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VAEP Shareables are images utilizing graphics, colour and text to quickly teach people about vaping. Each Shareable provides the reference on the bottom. Save them to your phone or hard drive and share.

Tobacco harm reduction

Tobacco harm reduction

Tobacco harm reduction

Smokers who aren’t willing or simply cannot quit smoking face a future of pain and suffering50. As health professionals, you have a responsibility to help these people with the best available strategies to improve health outcomes51.  
Learn how smokers are made

The biggest myth: there isn’t enough evidence

Health professionals are busy people, working long shifts in high stress environments. We understand that research is the last thing you want to do on your days off. VAEP was developed to make learning about tobacco harm reduction easy for health professionals and the public. This image is a screen shot from a medical data base. The search results for “e-cigarettes or vaping or vape or electronic delivery systems” provided over 22,000 published articles on vaping.
Eliquids are regulated

Keeping harm reduction safe

“If you are a smoker, vaping is a less harmful option than smoking.” Health Canada41. In May 2018, the Tobacco and Vaping Products Act came into effect and regulates eliquid manufacturing42. The government limits what can be put into eliquids to promote safety42.
Myth 2

We don’t know if vaping is less harmful than smoking

The multiple-criteria decision analysis (MCDA) is a decision-making tool that takes into account multiple factors and enables comparison of related subjects. Twelve experts compared sources of nicotine using 14 criteria of harm. Cigarettes are the most harmful source of nicotine at 100%. Vaping was assessed at less than 5% the harm52.
Myth 3

Second hand vapour is dangerous

Over 9000 observations of the constituents of vapour were compared to universally recognized workplace exposure standards known as Threshold Limit Values (TLVs). All constituents were valued at <1% TLV, except two constituents acrolein amd formaldehyde were <5%53. It’s important to note  that acrolein and formaldehyde are normal constituents of exhaled breath54.
Myth 4

Nicotine causes disease

Nicotine is an addictive mild stimulant. It elevates mood, stimulates cognitive function and increases energy55. It’s physiological effects and therefore addictive effects are similar to caffeine56. It is not a carcinogen and without the adjunct chemicals, nicotine presents as less additive than cigarette smoke55. Nicotine is so safe you don’t need a prescription or to be age of majority to buy nicotine patches, gums etc.
Further

The Royal College of Physicians (RCP)

RCP has been an authority in medicine for 500 years. ‘Nicotine without Smoke’, released by RCP in 2016, is a 200+ page report investigating the scientific research on vaping. Some of their key recommendations: “… the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco…in the interests of public health it is important to promote the use of e-cigarettes57…”
Myth 5

Vaping is a gateway to smoking

During the last 6 years, vaping has been mainstream in Canadian society58. This is the first generation of youth that have experimented with vaping58. It is normal adolescent behavour to experiment with adult taboos59. 20% of youth have tried vaping in the last 30 days60. If vaping was a gateway to smoking we would observe an increase in youth smoking prevalence. As per the biennual Canadian Student Tobacco and Drug Survey, grade 12 smoking prevalence has decreased 63% in the last 6 years58,60.
Further

The Canadian Institute for Substance Use Research

at the University of Victoria released in January 2017 ‘Clearing the Air: a systematic review of the harms and benefits of e-cigarettes and vapour devices’61. Tim Stockwell, an investigator on this review, stated: “The public has been misled about the risks of e-cigarettes. Many people think they are as dangerous as smoking tobacco but the evidence shows this is completely false62.”
Myth 6

Flavours are to attract youth

Considering that one in four Canadians are obese, and that alcohol comes in thousands of flavours we can deduce that adults like flavours63. This is why nicotine gum, lozenges and sprays come in flavours64. When smokers are detoxing off the 7000 chemicals found in cigarette smoke and transitioning to just pharmaceutical grade nicotine, pleasing flavours encourage continuation of harm reduction65. Further, the novelty of flavours encourages the continued compliance with vaping65.
Myth 7

Vaping’s ineffective for cessation

Considering that Canadian public health officials have utilized millions of our tax dollars to only oppress tobacco harm reduction by disseminating fear-based narratives about vaping66, the vaping industry has been driven solely by consumer demand; smokers’ demand for an alternative that reduces harm67. If vaping was ineffective it would not exist. From 2015 to 2017, the preferred smoking cessation method for Canadian smokers was vaping at 32% vs 24% with patches and 16% with gum68. In the United States, 54% of successful smoking cessation attempts were with vaping69.
Further

Controlled clinical trials

In 2014, smokers that did NOT want to quit smoking were given eliquid and vape pens (which aren’t as effective at nicotine delivery as the current devices). At 2 months,  34% of the subjects reported smoking cessation. eCO levels decreased significantly and continine (nicotine metabolite) remained the same. At six months, 21% remained exsmokers compared to 6% cessation with patches70.
Myth 8

Approved cessation methods are effective

Prior to vaping, only 2.5% of smokers quit long term even though 52% attempted cessation annually71,72. They had a 4% success rate with cold turkey; 8% success with nicotine replacement therapy (NRT) such as patches or gum; if adjunct counselling was added, success can reach 16%71,73. Smoking cessation methods currently approved by Health Canada have an 84% failure rate at best! Of those successful ‘quitters’ 80% relapsed in the first month74. Psychoactives have adverse effects such as suicidal ideation, violent outbursts, depression and psychotic episodes75.
Myth 9

Vaping is ineffective for smoking cessation

A significant aspect of smoking is the ritualistic behaviour of bringing a smoke to the mouth; tasting the smoke with a drag; feeling sensations in the throat and lungs with a full inhale; and observing the visible exhale76. The behaviour is repeated 240 times a day for a pack-a-day76 smoker; 87,600 times a year! This physical ritual is coupled with an immediate increase in serum chemicals61.  Further, smokers are proficient at maintaining therapeutic nicotine serum levels through inhalation77. Vaping uniquely satisfies this ritual and provides nicotine through the same route76.
Myth 10

Dual user isn’t quitting smoking

Utilizing vaping to transition from the most addictive product in Canada to nicotine-free is a process consisting of 4 stages61. The first stage is dual use which is when the smoker becomes familiar with how to use their vaping device to achieve therapeutic nicotine serum levels61. This may include trying different devices and eliquids to find what is right for them78. Stage two is smoking cessation and continued vaping61. Invariably, after a few months to adjust to the decrease of serum chemicals, vapers decrease their nicotine dose and some then titrate off of nicotine completely61.

Listen to the experts

Quotes from those that have done the research

“The most important

toxins in cigarette smoke are missing – those that remain are orders of magnitude lower.” Dr. Konstantinos Farsalinos

“Vapers should

be more concerned of the air they breathe in polluted cities rather than their vaping!” Dr. Riccardo Polosa

“Saying e-cigs

are 95% safer is not a medical claim, it’s a truth.” Professor Hajek

“People smoke

for nicotine but they die from the tar.” Professor Michael Russell, 1976

Dr. Konstantinos Farsalinos

“The most important toxins in cigarette smoke are missing – those that remain are orders of magnitude lower.”

Riccardo Polosa

“Vapres should be more concerned of the air they breathe in polluted cities rather than their vaping!” Dr.

Professor Hajek

Saying e-cigs are 95% safer is not a medical claim, it’s a truth.” 

Professor Michael Russell, 1976

“People smoke for nicotine but they die from the tar.” 

50. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette.

51. Canadian Nurses Association. (2017). Code of ethics for registered nurses.

52. Nutt, D. J., Phillips, L. D., Balfour, D., Curran, H. V., Dockrell, M., Foulds, J., Fagerstrom, K., Letlape, K., Milton, A., Polosa, R., Ramsey, J., & Sweanor, D. (2014). Estimating the harms of nicotine-containing products using the MCDA approach.

53. Burstyn, I. (2014). Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks.

54. Filipiak, W., Ruzsanyi, V., Mochalski, P., Filipiak, A., Bajtarevic, A., Ager1, C., Denz1, H., Hilbe W., Jamnig, H., Hackl, M., Dzien, A., & Amann, A. (2012). Dependence of exhaled breath composition on exogenous factors, smoking habits and exposure to air pollutants.

55. Laugesen, M. (2013). Nicotine and health. New York, NY: American Council on Science and Health.

56. Royal Society for Public Health. (2015). Nicotine “no more harmful than caffeine”.

57. Royal College of Physicians. (2016). Nicotine without smoke: Tobacco harm reduction: A report by the Tobacco Advisory Group of the Royal College of Physicians.

58. Government of Canada. (2015). Canadian Student Tobacco, Alcohol and Drugs Survey.

59. Jackson, C. A.,  Henderson, M., Frank, J. W., Haw, S. J. (2012). An overview of prevention of multiple risk behaviour in adolescence and young adulthood.

60. Government of Canada. (2019). Canadian Student Tobacco, Alcohol and Drugs Survey.

61. O’Leary, R., MacDonald, M., Stockwell, T., & Reist, D. (2017). Clearing the Air: A systematic review on the harms and benefits of e-cigarettes and vapour devices. Victoria, BC: Centre for Addictions Research of BC.

62. University of Victoria: UVic News. (2107). Clearing the air around e-cigarettes. Retrieved Feb. 19, 2020 from https://www.uvic.ca/news/topics/2017+e-cigarettes-carbc-macdonald-stockwell+media-release

63. Statistics Canada. (2017). Canadian Health Measures Survey.

64. Aslani, A., & Rafiei, S. (2012). Design, formulation and evaluation of nicotine chewing gum.

65. Russell, C., McKeganey, N., Dickson, T., & Nides, M. (2018). Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA.

66. Government of Canada. (2019). The risks of vaping.

67. Institute of Economic Affairs. (2013). Free market solutions in health: The case of nicotine.

68. Government of Canada. (2017) Canadian Tobacco, Alcohol and Drugs Survey (CTADS).

69. Farsalinos, K., Polosa, R., Cibella, C., & Niaura, R. (2019). Is e-cigarette use associated with coronary heart disease and myocardial infarction? Insights from the 2016 and 2017 National Health Interview Surveys.

70. Adriaens, K., Van Gucht, D., Declerck, P., & Baeyens, F. (2014). Effectiveness of the electronic 
cigarette: An eight-week Flemish study with six-month follow-up on smoking reduction, 
craving and experienced benefits and complaints.

71. Nides, M., Leischow, S.J., Bhatter, M., & Simmons, M. (2014). Nicotine blood levels and short-term smoking reduction with an electronic nicotine delivery system.

72. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette.

73. Shahab, L., Brose, L.S., & West R. (2013). Novel delivery systems for nicotine replacement therapy as an aid to smoking cessation and for harm reduction: Rationale, and evidence for advantages over existing systems.

74. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette.

75. Institute for Safe Medication Practices. (2008). QuarterWatch Report: Strong Safety Signal Seen for Chantix (Varenicline).

76. Dawkins, L. (2013). Why is it so hard to quit smoking?

77. Farsalinos, K., Spyrou, A., Tsimopoulou, K. et al. Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices.

78. Farsalinos, K., Spyrou, A., Stefopoulos, C. et al. Nicotine absorption from electronic cigarette use: comparison between experienced consumers (vapers) and naïve users (smokers).

Square Shareables

Education

Education

You have a right to make informed decisions

Learning sections

Quickly gain comprehensive understanding of the major areas in vaping. Sections consist of several pages, each on a  specific topic. You choose which topics you want to learn about.

Basic Vaping Info

Learn from the science, everything you need to know about vaping as a harm reduction strategy. This section covers cigarettes, quitting smoking , tobacco harm reduction, vaping outcomes, flavours and nicotine.

Vaping & Lung Injuries

From August to September 2019, an outbreak of vaping related lung injuries occurred in the USA. The cause was illegal THC cartridges and had nothing to do with vaping nicotine. Authority and media did not tell the truth.

Shareables

Dozens of images on key concepts to share on social media.
Explore

Currently under renovations

Health Professionals

If, despite your efforts to help your smoking patients, smoking cessation is not being achieved, the next best strategy for your patient is harm reduction. We invite you to look at the credible evidence to ensure best practice.

Adolescents and Adult Activities

It’s normal teenage behaviour to experiment with adult taboos. This is the first generation to encounter vaping. We explore the reasons youth try vaping, the consequences and unintended harm reduction in regards to smoking uptake.

Cigarettes

Cigarettes

Cigarettes

The most deadly form of nicotine

VAEP Shareables are images utilizing graphics, colour and text to quickly teach people about vaping. Each Shareable provides the reference on the bottom. Save them to your phone or hard drive and share.

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The reality

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Smoking kills

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Smoking is everyone’s problem

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Youth and smoking

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Gov’t and MSA payments

Gov’t and MSA payments

State governments & the MSA

On November 23, 1998, all but 4 states entered into the Master Settlement Agreement with the 4 big tobacco companies.

 

The tobacco companies committed to pay out around $200 billion over twenty years to the state governments… based on annual cigarette sales.

Money.

Vaping has been proven successful at getting smokers off of cigarettes and keeping them off.

If smoking rates drop because of vaping then the states get less money.

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In the first section of the MSA, this agreement was made “to avoid the further expense, delay , incovenience, burden and uncertainty of continued litigation” by the state against the tobacco industry for expenses occured to Medicaid as a result of smoking.

Unfortunately, the MSA did not make provisions for how the MSA money is to be spent.

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Since the 4 tobacco giants entered an agreement to pay the state though the MSA, other tobacco companies are to be penalized by the state for doing business. So, since vaping helps smokers get off of cigarettes (which would lower MSA payments) the states catigorized vaping as tobacco.

Vaping is no more tobacco than vitamin C is an orange.

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Some of the state governments issued bonds based on the projections for future MSA payments. Unfortunately, they underestimated the rate at which smokers would stop smoking which means the payments were lower than they banked on. Those payments were short to pay the bonds when due.

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MSA backed bonds at risk for default

The S & P securities ratings assessed the immerging vaping industry as reducing the amount of smokers. Therefore they anticipated a drop in cigarette sales and the amount of MSA payouts. This means the governments that issued the bonds would have to find money elsewhere to pay them out when due.

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What went wrong in the USA

What went wrong in the USA

What went wrong in the USA

During the investigation into the cause of EVALI, governments, health-related nonprofits, health authorities, medical professionals, anti-smoking groups and media repeatedly claimed that vaping was injuring people without specifying that the injuries were caused from illegal THC cartridges.

Over and over again, they included nicotine eliquid in their conversations, statements and announcements. A false narrative that blamed tobacco harm reduction (vaping nicotine eliquid) for the lung injuries spread throughout the public and the health community.

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For over 20 years, RealClearPolicy has been reviewing US domestic policy and analyzes “the most pivotal information on the day’s need-to-know issues”. They reviewed how the CDC handled EVALI in their article titled, Heads Should Roll at CDC after Botched Vaping Investigation.

Filter is a nonprofit, their mission is to …”advocate through journalism for rational and compassionate approaches to drug use, drug policy and human rights”. Their critique of how CDC handled EVALI is titled, Vapes and Lung Disease: The CDC’s Lesson in How Not to Handle an Illness Outbreak.

Expert warnings

Expert warnings

Expert warnings from the UK

Since the 2016 publication of Nicotine Without Smoke, UK health authorities have been promoting vaping as a smoking cessation aid for their citizens.

 

Scientists, health authorities and doctors in the UK issued statements and reports to help people see the deception about the 2019 vaping related lung injuries (EVALI).

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Repeated fear provoking narrative

The pervasive message in North America is that we have to ban vaping because their is a ‘youth vaping epidemic’.

In Great Britain, vaping is recognized as a significant harm reduction strategy and is promoted by their public health. Yet, less than 2% of 11-18 year olds vape more than once a week.

WHERE is the youth vaping epidemic in Great Britain?

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Youth experiment with adult activities, this is why 52% vaped “to give it a try”. Cigarette smoke is far more addictive than nicotine vapour and far more harmful. Since smoking tastes gross, perhaps the flavours in eliquid are preventing them from becoming smokers.

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CALL TO ACTION

Australasian Professional Society on Alcohol and other Drugs wrote a referenced paper about EVALI. It is the perfect document to enlighten health professionals about how they have been deceived about tobacco harm reduction.

Canada gov’t THC cartridges

Canada gov’t THC cartridges

Canada gov't THC cartridges

The Canadian federal government controls the sale of cannabis products and taxes the sales.

 

On October 19, 2020, during the EVALI outbreak, THC cartridges were approved for sale. The fact that EVALI was caused by illegal THC cartridges could have an adverse effect on legal THC cartridges sales revenue.

Nicotine eliquid was blamed.

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Due to the deception that nicotine vaping was the cause of EVALI, sales of the new cannabis products were not interupted but how many vapers switched back to the most lethal form of nicotine: tobacco cigarettes?

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What went wrong in Canada

What went wrong in Canada

What went wrong in Canada

During the investigation into the cause of EVALI, governments, health-related nonprofits, health authorities, medical professionals, anti-smoking groups and media repeatedly claimed that vaping was injuring people without specifying that the injuries were caused from illegal THC cartridges.

Over and over again, they included nicotine eliquid in their conversations, statements and announcements. A false narrative that blamed tobacco harm reduction (vaping nicotine eliquid) for the lung injuries spread throughout the public and the health community.

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What happened

What happened

What happened

Suddenly, there were hundreds of cases of severe lung injuries in areas around the USA. All the patients had vaped.

Yet, millions of smokers had been vaping nicotine for more than a decade without any cases of these lung injuries.

In August of 2019, the Centers for Disease Control and Prevention (CDC) announced they were investigating an outbreak of lung injuries.

Over 2800 cases were identified, causing 68 deaths in the USA; in Canada there were 19 cases and no deaths.

76% of the patients were under 35 and 66% were male.

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Vaping nicotine eliquid is a harm reduction strategy used by millions of smokers all over the world. Since the injuries only occurred in North America, it was clear the injuries were being caused by something other than standard nicotine eliquid.

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Almost 100% of the injured patients reported using illegal THC cartridges. Despite the evidence, the injury was named EVALI (E-cigarette or Vaping product use-Associated Lung Injury) implying the cause was nicotine eliquid.

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To identify the substance causing the injuries, lung samples from the patients were analyzed. The fat based substances identified as causing the injuries can not be disolved in nicotine eliquid because they would separate in the container.

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Vaping products used were analyzed

The patients submitted the products they were vaping to help identify the cause of the injuries. Nicotine eliquids contained no unexpected or harmful chemicals but 9 out of 10 illegal THC carts contained vitamin E acetate which is used as a cutting agent.

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More on what happened

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Basic Vaping Info

Basic Vaping Info

Basic vaping information

The facts will surprise you

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This 30 second video explains the  epidemic that is related to vaping.

Learn how vaping compares to smoking in this two minute video.

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Pages in this section:

Smoking is the most preventable cause of disease and death in North America.

Vaping satisfies the habit of smoking without the devastating consequences.

The simple ingredients in eliquid have been thoroughly analyzed for safety.

By reducing the toxins that enter the body, health has been shown to improve.

The transition to harm reduction is easier if it is pleasurable.

Nicotine is a stimulant that can cause dependency but does not cause disease.

Start here:

Flavours

Flavours

Flavours

Adults like flavours

VAEP Shareables are images utilizing graphics, colour and text to quickly teach people about vaping. Each Shareable provides the reference on the bottom. Save them to your phone or hard drive and share.

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Essential to success

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Harm promotion

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Nonprofits benefit from smoking-related diseases

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Youth and flavours

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Youth are seeking a head buzz from abusing JUULs by inhaling too much nicotine. Teens call it a “heady” and 8.3% of grade 8-12 students are “JUULing” to get high. JUUL has less than 5 flavours. Banning 1000’s of eliquid flavours will make harm reduction unattractive to adult smokers.

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Outcomes

Outcomes

Outcomes

Reducing harm improves health.

VAEP Shareables are images utilizing graphics, colour and text to quickly teach people about vaping. Each Shareable provides the reference on the bottom. Save them to your phone or hard drive and share.

Health improvements

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Smokers are profitable for pharmaceuticle companies

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Smokers get smoking-related diseases that are treated with drugs. Future smokers are future revenue for BigPharma. Youth are experimenting with vaping instead of smoking which means they won’t become smokers and get those smoking-related diseases. Agencies that are funded by BigPharma are pushing to ban vaping.

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Cancer

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Junk science

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Youth and industry

Commercial industries aren’t responsible to the stupid stuff youth do. Youth abuse alcohol & drugs. Yet, alcohol and pharmaceutical industries aren’t being held responsible for teen alcohol and drug abuse. Youth are also abusing vaping. The vaping industry aren’t responsible for teens abusing vaping.

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Mom and Pop vape shops were started by people who quit smoking with vaping. They quit their careers and invested their savings into their own businesses to help smokers in their communities. The are small businesses employing local people,  NOT tobacco companies. Misinformation from media & authority have demonized them and turned their communities against them.

Nicotine

Nicotine

Nicotine

A mild stimulant, much like caffeine

VAEP Shareables are images utilizing graphics, colour and text to quickly teach people about vaping. Each Shareable provides the reference on the bottom. Save them to your phone or hard drive and share.

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More on nicotine

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view full feature

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Nicotine and fear

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Tobacco smoke has 7000 chemicals in it, many of which cause damage to the body. This fear-provoking message from Health Canada suggests that all smokers have some kind of brain damage. How is it that they can identify nicotine as the cause and not the 7000 toxins found in cigarette smoke?

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Health Canada claims vaping “can” cause lung damage. They provide no evidence to support this speculation. Health Canada “can” deceive the public about harm reduction. They “can” have a motive to promote disease and serve the pharmaceutical industry.

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Quitting smoking

Quitting smoking

Quitting smoking

Vaping makes it easier

VAEP Shareables are images utilizing graphics, colour and text to quickly teach people about vaping. Each Shareable provides the reference on the bottom. Save them to your phone or hard drive and share.

Using vaping to quit smoking

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How vaping works

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Why are people vaping?

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Medical smoking cessation

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Youth and smoking uptake

Eliquid contains 4 ingredients and only the nicotine can cause dependence. The chances of a youth becoming a smoker is 20 times higher if they start their experimentation with smoking verses with vaping. Vaping is interrupting the historical process of creating smokers.

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Vaping

Vaping

Vaping

Less than 5% the risk of smoking

VAEP Shareables are images utilizing graphics, colour and text to quickly teach people about vaping. Each Shareable provides the reference on the bottom. Save them to your phone or hard drive and share.

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Harm reduction

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Government oversight

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Indoor vaping

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Youth and vaping

In Great Britain, vaping is recognized as a significant harm reduction strategy and is promoted by their public health. Yet, less than 2% of 11-18 year olds vape more than once a week. WHERE is the youth vaping epidemic in Great Britain?

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To compare statistical data from year to year, the parameters of that data must remain the same. The Government of Canada changed the parameters of youth vaping data which falsely inflates the numbers and perpetuates the fear-provoking narrative.

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This documentary investigated vaping during the height of the media frenzy to demonize vaping. It offers a comprehensive, indepth look at tobacco harm reduction.

view full feature

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This documentary investigated vaping during the height of the media frenzy to demonize vaping. It offers a comprehensive, indepth look at tobacco harm reduction.

view full feature

current context

current context

The current context

The current resistance about tobacco harm reduction is a familiar reaction.

A similar response occurred during the AIDS crisis in the 1980’s.

The rhetoric at that time was that distributing condoms would encourage youth to become promiscuous28.

Canadian Nurses Association harm reduction resources

Stay current in the credible evidence

Tobacco harm reduction hx

The neo-prohibitionist approach to smoking is “Quit smoking or suffer and die from smoking-related diseases.” All innovative products under this precautionary principle are oppressed which supports the tobacco industry by denying the population safer alternatives and supports the pharmaceutical industry by promoting the incidence of smoking-related diseases. About 95% of unaided smoking cessations attempts end in failure and attempts with nicotine replacement therapies (NRTs) have <10% success rate at six months29.

Snus is an oral tobacco product processed via fermentation which removes the tobacco-specific nitrosamines (the carcinogens found in tobacco). Due to pressure from public health groups, in 1992, the sale of snus was prohibited in the European Union (EU) despite the EU’s acknowledgement that snus is not a carcinogen. Sweden obtained an exemption to allow their smoking citizens a harm reduction option29.  As a result, Sweden has the lowest smoking rates and the lowest rates of lung cancer in the EU. It’s notable that 13% of Swedish men are smokers compared to an average 29% of men in the EU. Further, Sweden has the lowest rate of tobacco-related mortality even though Sweden consumes the same amount of tobacco by weight as other countries29.

This is an example of the efficacy and sensibility of tobacco harm reduction (THR). History also illustrates the oppression of tobacco harm reduction by authority29.

nicotine eliquid didn’t cause lung injuries

The recent outbreak of vaping-related lung injuries were a result of  illegal THC (cannabis) cartridges used in vaping devices30,31,32. Vitamin E acetate has been identified as the primary causative agent33,34.

During the outbreak, misisnformation was spread by media and health authorities. Click the link below and learn more from a letter released by the Australasian Professional Society on Alcohol and other Drugs35.

Outbreak named EVALI

E-cigarette or Vaping Product Use-Associated Lung Injury

People have been vaping in the USA for over 10 years without lung injury outbreaks36. In the summer of 2019, a sudden  outbreak of severe lung injuries occurred in North America, mainly the USA. Over 2800 cases were identified, causing 68 deaths30.

Absence of infection37

Hx of recent vaping

Age of patients (median 23):
15% under 18 years old
37% 18-24 years old
24% 25-34 years old
24% 35+ years old30

Patients presented with a nonproductive cough, shortness of breath, tachycardia, and fever38.

Investigations

Labs and interviews

58 American EVALI patients were interviewed; 91% reported using illegal THC cartridges39. 51 lung fluid samples of lung injured patients tested positive for fat based substances used in THC cartridges: 48 vitamin E acetate, 1 coconut oil, 1 limonene (a “terpene” found in cannabis)40.

EVALI quickly declined

Law enforcement responded

44 websites were seized that were advertising the sale of illegal THC cartridges41. Millions of dollars worth of THC concentrates and cartridges were seized from illegal operations in Wisconsin and Minnesota42, 43.

Commercial nicotine eliquid

Federal regulations

Ingredients in nicotine eliquids have been restricted by Canadian government regulations since May 201844. Lipophilic ingredients are not allowed in commercial nicotine eliquids44. Nicotine eliquid is an aqueous solution and lipids won’t dissolve in it45.

THC cartridges in Canada

Government controlled

THC cartridges were approved for sale in Canada October 19, 2019 during the lung injury outbreak46. Of the 19 Canadian patients with EVALI, 11 reported they only vaped nicotine (many during a time when THC cartridges were illegal)47. Neither toxicology screens nor lung fluid biopsies were performed to confirm patients’ self-reporting47.

Experiment with mice

Vitamin E Acetate aerosols

In this experiment, two controls were used: air and standard eliquid base of propylene glycol/vegetable glycerine blend. Mice exposed to the vitamin E acetate aerosols presented with signs consistent with EVALI48.

Wide-spread misinformation

Discouraged harm reduction

Public Health England, March 2020:

“The mistaken belief that e-cigarettes are more harmful than smoking increased rapidly among UK smokers following the US lung injury outbreak in autumn 2019.”49

Listen to the experts

Quotes from those that have done the research

“The burden of proof

is on the regulatory agency to
demonstrate that the product is unreasonably dangerous for its intended use…electronic cigarette prohibition will do harm to hundreds of thousands
of vapers already using electronic cigarettes in place of tobacco ones – a clear violation of nonmaleficence.”

Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or past mistakes? (2010) Cahn, & Seigel

 

“Current state of knowledge

about chemistry of liquids and
aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable
exposures to contaminants of the aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces.”

Peering through the mist: Systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. (2014) Burstyn.

“Even if there are longterm

vapers, this is not a problem, as long as they quit smoking. The problem is combusted tobacco, not nicotine. At the dosage  used by vapers or users of nicotine gums or patches,  nicotine is not toxic. Long term vaping is not a public health problem; not any more than long term use of nicotine  gums.”

Dr Jean-François Etter

“None of the toxicological

testing conducted in E-cigs has shown that users or bystanders are exposed to harmful levels of toxins or carcinogens. E-cigs eliminate exposure to the smoke toxicants responsible for nearly all smoking-related diseases.”

A fresh look at tobacco harm reduction: The case for the electronic cigarette. (2013) Polosa, Rodu, Caponnetto, Maglia, & Racitti

“The burden of proof

is on the regulatory agency to demonstrate that the product is unreasonably dangerous for its intended use…electronic cigarette prohibition will do harm to hundreds of thousands of vapers already using electronic cigarettes in place of tobacco ones – a clear violation of nonmaleficence.”

Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or past mistakes? (2010) Cahn, & Seigel 

“Even if there are longterm

vapers, this is not a problem, as long as they quit smoking. The problem is combusted tobacco, not nicotine. At the dosage  used by vapers or users of nicotine gums or patches,  nicotine is not toxic. Long term vaping is not a public health problem; not any more than long term use of nicotine  gums.”

Dr Jean-François Etter

“Current state of knowledge

about chemistry of liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures to contaminants of the aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces.”

Peering through the mist: Systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. (2014) Burstyn.

“None of the toxicological

testing conducted in E-cigs has shown that users or bystanders are exposed to harmful levels of toxins or carcinogens. E-cigs eliminate exposure to the smoke toxicants responsible for nearly all smoking-related diseases.”

A fresh look at tobacco harm reduction: The case for the electronic cigarette. (2013) Polosa, Rodu, Caponnetto, Maglia, & Racitti

Facilitate informed decision making

Your patients’ lives depend on it

In the next section we look at the current false narratives about nicotine vaping and offer evidence to help you make informed decisions.

 

28. Sellers, D., McGraw, S., & McKinlay, J. (1994). Does the promotion and distribution of condoms increase teen sexual activity? Evidence from an HIV prevention program for Latino youth.

29. Institute of Economic Affairs. (2013). Free market solutions in health: The case of nicotine.

30. Centers for Disease Control and prevention. (2020). Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Updated February 25, 2020.

31. FDA. (2019). Vaping Illness Update: FDA warns public to stop using tetrahydrocannabinol (THC)-containing vaping products and any vaping products obtained off the street.

32. Utah Department of Health. (2019). Vaping-related lung injury, Utah, 2019: Investigation to date updated September 30, 2019.

33. Duffy, B.; Li, L.; Lu, S.; Durocher, L.; Dittmar, M.; Delaney-Baldwin, E.; Panawennage, D.; LeMaster, D.; Navarette, K.; Spink, D. (2019). Analysis of cannabinoid-containing fluids in illicit vaping cartridges recovered from pulmonary injury patients: Identification of vitamin E acetate as a major diluent.

34. Blount, B., Karwowski, M., Shields, P., Morel-Espinosa, M., Valentin-Blasini, L., Gardner, M., Braselton, M., Brosius, C., Caron, K., Chambers, D., Corstvet, J., Cowan, E., et al., (2019). Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI.

35. Australasian Professional Society on Alcohol and other Drugs. (2020). Miscommunication about the causes of the US outbreak of lung diseases in vapers by public health authorities and the media.

36. Public Health England. (2019). Vaping and lung disease in the US: PHE’s advice.

37. M. Perrine CG, Pickens CM, Boehmer TK, et al. Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:860–864.

38. J. Schier JG, Meiman JG, Layden J, et al. Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance. September 6, 2019 MMWR Morb Mortal Wkly Rep 2019;68:787–790

39. A. Taylor J, Wiens T, Peterson J, et al. Characteristics of E-cigarette, or Vaping, Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement — Minnesota, 2018 and 2019. MMWR Morb Mortal Wkly Rep 2019;68:1096-1100.

40. B. Blount, B.C., Karwowski, M.P., Shields, P.G. et al. (2020). Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI.

41. C. US Food and Drug Administration. (2019). FDA, DEA seize 44 websites advertising sale of elicit THC cartridges to US consumers as part of Operation Vapor Lock.

42. D. ABC News. (2019). Sheriff details charges against brothers accused of running THC vape ring.

43. E. ABC News. (2019). Minnesota police seize over 75,000 THC vaping cartridges in record bust.

44. Government of Canada. (2018). Tobacco and Vaping Products Act.

45. F. Campagna, D., Amaradio, M.D., Sands, M., & Polosa, R. (2016). Respiratory infections and pneumonia: potential benefits of switching from smoking to vaping.

46. Government of Canada. (2019). Backgrounder: Final regulations on new cannabis products.

47. H. Government of Canada. (2019). Vaping-associated lung illness.

48. K. Bhat, T.A., Kalathil, S.G., Bogner, P.N., Blount, B.C., Goniewicz, M. L., & Thanavala, Y.M. (2020). An animal model of inhaled vitamin E acetate and EVALI-like lung injury.

49. L. Public Health England. (2020.) False fears preventing smokers from using e-cigarettes to quit.

Bioethics

Bioethics

Bioethics

 

Patients are a vulnerable population79.

They trust health professionals with their health, well being and their lives.

They deserve to know all their options.

 

Advocate for utilization of harm reduction

From first year of post-secondary education, health professionals are trained to trust “credible sources” such as health-related nonprofits, health authorities, regulatory bodies and internal information sources in the work place. Health professionals trust that the information that comes from credible sources are unbiased, accurate, and ethical79.

However, in reference to the Syphilis Study at Tuskegee, health professionals are required to think critically and challenge unethical practices80. This study, from 1932 to 1972, recorded the untreated effects of syphilis in 399 males against a control of 201 uninfected men. Subjects were poor and illiterate. They were not informed that they had syphilis, nor were they offered penicillin when it was found to be an effective treatment in 1945. In 1969 the Centers for Disease Control backed by the American Medical Association and the National Medical Association refused to inform the subjects of their infection nor offer treatment despite concerns voiced by citizens. Public outcry ended the study in 197280. Over 40 years, multiple doctors, nurses and other health professionals violated informed decision making and promoted harm.

Health professionals have a responsibility to resist blindly following authority, review the evidence and advocate for harm reduction to promote improved health outcomes79.

Tobacco harm reduction

Compassionate and just approach

Health professionals’ primary bioethic is nonmaleficence; to do no harm. Miscommunication about tobacco harm reduction has compromised health professionals’ ability to promote autonomy in their smoking patients, specifically facilitating informed decision making81. Ensure beneficence by reviewing the credible evidence.

 

Misinformation

Supports continued profits

Public Health England estimates vaping helps at least 18,000 and as high as 57,000 smokers quit each year in the UK82. Not only have pharmaceutical smoking cessation prescriptions dropped more than 50% since vaping has been introduced but current vapers83, and subsequently former smokers, are reporting a decreasing need for their medications for managing their smoking-related diseases84.

Youth vaping epidemic

What about youth smoking?

Why are all the credible sources omitting significant data such as youth smoking rates are plummetting85,86; vaping is a fraction the harm of smoking87; nicotine is less addictive than cigarette smoke84; and smokers are quitting using tobacco harm reduction88? The hysteria over youth experimenting with vaping disregards the reduction in youth smoking uptake. One must look at the  potential reduction in harm if youth are choosing to experiment with vaping instead of smoking due to the significant reduction in health destroying toxins and reduction in addiction potential89.

Long term effects

We know the LT effects of smoking

Unlike with cigarettes, vaping has been developed in an age when science has studied and catalogued thousands of substances and how they effect human health90. Eliquid and vapour have been thoroughly analyzed and the results consistently indicate that vaping is a very small fraction of the harm compared to smoking87.

Bad science

False claims

Omitting significant data is coupled with false claims such as youth smoking rates are inclining91 and vaping causes heart attacks92. These questionable researchers have the audience of the most powerful tobacco control bureaucrats in Canada93. It’s time the health community review the evidence and advocate for the effective utilization of vaping  before these bureaucrats enact oppressive regulations which will destroy the industry that supplies Canadians with tobacco harm reduction94.

Media

Click bait headlines

Mainstream media has been instrumental at spreading false narratives. Is the free press particularly Canada’s publicly funded CBC not responsible to report the facts so Canadians can make informed decisions on issues of public health95?  One must consider that media is significantly funded by the pharmaceutical industry96.

Credible sources

Are they trustworthy?

Health-related nonprofits97, health authorities, regulatory bodies and universal health care agencies have close and often financial relationships with industry that profit from ill-health such as the pharmaceutical, medical supply, and medical equipment industries. These industries fund a large portion of our scientific research, medical schools98, tobacco control conferences99 and so on.

Health-related nonprofits

Revenue contingent on disease

Health professionals trust these agencies as credible sources of information because they have been trained to. It’s time to start questioning sources of information that revenue comes as a result of diseases. These agencies do not have answer to the bioethics of professional codes of ethics that guide the practice of health professionals.

Regulatory bodies

On the bandwagon

Professional regulatory bodies make professional conduct and responsibilities for their members. But do these ethics apply to the agencies as well? The Canadian Nurses Association has been a leader in harm reduction for illicit drug users since 2007100.

Front line workers

The final fail safe

When the system fails, it’s the front line workers that must advocate for appropriate application of science to improve population health outcomes. These health professionals witness the suffering caused from smoking everyday. Will they review the evidence, challenge the opinion of majority and do the right thing?

79. Canadian Nurses Association. (2017). Code of ethics for registered nurses.

80. Centers for Disease Control and Prevention. (2015). U.S. Public Health Service Syphilis Study at Tuskegee.

81. Huang. J. et al. (2019). Changing perceptions of harm of e-cigarette vs cigarette use among adults in 2 US National surveys from 2012 to 2017.

82. Public Health England. (2018). Key questions and findings from our e-cigarette evidence update

83. NHS Digital. (2019). Statistics on smoking, England – 2019.

84. Farsalinos, K. E., Romagna, G., Tsiapras, D., Kyrzopoulos, S., & Voudris, V. (2014). Characteristics, perceived side effects and benefits of electronic cigarette use: A worldwide survey of more than 19,000 consumers.

85. Government of Canada. (2015). Canadian Student Tobacco, Alcohol and Drugs Survey.

86. Government of Canada. (2019). Canadian Student Tobacco, Alcohol and Drugs Survey.

87. Abrams, D. B., Glasser, A. M., Pearson, J. L., Villanti, A. C., Collins, L. K., & Niaura, R. S. (2018). Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives. Annual Review of Public Health.

88. Farsalinos KE, Barbouni A. Association between electronic cigarette use and smoking cessation in the European Union in 2017: analysis of a representative sample of 13 057 Europeans from 28 countries.

89. A Consensus Study Report of the National Academies of Sciences, Engineering and Medicine. (2018). Public Health Consequences of E-cigarettes. Page 33.

90. Canadian Centre for Health and Safety. (2020). Registry of Toxic Effects of Chemical Substances (RTECS).

91. Hammond, D. et al. (2019). Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys.

92. Journal of the American Heart Association. (2020). Retraction to: Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health.

93. University of Ottawa Heart Institute. (2020). Top Smoking Cessation Authorities Gather at Ottawa Conference – Day 1. Retreived Feb. 19, 2020 from https://www.ottawaheart.ca/media-release/top-smoking-cessation-authorities-gather-ottawa-conference-day-1.

94. Public Health Agency of Canada (2020). Statement from the Council of Chief Medical Officers of Health on Nicotine Vaping in Canada.\

95. Canadian Broadcast Corporation. (2017). Code of Conduct: Working together: Our values, ethical principles and expected behaviour. Retrieved Feb. 19, 2020 from https://site-cbc.radio-canada.ca/documents/values-ethics/values-ethics/code-conduct-en.pdf

96. Kantar US Insights. (2017). Retrieved Feb 19, 2020 from https://us.kantar.com/business/health/2017/drug-advertising-booms/

97. Women and Health Protection (WHP). (2005). Marching to Different Drummers: Health Advocacy Groups in Canada and Funding from the Pharmaceutical Industry. Retrieved Faeb. 19, 2020 from http://www.whp-apsf.ca/pdf/corpFunding.pdf

98. Canadian Medical Association Journal. (2013). Pharma influence widespread at medical schools: study. Retrieved Fab. 19, 2020 from https://www.cmaj.ca/content/185/13/1121

99. 12th Annual Ottawa Conference State of the Art Clinical Approaches to Smoking Cessation. (2020). Conference program. Page 17. Retrieved Feb. 19, 2020 from https://ottawamodel.ottawaheart.ca/sites/default/files/2020_program_-_web.pdf

100. Canadian Nurses Association. (2020). Harm reduction. Retrieved Feb. 19, 2020 from https://www.cna-aiic.ca/en/policy-advocacy/harm-reduction.

 

 

 

Health professionals

Health professionals

Health professionals

Smoking is the most preventable cause of morbidity and mortality in Canada.1

We invite you to make informed decisions about tobacco harm reduction.

 

Optimal patient care

If you are a health professional, you have chosen a caring profession that entrusts you to advise your patients with accurate information to improve their health outcomes.2 You are trusted by the public, authorities and your colleagues to communicate relevant information and you rely on your sources to provide you with current, unbiased and credible evidence3.

Undoubtedly, you care for and treat patients that are hopelessly addicted to cigarette smoke. As much as you communicate the devastating health effects of smoking and witness the patients’ resulting decline, they are powerless and you are frustrated that they can’t quit4.

If cessation of high risk behaviours (in this case cigarette smoking) is not happening, the next best strategy is harm reduction3. Would you want to know if your current best educated advice for smokers is actually causing great harm? We invite to look at the credible evidence to ensure best practice.

Section 1

Smoking

Before you can understand the relevance of harm reduction you first must understand what is causing harm5. Learn about what goes into cigarettes, the constituents of the smoke, and the social cost.

Section 2

The current context

Since summer of 2019, the media, health-related nonprofits, regulatory agencies and health authorities have been repeating the same congruent narratives about vaping without debate nor deviation. The current discourse about harm reduction omits significant data6.

Section 3

Tobacco harm reduction

Vaping has been thoroughly studied in labs and in real life context. A search on a medical data base resulted in over 22,000 published articles. We take you through the 10 most common myths about vaping and link you to more evidence.

Section 4

Bioethics

In this section we challenge health professionals to apply bioethics to the current context. Health professionals care about their patients’ outcomes and are required to advocate for change when current practice is causing harm3.

1. Health Canada. (2014). Health concerns: Notice of proposed order to amend the schedule to the Tobacco Act.

2. Canadian Nurses Association. (2017). Code of ethics for registered nurses.

3. Canadian Nurses Association. (2018). Harm reduction and substance use: Joint position statement.

4. Centers for Disease Control and Prevention. (2010). A report of the surgeon general: How tobacco smoke causes disease: What it means to you.

5. Canadian Nurses Association. (2017). Harm reduction and illicit substance use: Implications for nursing.

6. Australasian Professional Society on Alcohol and other Drugs. (2020). Miscommunication about the causes of the US outbreak of lung diseases in vapers by public health authorities and the media.

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Our learning resources are based on scientific evidence yet written in a way that’s simple to understand.

We aim to help people learn about vaping from a harm reduction perspective.

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The Facts in Five Minutes

This is a five minute slide show explaining the basics of vaping, complete with narrative. It is designed to fit into the presentation time allowed by a committee or city council.

The information is based on ‘Vaping, the Truth’ and we HIGHLY recommend  you study this paper and the slideshow prior to your presentation to ensure your knowledge base!

It features an additional 16 slides that provide more information on vaping to expand the audience’s knowledge. Use these to add to the presentation if the time allotment is more than 5 minutes or to answer questions or if more information is requested.

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Our learning resources are based on scientific evidence yet written in a way that’s simple to understand.

We aim to help people learn about vaping from a harm reduction perspective.

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Vaping (electronic cigarette use) The Truth

This paper is based on scientific evidence yet written in conversational English. In a short read, it provides the reader with the basic knowledge about vaping as a harm reduction strategy. It has many colourful graphs throughout; side columns of quotes; and fifty-two references listed in the back. The two versions reflect American and Canadian statistics.

This paper was copyrighted in 2015 and clearly illustrates the harm reduction application of vaping. How many smokers have been diagnosed with chronic smoking-related diseases in the last 5 years because they didn’t know they had a harm reduction strategy?

Le vapotage (L’utilisation de la cigarette électronique) La vérité

Ce document est basé sur des preuves scientifiques. Dans une courte lecture, vous pouvez apprendre les connaissances de base pour comprendre vaping comme une alternative viable pour le tabagisme. Il fournit au lecteur des informations pour prendre une décision éclairée sur le vapotage en tant que stratégie de réduction des risques.

Nous prévoyons desservir la communauté québécoise. VAEP incorporé en français et en anglais.

CBC correction

The pervasive, fear-provoking, biased misinformation that media continues to publish harms people because they cannot make informed decisions about harm reduction. The CBC produced a series called “Vape FAIL”. Their first article, “The Road to Vaping”, was so jammed packed with misinformation, half-truths and biased perspective that we felt compelled to write a correction. We have added the significant data they omitted, corrected their deceptions and exposed their integrity.

Outlawing Vaping in Public

This paper discusses the social issue of public vaping. It looks at the contexts of current public risks; effective transition to vaping and adolescent experimentation.

A quick read to start critical thinking about society’s role in promoting harm reduction. Smoking is a social issue with very high costs. We should be looking at all the options to reduce the suffering caused from inhaling smoke from burning, chemically laden tobacco.

Vaping vs smoking chart

Harm reduction means to reduce the negative consequences of the things people do. Examples would be seat belts, condoms and helmets.

To understand if a new thing will reduce harm; it must first be compared to the thing it is replacing. This chart makes a direct comparison of vaping to smoking in several areas: ingredients, what’s inhaled, bystanders, addiction, health effects and costs.

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8 things you should know about vaping

Utilizing our Shareables, this infographic covers eight key points that illustrate how vaping is a significant harm reduction strategy for current smokers and more.

Youth smoking and vaping

These infographics illustrate the smoking and vaping trends of youth in 2017. The data is expressed in percentages. Graphs are utilized to show frequencies of use and to draw comparisons. We have two colour options for printer preferences.

Canadian version

This infographic reflects the data collected from Government of Canada’s population surveys. We have used the Canadian Student Tobacco, Alcohol and Drugs Survey (CTADS) for 2014-15 and 2016-17 as well as the Canadian Tobacco Use Monitoring Survey (CTUM): Overview of historical data 1999 to 2012.

American version

This infographic reflects the data collected from U.S. government population surveys. We have used the National Youth Tobacco Surveys from 1999-2017.

Due to inconsistencies in data collection, in the section titled “Difference in Smoking Rates over 2 year Periods (%)”, an average was used for years 2001, 2003, 2005, and 2007.

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We aim to help people learn about vaping from a harm reduction perspective.

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Card with VAEP QR code

This card is an effective and inexpensive way to educate your community about vaping. Print off these business cards and hand them out.

Encouraging education will promote more social support for current smokers to try harm reduction. Make it easy for people to visit our website and learn the truth about vaping!

Get your facts straight business card

We got a request to use one of our Shareables as a business card. So, here it is! This card gives some information to understand that vaping is tobacco harm reduction.

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Our learning resources are based on scientific evidence yet written in a way that’s simple to understand.

We aim to help people learn about vaping from a harm reduction perspective.

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VAEP info and youth infographics

These were a big hit at an expo so we have made them available here for anyone who wants them!

They feature our youth smoking and vaping infographics for both Canada and the US. The front drives people to our website for self directed learning, creating more support and customers for harm reduction.

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