The federal government and some provincial governments, have announced their intentions to further restrict vaping with bans on all non-tobacco flavours in vaping products and/or a 70% reduction of the nicotine cap to 20 mg per mL. Sadly, the predictable result of either restrictions will be the return of a large number of ex-smokers who currently vape back to significantly more toxic combustible tobacco products as well as to considerably decrease the number of current smokers who would otherwise attempt and succeed at switching to a far less harmful source of nicotine.
Vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits over continued smoking.1
- Compared to cigarettes, the aerosols produced by vaping contain 99% less carbonyls (an important group of carcinogens) per puff.2
- The geometric mean urinary NNAL (an important group of carcinogens) is significantly lower (6.3) among e-cigarette users compared to smokers (285.4).3
- A significant improvement in vascular health is observed within 1 month of switching from tobacco to electronic cigarettes, particularly among women.4
- No differences in inflammatory or oxidative stress (which are predictors of cardiovascular and pulmonary illness as well as cancer) can be observed between e-cigarette users and non-smokers.5
Indeed, vaping’s potential to save lives is such that, if all the smokers across the globe who had made at least one attempt to quit smoking between 2008 and 2014 had opted for an electronic cigarette, this might have saved the lives of between 3.1 million to 22.8 million smokers worldwide.6
“It is better to vape than to smoke tobacco, and the former is a legitimate means of cessation of the latter.”
— The honourable Daniel Dumais j.c.s., Association québécoise des vapoteries c. Procureure générale du Québec, Cour supérieure du Québec; mai 2019
Flavours increase successful quit rates
The availability of a wide variety of flavours in vaping products is key to successful tobacco cessation. According to a survey of nearly 70 000 vapers7, the most commonly used flavours at initiation are: 82.8% fruit, 68.6% dessert, and 52.2% candy; tobacco flavour ranks only in 6th place in terms of popularity. It is important to note that this trend is sustained at the critical moment of complete transition from tobacco to vaping.
A study by the Yale School of Public Health found that the odds of cessation for those favoring non tobacco flavors were 2.3 times that of those who used tobacco-flavored e-cigarettes, and was not found to be associated with greater youth smoking initiation.8
Flavours can encourage smokers to transition from tobacco to vaping, and they also serve to prevent relapses. In other words, flavoured vaping products are a gateway out of tobacco use. Conversely, a ban on flavours pushes smokers back to tobacco.9
Reducing the nicotine cap: Heavy smokers will be the biggest losers
Heavy smokers are at far greater risk of tobacco-related illness or death as well as being the most resistant to quitting smoking. Getting the right amount of nicotine is key to successful tobacco cessation, and that is all the more true with heavy smokers.
A study funded by Cancer Research UK concluded that devices containing 20mg per mL were less effective at reducing the urge to smoke than those containing 59mg per mL.10
« [50 mg per mL] should be the floor, not the ceiling… In fact, the pharmacokinetics show that all those doses [20 mg and less] are too low for the average smoker… The goal is to have the nicotine level in the product high and then to minimise the use of the product. »
— Prof Jasjit Ahluwalia, physician and public health scientist at Brown University, Cochrane TAG podcast Let’s talk e-cigarettes, episode 2, January 2021
The high levels of tobacco cessation thanks to vaping are undeniable. For example, a randomized trial of nearly 900 smokers, funded by the National Institute for Health Research and Cancer Research UK, observed that 1 year tobacco abstinence rates among those randomized to electronic cigarettes was 18% compared to only 9.9% among those randomized to a nicotine replacement therapy.11
Indeed, in its most recent review of the scientific literature, the prestigious Cochrane Tobacco Addiction Group found that electronic cigarettes were 69% more effective for tobacco cessation than nicotine replacement therapies such as gums or patches, and that these findings are consistent with population and cohort studies.12
Adult smokers and vapers’ health matters!
A precedent-setting Quebec Superior Court ruling recognized13 that the province’s citizens have a Charter right to access these harm reduction products. This same right must also be recognized for all Canadian citizens throughout the country.