Canada, and the approval of BAT's application may facilitate their doing so. This development raises questions about the adequacy of Canadian law to protect the public from the marketing strategies of tobacco companies, about Canada's application of Article 5.3 of the Framework Convention on Tobacco Control, and about the need for an integrated nicotine strategy.</p><p><b style="background-color: #cfe2f3;">Canadian law does not currently allow for the sale of nicotine pouches, other than as regulated medicines. </b></p><p>Three federal regulatory systems are in place which control the sale of nicotine products:</p><p><b>1. By default, nicotine is a prescription drug</b></p><p>Under the <i><a href="https://laws-lois.justice.gc.ca/eng/acts/f-27/" target="_blank">Food and Drugs Act</a>,</i> Health Canada establishes which drugs are only available by prescription. Nicotine is currently <a href="https://hpr-rps.hres.ca/pdl.php?lang=en" target="_blank">included on this list</a>, which means nicotine-bearing products can only be sold under prescription unless they are specifically exempted under other laws or regulations. The two current exemptions are tobacco and vaping products (<a href="https://laws-lois.justice.gc.ca/eng/acts/F-27/page-1.html?txthl=tobacco#s-2.3" target="_blank">which are exempted in the legislation</a>) and NRT (which is e<a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/prescription-drug-list/notices-changes/notice-nicotine-salts.html" target="_blank">xempted in the Prescription Drug List</a>). The Prescription Drug List is set by Health Canada at an administrative level.</p><p><b>2. NRT is regulated as a Natural Health Product</b></p><p>Certain NRT delivery-systems qualify as natural health products and are regulated under the <a href="https://laws-lois.justice.gc.ca/PDF/SOR-2003-196.pdf" target="_blank"><i>Natural Health Products Regulations</i></a>. These include gums, patches, lozenges and NRT in "a form to be administered into the oral cavity by means of a non-active device (one that operates on energy generated by the human body or by gravity)." The maximum allowable nicotine per dose is 4 mg, except for patches which can deliver 22 mg per day.<a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/prescription-drug-list/notices-changes/notice-nicotine-salts.html" target="_blank"> These criteria</a> can be changed by Health Canada.</p><p>Manufacturers may not sell NRT products unless they receive authorization from Health Canada. Authorization is given for each product and is contingent on Health Canada being provided with evidence to support safety and efficacy as well as support for health claims. Those products which are authorized are given a Natural Product Number (NPN) which is linked with a specific recommended use and specific risk information and contra-indications. (The <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80125630" target="_blank">NPN for Zonnic pouches is 80125630</a>).</p><p style="border: 0px rgb(225, 225, 225); box-sizing: border-box; font-feature-settings: inherit; font-kerning: inherit; font-optical-sizing: inherit; font-stretch: inherit; font-variant-alternates: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; font-variation-settings: inherit; line-height: inherit; margin: 0.85em 0px; padding: 0px; vertical-align: baseline;">If nicotine were not plant-derived, <a href="https://www.canada.ca/en/health-canada/services/self-care-regulation-non-prescription-drugs.html">NRT products would be regulated as non-prescription drug</a>.</p><p style="border: 0px rgb(225, 225, 225); box-sizing: border-box; font-feature-settings: inherit; font-kerning: inherit; font-optical-sizing: inherit; font-stretch: inherit; font-variant-alternates: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; font-variation-settings: inherit; line-height: inherit; margin: 0.85em 0px; padding: 0px; vertical-align: baseline;"><b>3. Nicotine in Tobacco and Vaping Products is regulated as a recreational drug</b></p><p style="border: 0px rgb(225, 225, 225); box-sizing: border-box; font-feature-settings: inherit; font-kerning: inherit; font-optical-sizing: inherit; font-stretch: inherit; font-variant-alternates: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; font-variation-settings: inherit; line-height: inherit; margin: 0.85em 0px; padding: 0px; vertical-align: baseline;">When nicotine is contained in tobacco or a vaping product, it is regulated under the <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/"><i>Tobacco and Vaping Products Act</i></a>. Products which meet the definitions of this act are exempt from the controls in the Food and Drugs Act, and do not need pre-approval to be marketed. There are many restrictions on how tobacco and vaping products can be promoted and packaged. </p><div> Under this set of laws, the only regulatory path open to BAT to legally market nicotine pouches in Canada is as a natural health product. They are, however, restricted to selling products that contain no more than 4 mg of nicotine per dose.</div><div><br /></div><div><span style="background-color: #cfe2f3;"><b>Over the past five years, BAT and other tobacco companies have launched "modern oral" products as a way to expand their range of nicotine products to overcome reduced cigarette use.</b></span></div><div><span style="background-color: #cfe2f3;"><b><br /></b></span></div><div><div>BAT and other tobacco companies have responded to the gradual reduction in smoking in ways which seek to increase profitability (so profits stay high while volume sales go down), which seek to expand their range of nicotine products (so they retain customers who would use nicotine but who might not smoke cigarettes). They are also expand their operations into other pharmacological substances (using their expertise with drug delivery systems to build a non-nicotine revenue stream). </div><div><br /></div><div>Four years ago, <a href="https://smoke-free-canada.blogspot.com/2019/11/yet-another-novel-nicotine-product-on.html" target="_blank">BAT identified nicotine pouches as "an exciting new space"</a>, and began to manufacture <a href="https://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DO9PQJLD" target="_blank">"modern oral"</a> products by extracting nicotine from tobacco plants and then blending it with bleached tree fiber (cellulose) and flavourings. In addition to giving the impression of being less risky, these nicotine products had the advantage of not being subject to tobacco taxes. (<a href="https://www.smoke-free.ca/SUAP/2020/taxrates-oral.pdf" target="_blank">Taxes on a tin of oral tobacco in Canada are about $20</a>). </div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRQzyBhjvxVJBqVW1ewTD7pArpoOadW-L7SnpoI0bRD-zYkUzcWbQi2BIart9KHNrDWiDL2AZnUQNcBRlftrz-ZcIm8mAgu5vpJJJhvdqERktVGYyCgo8mmu87HzRcSKMzOViFDzN6wxY/s1530/Capture-nov2.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="873" data-original-width="1530" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRQzyBhjvxVJBqVW1ewTD7pArpoOadW-L7SnpoI0bRD-zYkUzcWbQi2BIart9KHNrDWiDL2AZnUQNcBRlftrz-ZcIm8mAgu5vpJJJhvdqERktVGYyCgo8mmu87HzRcSKMzOViFDzN6wxY/w400-h229/Capture-nov2.JPG" width="400" /></a></div><br /><div><br /></div><div><br /></div><div><b style="background-color: #cfe2f3;">BAT's nicotine pouch is sold under the brand name VELO and is currently available in at least 22 countries. </b></div><div><b style="background-color: #cfe2f3;"><br /></b></div><div>Originally called EPOK, LYFT and VELO, BAT h as now branded its nicotine pouches under the VELO trademark.</div><div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div>Over the past 4 years, BAT has expanded its <a href="https://www.velo.com/" target="_blank">marketing of VELO nicotine pouches to 22 countries</a> (17 of which are in Europe). Typically, <a href="https://www.velo.com/gb/en/our-products" target="_blank">these are sold in a dozen or more flavours, and in strengths ranging from 4 mg to 17 mg of nicotine per pouch</a>.</div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTa3xrQVfpAxai3FRQaWVqEatGc-243aGcauZLDS1mkpCy8WtNorhiWVHhBe4-uscZNcCRVHSG4nwtlQJWMk77LCAoindWBm_5fvo93xSYBjactTz1aFou1HVNxXk21tmD6vf4eePF7u5UQLWC9HisdRxOC8cavPL7Kr6hG0kHr8rM4joYO_IVq0JfQxQ/s927/instagram2.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="793" data-original-width="927" height="343" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTa3xrQVfpAxai3FRQaWVqEatGc-243aGcauZLDS1mkpCy8WtNorhiWVHhBe4-uscZNcCRVHSG4nwtlQJWMk77LCAoindWBm_5fvo93xSYBjactTz1aFou1HVNxXk21tmD6vf4eePF7u5UQLWC9HisdRxOC8cavPL7Kr6hG0kHr8rM4joYO_IVq0JfQxQ/w400-h343/instagram2.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.instagram.com/explore/tags/youvegotvelo/" target="_blank">BAT Instagram promotions for VELO</a></td></tr></tbody></table><br /><div><br /></div><div><b style="background-color: #cfe2f3;">BAT is hoping to expand the market for modern oral tobacco beyond the Nordic countries, including in North America.</b> </div><div><br /></div><div>BAT initially focused different alternative-nicotine products in different parts of the world: In Europe and North America, its emphasis has mostly been on vaping products. In the Nordic countries, where snus use was established, it has focused on modern oral. In Japan it has focused on heated tobacco products (its i-glo heated tobacco product was sold for a brief time in Canada). In Central and Eastern Europe the company has been equally focused on heated tobacco and vaping market. (<a href="https://www.bat.com/group/sites/uk__9d9kcy.nsf/vwPagesWebLive/DOCSHH3C/$FILE/medMDCBWKHN.pdf?openelement" target="_blank">BAT, slide 33</a>)</div><div><br /></div><div>This year <a href="https://www.bnnbloomberg.ca/big-tobacco-pushes-nicotine-pouches-as-vaping-hit-by-curbs-1.1908060" target="_blank">it has been reported</a> that in response to additional restrictions on vaping products, BAT and other tobacco companies have increased efforts to include nicotine pouches in their product offerings. Even in countries without an oral tobacco tradition (such as the United Kingdom and Europe), BAT is promoting VELO using lifestyle imagery and messages about as an alternative reduced-risk product. </div><div><br /></div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3flkXKoXIY9ZiiALpQ6mX37_2XhOo3AysIA8J7d6IrHJjUq1UD0UJ8tN01PKJBsokPzWQPppceFe9QqAFUAf-0CKNX2CwIv6UDjMZZPdfgdWSSTcVZ2BFI1rmqaIcZxhW1imkov0WMUbMUMhehEEZowPz1GXPIdD7ne-ehUWMewnRigES4XIu7xL2JQM/s892/global%20distribution.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="608" data-original-width="892" height="272" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3flkXKoXIY9ZiiALpQ6mX37_2XhOo3AysIA8J7d6IrHJjUq1UD0UJ8tN01PKJBsokPzWQPppceFe9QqAFUAf-0CKNX2CwIv6UDjMZZPdfgdWSSTcVZ2BFI1rmqaIcZxhW1imkov0WMUbMUMhehEEZowPz1GXPIdD7ne-ehUWMewnRigES4XIu7xL2JQM/w400-h272/global%20distribution.jpg" width="400" /></a></div></div><p><b style="background-color: #fcff01;"><br /></b></p><div><b style="background-color: #cfe2f3;">BAT and other tobacco companies have bought out independent companies which made nicotine replacement therapies. </b></div><div><b style="background-color: #cfe2f3;"><br /></b></div>Tobacco investments in NRT products include BAT's <a href="https://tobaccotactics.org/article/kind-consumer-limited/" target="_blank">2010 acquisition of marketing rights for VOKE</a> (a nicotine inhaler), Philip Morris International's <a href="https://www.pharmaceutical-technology.com/news/philip-morris-fertin-pharma/" target="_blank">2021 purchase of Fertin Pharma</a>, and the 2023 acquisition by Imperial Brands of the start-up <a href="https://www.imperialbrandsplc.com/media/key-announcements/2023/imperial-acquires-us-nicotine-pouches-range-from-tjp" target="_blank">Canadian nicotine-pouch manufacturer TJP </a>.</div><div><br /></div><div>Preceding these purchases was the <a href="https://www.niconovum.se/" target="_blank">2009 purchase by Reynolds American (RAI) of the Swedish company Niconovum,</a> which developed the ZONNIC brand nicotine pouches and other NRTs. For a time, RAI sold <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-017-0124-3" target="_blank">ZONNIC-brand gum in the United States through convenience channels</a>, and was the first tobacco company to be authorized by the FDA to sell stop-smoking medication. When BAT purchased Reynolds American in 2017, <a href="https://www.niconovum.se/" target="_blank">it also acquired Niconovum.</a> In 2019, <a href="https://journalnow.com/rarticle_0ee59294-8fee-540a-a61b-87abda6174f3.html" target="_blank">ZONNIC gum was withdrawn from the U.S. market. </a></div><div><br /></div><div><div>Although BAT owns Niconovum, it is using a different subsidiary, Nicoventures, to sell ZONNIC in Canada. Nicoventures is the branch of BAT that is responsible for selling VUSE vaping products. Nicotine pouches will not be sold in Canada by a pharmaceutical branch of a multinational conglomerate, but by a company that has a mission to increase nicotine use. </div></div><div><br /></div><div><div><b style="background-color: #cfe2f3;">Scandinavian countries have permitted the use of mint-flavoured 4 mg nicotine pouches as a form of NR, and BAT acquired the company which pioneered that form of NRT. </b></div><p>Although Many governments permit the sale of nicotine pouches, in only a few are they sold with medical claims or as a form of NRT. </p><a href="https://www.niconovum.se/" target="_blank">Niconovum reports</a> that Zonnic pouches are currently sold as NRT in the Nordic countries of <a href="https://www.zonnic.se/nikotinpasar/" target="_blank">Sweden</a>, <a href="https://www.zonnic.no/nikotinposer/" target="_blank">Norway</a>, <a href="https://www.zonnic.fi/" target="_blank">Finland </a>and <a href="https://www.zonnic.se/nikotinpasar/" target="_blank">Iceland</a>. In these countries it is available in only o<a href="https://www.zonnic.se/nikotinpasar/" target="_blank">ne flavour (Mint)</a> </div><div><br /></div><div>The pouch was approved for sale by the Swedish drug authority in 2012 , and an <a href="https://docplayer.net/135452112-Public-assessment-report-scientific-discussion-zonnic-mint-2-mg-oromucosal-powder-in-pouch-nicotine-se-h-1117-01-dc.html" target="_blank">assessment record for that decision is available</a>. The package leaflets which are available from medicine authorities in <a href="https://docetp.mpa.se/LMF/Zonnic%20Mint%204%20mg%20oromucosal%20powder%20in%20pouch%20ENG%20PL_09001be6801a4768.pdf" target="_blank">Sweden</a>, <a href="https://www.legemiddelsok.no/_layouts/15/Preparatomtaler/Spc/12-9263.pdf" target="_blank">Norway, </a> <a href="https://spc.fimea.fi/indox/nam/html/nam/humpil/3/24737283.pdf" target="_blank">Finland</a> and <a href="https://old.serlyfjaskra.is/FileRepos/ed331ee9-cb72-ec11-8111-005056a1b61b/Zonnic_Mint_4mg_Fylgise%c3%b0ill.pdf">Iceland</a> contain information on the regulator's views of the risks and uses of the product, and also the ingredients used.</div><div><div><b style="background-color: #cfe2f3;"><br /></b></div><div><b style="background-color: #cfe2f3;">In Canada, BAT is using the brand name ZONNIC of the Scandinavian-approved pouch NRT but has received Health Canada authority to market a product that has different ingredients and flavourings. </b></div><div><div><p><span style="background-color: white;">The ingredient lists on the Scandinavian package leaflets and the Health Canada authorization show that the ZONNIC product licensed for sale in Canada is not the same as the one licensed for sale in Nordic Countries. Instead, BAT's Canadian natural health product nicotine pouches are made with the same ingredients that they use for the VELO recreational nicotine they sell in other countries.</span></p><p>The following ingredients are listed for ZONNIC in the<a href="https://docetp.mpa.se/LMF/Zonnic%20Mint%204%20mg%20oromucosal%20powder%20in%20pouch%20ENG%20PL_09001be6801a4768.pdf" target="_blank"> package leaflet authorized in Sweden</a> and other Scandinavian countries: <i>Active substance: nicotine - 4 mg; </i><i>Other ingredients: cellulose (microcrystalline), ascorbyl palmitate (E304), trisodium phosphate, acesulfame potassium (E950), aspartame (E951); </i><i>Flavourings: mint flavour</i></p><p>The following i<a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80125630" target="_blank">ngredients for ZONNIC are identified in Health Canada's natural health product database</a>: <i>Medicinal ingredient: 1-Methyl-2-(3-pyridyl)pyrrolidine [nicotine] - 4 mg; </i><i>Non-medicinal ingredient: Microcrystalline cellulose; Propylene glycol; Sodium alginate; Sodium bicarbonate; Sodium chloride; Sucralose; Water; Xylitol; </i><i>Flavourings: Berry flavour; Cranberry flavour; Mint flavour; Spearmint flavour, Topical citrus flavour</i></p></div><div><p>An ingredient list is provided for VELO pouches <a href="https://nicopouches.fr/gb/velo-nicotine-pouches/507-ice-alaska-x-strong-109-mg-3664581022560.html" target="_blank">on some retail websites </a> (although <a href="https://www.bat.com/snus#:~:text=Our%20Modern%20oral%20products%20are,global%20brand%20of%20nicotine%20pouches." target="_blank">BAT's information is less specific</a>). <i><span style="background-color: white;">N</span>icotine; </i><i>Microcrystalline cellulose fibers (E460 (i)), </i><i>propylene glycol (E1520), s</i><i>odium alginate (E401); </i><i>sodium bicarbonate (E500), </i><i>salt (sodium chloride), sucralose (E955), </i><i>water, </i><i>Xylitol (E967); </i><i>Flavors</i></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizoLYHeWSIYf1q1qvq-ASVSYziHZ_UQhIfVqiXo1wefWQyRQkpYu4IN3gWJUbatLDtkpzzKr6UyaDLlF5yY0lrvc16iBjJnapvBgZC_Ill5OLI0pvyzxnbdBy-PTBJRlT0n8vJ-wOTArNP66rOn4RL_I0maABS6ubBMxY-9Nnww-0odTLaCn0KMg9bpEE/s707/ingredients.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="610" data-original-width="707" height="345" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizoLYHeWSIYf1q1qvq-ASVSYziHZ_UQhIfVqiXo1wefWQyRQkpYu4IN3gWJUbatLDtkpzzKr6UyaDLlF5yY0lrvc16iBjJnapvBgZC_Ill5OLI0pvyzxnbdBy-PTBJRlT0n8vJ-wOTArNP66rOn4RL_I0maABS6ubBMxY-9Nnww-0odTLaCn0KMg9bpEE/w400-h345/ingredients.jpg" width="400" /></a></div><br /><i><br /></i><p></p></div><div><p><b style="background-color: #cfe2f3;">Based on the ingredient list and flavourings, the product approved by Health Canada this week is almost certainly a 4mg version of their VELO product.</b></p></div></div><div><p>Health Canada <a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80125630" target="_blank">has authorized BAT/Nicoventures to sell Zonnic in the following five flavours</a>: Polar Mint; Berry Frost; Chill Mint; Cranberry Fizz; Tropic Breeze.</p><p>Some of these flavours - tropic breeze, polar mint - are identical to those sold with VELO in other markets. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_Hptd_BKxvQ42FQxtNKSuDawnsI5OfXt6xWwl__HkIo4kyHOJckEH691wwaRV-SCEN17TG-YVw0WVatFvX7yIYUbL3DFbSZ61_PXU3OGuTGZqZ06S81sAEOct5IM6bLV_1lNDMFF58vBeIt14SHBMCRyVds_t-xsbj3wabC0VlY_csxDu2BZXblDlRio/s1720/velo.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1720" height="209" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_Hptd_BKxvQ42FQxtNKSuDawnsI5OfXt6xWwl__HkIo4kyHOJckEH691wwaRV-SCEN17TG-YVw0WVatFvX7yIYUbL3DFbSZ61_PXU3OGuTGZqZ06S81sAEOct5IM6bLV_1lNDMFF58vBeIt14SHBMCRyVds_t-xsbj3wabC0VlY_csxDu2BZXblDlRio/w400-h209/velo.png" width="400" /></a></div></div><div><br /></div><p><b style="background-color: #cfe2f3;">There are currently very few restrictions on how BAT can market these nicotine pouches in Canada, other than with respect to how it represents the therapeutic benefits of the product.</b></p><p>In Canada, federal law puts severe limits on <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/marketing-drugs-devices/illegal-marketing/prescription-drugs.html" target="_blank">most direct-to-consumer advertising of prescription drugs,</a> as it does for <a href="https://www.canada.ca/en/health-canada/services/smoking-tobacco/regulating-tobacco-vaping/tobacco.html" target="_blank">tobacco and vaping products</a>. There are fewer restrictions on advertising for non-prescription or health products. </p><div><p>As a result, advertisements for BAT's nicotine pouches will be allowed on television, in video-games, in corner stores, on social media and in other places where young people have access.</p></div><div>Health Canada has approved <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/" target="_blank">Guidelines for Consumer Advertising of Health Products</a>. These explain that the constraints that BAT will face in promoting ZONNIC pouches mostly relate to ensuring that the advertising claims are consistent with the license or authorized labelling. </div><div><br /></div><div>Although the<a href="https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80125630" target="_blank"> authorization counsels consumers to not use the product if they are under 18</a> there are no age restrictions on the purchase of natural health products. </div><div><br /></div><div><b style="background-color: #cfe2f3;">Unless there are legal changes, BAT will be allowed to advertise nicotine pouches in all media, with no restrictions on the use of lifestyle imagery, contests, give-aways or other promotions.</b></div><div><br /></div><div>As the <a href="https://www.thrive2quit.ca/en-ca/" target="_blank">Thrive website</a> illustrates, in Canada NRT can be promoted with imagery that convokes "glamour, recreation, excitement, vitality, risk or daring". Such promotions are not allowed for prescription medicines or <a href="https://laws-lois.justice.gc.ca/eng/acts/t-11.5/page-1.html" target="_blank">tobacco or vaping products</a>. </div><div><br /></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJa-IeiU6kwYFD5F6OennIIzp0AbJLTPc6REiRXytnSnSYNSAvnrcdCkDUUgcGLhOg-FHBFHvZ4Fdyjj9ltLIuPmEhpRl-bcsK7JeIJZcqk3RjHiYSBenELSfO7kVWPG0Q8PFgWsIQJnWyd66Vgl5BYGaXuaGIXeJRGc66BgVjDUoLjzJcIFW5V601XLY/s745/thrive.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="522" data-original-width="745" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJa-IeiU6kwYFD5F6OennIIzp0AbJLTPc6REiRXytnSnSYNSAvnrcdCkDUUgcGLhOg-FHBFHvZ4Fdyjj9ltLIuPmEhpRl-bcsK7JeIJZcqk3RjHiYSBenELSfO7kVWPG0Q8PFgWsIQJnWyd66Vgl5BYGaXuaGIXeJRGc66BgVjDUoLjzJcIFW5V601XLY/w400-h280/thrive.jpg" width="400" /></a></div><br /><div><br /></div><div><b style="background-color: #cfe2f3;">Based on historical marketing practices of BAT, we can expect that the product and promotional material will be available in convenience store outlets in most provinces. </b></div><div><b style="background-color: #cfe2f3;"><br /></b></div>BAT has the economic power to distribute and promote nicotine pouches through the <a href="https://www.imperialtobaccocanada.com/group/sites/BAT_AXYKCM.nsf/vwPagesWebLive/DO9T5K3S?opendocument" target="_blank">29,000 retail outlets</a> with which they currently have distribution contracts. </div><div><br /></div><div>Based on the company's recent marketing of vaping devices, likely promotions include signage, introductory pricing, incentives to retailers, free distribution, counter-top and self-service displays.</div><div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3zJ8XUEFnnSUssXkBkZapS03mvtiaAtqVPSjwp7-C86cOmIPr9PjVBXZ5o5Itg5_R-2794TtGyHfIF_jqRYpRnUSMUQRbBrYrfX8IMhIEle6GegYC7Vf_JBGZ2zY6yYU-3z3rJ7-MMxkO8U68WohNb5p5GwNSnV-h9fX-99cVaqSTBYoDfza-ZHbe1wA/s613/vypead.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="382" data-original-width="613" height="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3zJ8XUEFnnSUssXkBkZapS03mvtiaAtqVPSjwp7-C86cOmIPr9PjVBXZ5o5Itg5_R-2794TtGyHfIF_jqRYpRnUSMUQRbBrYrfX8IMhIEle6GegYC7Vf_JBGZ2zY6yYU-3z3rJ7-MMxkO8U68WohNb5p5GwNSnV-h9fX-99cVaqSTBYoDfza-ZHbe1wA/w400-h249/vypead.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.tbdhu.com/blog/youth-vaping-epidemic-haven-t-i-seen-one-before" target="_blank">BAT nicotine promotions identified by TBDHU in 2019</a></td></tr></tbody></table></div><div><br /></div><div><p><b style="background-color: #cfe2f3;">Provincial governments have the authority to set restrictions on where the product can be sold and how it can be promoted, but few have such measures currently in place.</b></p>Provincial governments have <a href="https://www.napra.ca/national-drug-schedules/national-drug-schedules-program/" target="_blank">coordinated their regulations on non-prescription pharmaceutical products</a>, but do not have a coordinated system for natural health products. They do retain authority over retailing, and can impose restrictions on if, how and where nicotine pouches can be sold or promoted. </div><div><br /></div><div>For example, <a href="https://www.legisquebec.gouv.qc.ca/en/document/cr/p-10,%20r.%2012" target="_blank">Quebec regulations do not allow the sale of conventional NRT except in pharmacies</a>, but the wording of the regulation did not anticipate nicotine pouches, and refers only to <i>"chewing gums, inhalers, lozenges or transdermal nicotine replacement patches."</i></div><div><br /></div><div><b style="background-color: #cfe2f3;">Other companies are positioned to start selling nicotine pouches in Canada, and the approval of BAT's application may facilitate their doing so. </b></div><div><b style="background-color: #cfe2f3;"><br /></b></div><div>According to Health Canada officials, more than two dozen applications have been received for market authorization for nicotine pouches, some of which have been refused and some of which are still under review. </div><div><br /></div><div>Those applications which were refused to date failed to provide sufficient evidence that the products were effective as stop smoking aids. Now that the department has accepted the evidence provided by BAT/Nicoventures, the road for other applications will be smoother.</div><div><br /></div><div>Health Canada faces limits in its ability to refuse authorization: companies can (and do) successfully challenge refusals to grant authorization to natural health products.<a href="https://www.torys.com/en/our-latest-thinking/publications/2016/05/health-canada-ordered-to-grant-license-for-resolve" target="_blank"> One of these contested decisions has involved a stop-smoking aid (Resolve).</a> </div><div><br /></div><div><b style="background-color: #cfe2f3;">This development raises questions about the adequacy of Canadian law to protect the public from new nicotine products.</b></div><p>Health Canada has indicated that the results of a clinical trial were submitted with BAT/Nicoventure's application, but further information is not known at this time.</p><p>There has been one published Randomized Clinical Trial of Zonnic as a stop-smoking aid, which was conducted in New Zealand and <a href="https://www.researchgate.net/profile/Simon-Thornley-2/publication/24439215_A_single-blind_randomized_crossover_trial_of_the_effects_of_a_nicotine_pouch_on_the_relief_of_tobacco_withdrawal_symptoms_and_user_satisfaction/links/618048630be8ec17a95d48e6/A-single-blind-randomized-crossover-trial-of-the-effects-of-a-nicotine-pouch-on-the-relief-of-tobacco-withdrawal-symptoms-and-user-satisfaction.pdf" target="_blank">published in Nicotine and Tobacco Research over 14 years ago</a>. The study was paid for by Niconovum,</p><p>This study provides a very slender evidence base on which to permit a new category of nicotine products on the market. It involved only 28 people who agreed to abstain from smoking for three days on each of three occasions: one time using a placebo pouch, another using NRT gum and a third time using Zonnic nicotine pouches. Twenty-one of 28 people abstained from smoking for 3 days using 4 mg Zonnic - a better result than was obtained with 4 mg NRT gum. </p><p>There are no other published clinical trials of ZONNIC or other non-tobacco nicotine pouches as smoking cessation aids currently identified on Pubmed, although there are studies which compare the way the body receives nicotine from pouches with other NRT. The inventor of Zonnic (Karl Fagerstrom) promotes pouches (NP) as a harm reduction product, but recently <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887571/" target="_blank">acknowledged that </a><i>"The NP have so far not been well researched and there are only a few papers published."</i></p><p><b style="background-color: #cfe2f3;">This decision raises questions about Canada's application of Article 5.3 of the Framework Convention on Tobacco Control .</b></p><p>Like the recent <a href="https://www.cbc.ca/news/health/philips-morris-divestment-medicago-1.6700103" target="_blank">Medicago debacle</a>, Health Canada is again caught in the position of licensing medical products manufactured by tobacco companies. As these c<a href="https://exposetobacco.org/wp-content/uploads/STOP-Pharma-Brief.pdf" target="_blank">ompanies expand into medically-regulated products</a>, so does the potential for governments to breach their obligations to protect public health from tobacco industry interference. This is especially relevant with respect to stop-smoking medications, which could permit tobacco companies to engage in public relations efforts to forestall tobacco regulations.</p><p><b style="background-color: #cfe2f3;">This development is a reminder that Canada needs an integrated nicotine strategy.</b></p>As with <a href="https://smoke-free-canada.blogspot.com/2023/04/sesh-another-nicotine-product-hits.html" target="_blank">SESH+ nicotine gum</a>, this stop-smoking product is a sharp reminder that Canada needs an integrated nicotine policy. Health Canada has not yet acknowledged the need for such reforms.<div><br />In the meantime, provincial governments can help by imposing restrictions on the sale and promotion of nicotine pouches that are equivalent to those in place for tobacco and vaping products. Urgently needed are promotional restrictions and bans on sales to minors.</div> Cynthia Callardhttp://www.blogger.com/profile/07990135394250437576noreply@blogger.com