
Gov’t and MSA payments

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.
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.
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
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.
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
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
Commercial nicotine eliquid
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
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
Wide-spread misinformation
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
Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or past mistakes? (2010) Cahn, & Seigel
Peering through the mist: Systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. (2014) Burstyn.
Dr Jean-François Etter
A fresh look at tobacco harm reduction: The case for the electronic cigarette. (2013) Polosa, Rodu, Caponnetto, Maglia, & Racitti
Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or past mistakes? (2010) Cahn, & Seigel
Dr Jean-François Etter
Peering through the mist: Systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. (2014) Burstyn.
A fresh look at tobacco harm reduction: The case for the electronic cigarette. (2013) Polosa, Rodu, Caponnetto, Maglia, & Racitti
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.
Patients are a vulnerable population79.
They trust health professionals with their health, well being and their lives.
They deserve to know all their options.
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.
Misinformation
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
Long term effects
Bad science
Media
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
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
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
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
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.
Smoking is the most preventable cause of morbidity and mortality in Canada.1
We invite you to make informed decisions about tobacco harm reduction.
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
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
Section 3
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
Section 5
Since 2016, VAEP, our Canadian nonprofit, has been reviewing the evidence and producing open source learning tools to facilitate informed decision making about tobacco harm reduction. In this section, we link you to more of our resources to your further knowledge.
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.
As health professionals, you have a responsibility to help these people with the best available strategies to improve health outcomes51.
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.
Myth 2
Myth 3
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 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
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
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
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
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
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 Kingdom, 54% of successful smoking cessation attempts were with vaping69.
Further
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
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
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
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.
toxins in cigarette smoke are missing – those that remain are orders of magnitude lower.”
Dr. Konstantinos Farsalinos
be more concerned of the air they breathe in polluted cities rather than their vaping!”
Dr. Riccardo Polosa
are 95% safer is not a medical claim, it’s a truth.”
Professor Hajek
for nicotine but they die from the tar.”
Professor Michael Russell, 1976
“The most important toxins in cigarette smoke are missing – those that remain are orders of magnitude lower.”
“Vapers should be more concerned of the air they breathe in polluted cities rather than their vaping!”
“Sayong ecigs are 95% safer is not a medical claim, it’s a truth.”
” 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).
Every year in Canada, smoking causes 18% of all deaths and costs the taxpayers $16 billion7.
Over one million Canadians suffer with smoking-related diseases7,8.
Smoking morbidity and mortality is 100% preventable9.
Cigarettes became mainstream in the early 20th century due to automation which made them economically viable to produce10. Over decades, tobacco company scientists experimented with chemicals to produce the most addictive product in the world10.
Currently, up to 600 ingredients are added to tobacco cigarettes to cause physiological outcomes and enhance the delivery and effects of nicotine11. Ammonium salts increase nicotine bioavailability; menthol acts as a local anaesthetic and cough suppressant12. Eucalyptol and theobromine are bronchial dilators to increase the volume of smoke inhaled12. Then, lactones reduce the body’s ability to metabolize nicotine; and acetaldehyde mimics monoamine oxidase inhibitors (anti-depressant effect)12.
Cigarettes are more addictive than just nicotine on its own and the most harmful source of nicotine13. When smokers switched to tobacco harm reduction (THR), they reported improvements in chronic diseases14 and general health 15.
Those with metal health disorders have double the smoking prevalence of the general population16. For instance, people with schizophrenia have up to 80% prevalence17. Cigarettes are the most harmful source of nicotine18.
While smoking prevalence has significantly declined in the last 50 years, people of lower socio-economic status prevalence has hardly changed19. Considering that a pack of cigarettes in Canada costs up to $20, this expense adversely effects their ability to afford healthy food for themselves and their children.
Smoking rates
7000+ chemicals in smoke
Burning chemical laden cigarettes cause new toxins to form22. Cigarette smoke contains hundreds of known disease causing agents and 69 carcinogens11, 22. Smoking is responsible for 36% of respiratory diseases, 29% of cancers, 14% of cardiovascular diseases, 85% of lung cancer and 87% of COPD23.
100% preventable costs
The needless suffering
The accumulative effects of the toxins deteriorates the smoker’s health22. This adversely effects their families such as when the main earner can no longer work and their children cannot afford a higher education24.
Long term effects
If we help grandparents stop smoking, they can enjoy active relationships with their grandchildren. After one year of quitting smoking, patients’ risk of heart attack reduces by 50%; after 10 years, risk of lung cancer is reduced to 50% and risk of coronary heart disease is the same as a never smoker25.
Let the scientific findings guide your practice.
7. The Conference Board of Canada. (2017). The costs of tobacco use in Canada, 2012.
8. Centres for Disease Control and Prevention. (2014). Fast facts: Diseases and death.
9. Health Canada. (2014). Health concerns: Notice of proposed order to amend the schedule to the Tobacco Act.
10. Institute of Economic Affairs. (2013). Free market solutions in health: The case of nicotine.
11. Rabinoff, M., Caskey, N., Rissling, A., & Park, C. (2007). Pharmacological and Chemical Effects of Cigarette Additives.
12. Europa. (2010). Public Health: Tobacco additives.
13. Laugesen, M. (2013). Nicotine and health.
14. 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.
15. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette.
16. Mental Health and Smoking Partnership. (2017). Statement on Electronic Cigarettes
17. Royal College of Physicians. (2013). Smoking and mental health: A joint report by the Royal College of Physicians and the Royal College of Psychiatrists.
18. 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.
19. Public Health England. (2015). E-cigarettes: an evidence update A report commissioned by Public Health England.
20. Reid, J., Hammond, D., Tariq, U., Burkhalter, R., Rynard, V.L., & Douglas, O. (2019). Tobacco Use in Canada: Patterns and Trends, 2019 Edition.
21. Public Health Agency Canada. (2014). Tobacco.
22. A Report of the Surgeon General. (2010). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General.
23. Dawkins, L. (2013). Why is it so hard to quit smoking?
24. Conference Board of Canada. (2017). The Costs of Tobacco Use in Canada, 2012.
25. Canadian Cancer Society. (2020). Amazing ways your body bounces back.
26. Canadian Nurses Association. (2017). Harm reduction & illicit substance use: Implications for nursing.
27. Canadian Nurses Association. (2018). Harm reduction and substance use: Joint position statement.
Updated 01FEB2020
“Vaping nicotine can alter teen brain development.”
– Health Canada
“Vaping can cause lung damage.”
– Health Canada
Harm
reduction
“Every 10 minutes, two Canadian teenagers start smoking cigarettes; one of them will lose her life because of it.” -Health Canada (22)
The current
narrative
Making a
smoker
What about
vaping?
Harm
reduction
Making a
smoker
What about
vaping?
Youth and
vaping
The current
narrative
Harm
reduction
When children grow up in a home with one smoker, they have a 72% increase of smoking uptake. Many parents who smoke have tried multiple times to quit and failed. Tobacco harm reduction may be the best option for them and their children.
People start smoking in their teens because youth experiment with adult taboos due to peer pressure and “sensation seeking”. ? Also, because the brain ? is still developing; it is building new connections making them more vulnerable to addiction.
93% of smokers start before they’re 20 because they experiment with adult taboos. Addiction is a loss of autonomy which means to act independently of something (say ‘no’ to the next one.) It’s a numbers game, after 20 cigarettes, 50% lose some autonomy.
They’re banning flavours to save youth from nicotine. 33% of youth vaped and more smoked. 65% drank alcohol. Should we ban flavor in alcohol? Twice as many teens are watching porn. Should we ban the color in porn? Tide Pods look like gummies…
Youth are seeking a head buzz from abusing JUULs (overdosing). Teens call it a “heady” and 8.3% of grade 8-12 students are “JUULing” to get high. JUUL has 4 flavours. Banning 1000’s of eliquid flavours will make harm reduction unattractive to smokers.
In Great Britain, vaping is recognized as a significant harm reduction strategy and is promoted by Public Health England. ? Yet, less than 2% of 11-18 year olds vape more than once a week. WHERE is the youth vaping epidemic in Great Britain❓❓❓
In Great Britain, health authorities have embraced vaping for smokers. Only, 93.8% of 11-18 year olds that have never smoked, have never ‘tried’ a vape. Teens in North America are given fear-based narrative and that makes them want to try it even more.
This quote proposes vaping’s harm reduction potential not only for current smokers but for preventing the next generation of smokers. The graph illustrates the significant drop in American youth smoking rates since vaping has been introduced in the USA.
In 2017, 15.6% of grade 10-12 students had one puff or more 30 days; an increase of 65% since 2015. 1.8% vaped daily versus 2.2% smoked daily. Daily smokers dropped 27% from 3% to 2.2% since 2015. Vaping up, smoking down.
? Tobacco smoke contains over 7000 chemicals: 1500 cause disease and 69 cause cancer. ? Vaping is 5% the risk of smoking. ? 35% of grade 10-12 students have ever smoked and 33% have ever vaped. ? Is there a smoking epidemic?
This graph shows a 16 year history of current smoking rates of 15-19 year olds over a 16 year period. Within 3 years of vaping being introduced, the smoking rate decreased at a level not seen in 14 years!
Grade 12 smokers are the next adult smokers! A 35% drop in grade 12 smoking rates is very significant! If vaping was a gateway to smoking, we would see an increase in the smoking rates. Instead the youth smoking rates are dropping. This suggests that vaping may be reducing the uptake of smoking in youth.
In 2017, about the same amount of US youth had tried vaping as smoking. Maybe the youth that have a curiosity about inhalants try both. Consider that the smoking rate is dropping, vaping maybe interrupting smoking addiction.
Since vaping has been introduced into mainstream, youth are experimenting with vaping. The thing is that the US youth smoking rates are dropping at rates not seen since at least 2001. Vaping could be preventing new smokers!
An epidemic is a disease with very high rates in a population. ? Youth that used a vape in the last 30 days: – 36% used 1-2 days, – 17% used 3-5 days, – 9% used 6-9 days, – 10% used 10-19 days, – 5% used 20-29 days.
9 of 10 smokers start before 20. 94% of youth that smoke 100 cigarettes, lose some ability to say no to the next one – they are becoming addicted. Vaping may be interrupting those 100 cigarettes considering their smoking rates are dropping.
Tobacco smoke has 7000 chemicals in it, many of which cause damage to the body. This fear-provoking message is suggesting that all smokers have some kind of brain damage. How is it that they can identify nicotine as the culprit and not the other toxins?
The current fear-provoking narrative on vaping scares smokers away from tobacco harm reduction. It would be unethical to give nicotine to teens and then test their brains. ? The reference used was a study on rats at 2mg/kg/d nicotine IV. ?
Over 20, 000 US youth were surveyed. Of the high school students that reported they had ever tried vaping, 1 out of 3 admitted they used cannabis in a vaping device. Flavours in regulated nicotine eliquid are for the smokers looking for harm reduction.