What went wrong in Canada

(source) (source) (source)

First case of EVALI in Canada

Dr. Chris Mackie, the medical officer for the Middlesex-London Health Unit in Ontario declared the first of 19 cases in Canada. His diagnosis was lipoid pneumonia. Countless headlines, articles, TV news programs and experts repeated the narrative and blamed harm reduction.

The science is clear

A 2016 study “Respiratory infections and pneumonia: potential benefits of switching from smoking to vaping” concluded vaping cannot cause lipoid pneumonia. Water based vapor cannot cause a oil based lung injury.

(source) (source) (source) (source)

Enduring false causation

For weeks, Dr. Mackie continued to blame nicotine vaping for the lung injury during interviews with media. Anti-smoking agencies across Canada and the US demanded banning flavours in eliquid making tobacco harm reduction less attractive to smokers.

Anti-harm reduction advocates

Daily, health authorities & media deceived the public about EVALI. Experts repeatedly referred to vaping as causing the injuries without specifying that it was illegal THC cartridges that was hurting people. They repeatedly include vaping nicotine eliquid in their discussions!

Recommends inhaling nicotine

Dr. Tereza Martinu, respirologist, was a guest on media. She admitted that vitamin E acetate was found in all the EVALI biopsies & is used in THC concentrates. She suggests that inhaling nicotine through vaping may be the cause. Then she encourages people to use nicotine inhalers.

Trying hard to blame harm reduction

Question: since vaping has been around for 10 years, why the sudden outbreak of EVALI? Dr. Martinu’s answer was there was such an increase in vaping that there are now enough cases to see it. She failed to give the percent of increase or the time frame.

(source) (source) (source)

Deceptive authority

With endless resources and funding, the government is fully capable of reviewing the evidence on vaping. Yet, they are still deceiving the public by blaming nicotine eliquid for EVALI. Eliquid has been legal & regulated in Canada since May 2018.

Fake news

The United Kingdom (UK) promotes vaping for smokers. They are different than most of the world because they reviewed the science on vaping before the global narrative got to them. The deceptions were so pervasive that even their citizens became misinformed.

The lies are working

The misinformation has convinced the public that eliquid is a source of EVALI. An increase of 13% of the people believe that vaping is MORE harmful than smoking, The public now demands tobacco harm reduction bans.

Canada gov’t & THC cartridges

what happened

what went wrong in the USA

state governments & the MSA

expert warnings from the UK

What happened

by Kellie Ann Forbes | Mar ,Fri, 2021 | education, evali, shareables

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.

Vaping history of 15 years with no 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.

Injuries were isolated to North America

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.

Patients admitted illegal drug use

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.

Lung biopsies found vitamin E acetate

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.

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.

Public warnings from the FDA

The Food and Drug Administration issued warnings that were specific to the injuries. To best ensure the public can make informed decisions about safety, the more specific information about the dangers, the better.

Lung injuries declined rapidly

Word spread on the street that illegal THC cartridges were making people sick. Law enforcement busted several illegal THC cartridge makers and distributors. A legal thinning agent, ‘Honey Cut’ was removed from the market. The injuries declined.

EVALI patients use of vaping products vs vapers without injuries

Vaping habits of 66 vapers that suffered with the lung injury were compared to the vaping habits of 519 vapers that didn’t have the lung injuries. The injured vapers clearly showed a significant increase in THC vaping, illegal THC use and purchased the illegal brand that was associated with the lung injuries. This study further confirmed the safety of nicotine eliquid.

Law enforcement seizures

Confiscated illegal THC cartridges from 2018 and 2019 found that the vitamin E acetate was only detected in the 2019 cartridges and not the 2018 cartridges. This shows that the causative agent was recently introduced to illegal THC cartridges.

Nicotine eliquid is proven safe

Illegal THC cartridges caused the death of 68 people. Smoking kills half a million Americans and over 45,000 Canadians every year. Vaping nicotine eliquid has helped millions of smokers quit and has killed no one.

More on what happened

Shocking images alarmed the public

Despite the overwhelming evidence, the public were constantly bombarded with claims that nicotine eliquid caused EVALI. Thousands of vapers that had successfully quit smoking with vaping, returned to smoking out of fear.

Cannabis was/is still illegal

Because illegal drug use has very serious legal consequences, patients sometimes lie about what they have taken because they are afraid of getting into trouble. Canadian authorities neglected to test lung samples, perform toxicology screening and analyze vaping products used.

Buy products from legitimate sources

Since May, 2018, eliquid has been regulated by the Canadian federal government. Nicotine based eliquid from a vape shop is a 95% reduction in risk compared to smoking. This is called tobacco harm reduction or simply “vaping”.

Utah Department of Health warnings

The public was bombarded by media, gov’t, nonprofits and health authorities blaming tobacco harm reduction (vaping regulated nicotine eliquid) for what was causing EVALI. Utah Department of Health were one of the few health authorities that told the public the truth.

Wording matters

When we say “smoking” we think of smoking cigarettes. When people smoke something else, we specify such as smoking a pipe or cannabis. Just the word “vaping” or “e-cigarettes” is referring to nicotine eliquid. Vaping THC carts is vaping cannabis products.

Warnings were not specific enough

North American health authorities recommended people stop all vaping and did not specify the injuries were caused from THC cartridges. Cannabis users were left at risk because “vaping” is commonly known as vaping nicotine eliquid.

Utah activated vape shops

With a disease outbreak, it’s important to notify the public & the population at risk. Vape shops across Utah were utilized to get the word out about the cause of EVALI & ensured their customers could make informed decisions about harm reduction

Confirmation with mouse study

30 mice were studied: 10 for vitamin E acetate; 10 for eliquid (propylene glycol & glycerine); and 10 for air (control). The first group were given the equivalent of human dose for a THC cart user and labs results showed the same lung injury. The injury was not present in the eliquid nor air groups.

What went wrong in Canada

What went wrong in the USA

what happened

canada gov't THC cartridges

state governments & the MSA

expert warnings from the UK

current context

by Kellie Ann Forbes | Mar ,Mon, 2020 | education, health professionals

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

Miscommunication about the causes of the US outbreak of lung diseases in vapers by public health authorities and the media

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 devices^30,31,32. Vitamin E acetate has been identified as the primary causative agent^33,34.

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 Minnesota^{42, 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.

Next section: tobacco harm reduction

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

by Kellie Ann Forbes | Feb ,Mon, 2020 | education, health professionals

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.

Basic vaping information

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 plummetting^85,86; 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

by Kellie Ann Forbes | Feb ,Sun, 2020 | education, 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.

First section: Smoking

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.

Smoking

by Kellie Ann Forbes | Feb ,Thu, 2020 | health professionals

Smoking

Every year in Canada, smoking causes 18% of all deaths and costs the taxpayers $16 billion⁷.
Over one million Canadians suffer with smoking-related diseases^7,8.

Smoking morbidity and mortality is 100% preventable⁹.

Diagnose the problem

Cigarette smoke addiction

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 diseases¹⁴and general health ¹⁵.

Smoking vs. vaping chart

At-risk populations

Higher prevalence in vulnerable populations

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.

Learn from the experts in THR

Smoking rates

15% of Canadians smoke

About 4.6 million Canadians 15 years and older are addicted to cigarette smoke²⁰. It is the most common addiction in Canada²¹. Toxins in smoke include: carbon monoxide which displaces oxygen on RBC; hydrogen cyanide which paralyses lung cilia; free radicals which cause atherosclerosis²².

7000+ chemicals in smoke

Combustion is a problem

Burning chemical laden cigarettes cause new toxins to form²². Cigarette smoke contains hundreds of known disease causing agents and 69 carcinogens^{11, 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

Death and taxes

Premature deaths caused from smoking leads to 599,390 potential years of life lost²⁴. Tax expenditures include $6.4 billion in direct health care costs and indirect costs includes $6.8 billion for long-term disability²⁴.

The needless suffering

The human element

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

The next generation

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.

Harm reduction for smokers

Medical autonomy

When patients are unable to cease risky behaviours, the next best intervention is harm reduction such as practising safe sex to avoid HIV²⁶. Health professionals are responsible to promote harm reduction²⁷.

Stay current in the evidence

What you don’t know can harm your patients

Let the scientific findings guide your practice.

Next section: the current context

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.

to edit Downloads

by Kellie Ann Forbes | Feb ,Sat, 2020 | printable resouces

Downloads

Free printable and digital resources

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

Download the PDF’s for quality printing.

Posters

You are being deceived

Most vapers are aware that there is rampant misinformation about vaping. This 18″ x 24″ poster features 9 Shareables that give a base knowledge about vaping as a harm reduction strategy.

download

It’s all bull sh*t

This poster addresses the current fear-provoking message that tobacco harm reduction (vaping regulated nicotine eliquid) is what is making people sick. The ‘vaping related’ lung injuries are clearly caused from mostly black market cannabis products used in a vape device.

We are VERY concerned that authority and media group these dangerous products with nicotine eliquid. In the interest of public health, it is unethical to (1) not clarify what is making people sick and (2) actively oppress tobacco harm reduction!

The emojis are humour that create receptiveness followed by a command to invite learning. We have two styles for your preference.

download

Rack cards

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.

front

back can

back usa

Business cards

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!

download

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.

download

Infographics

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.

download

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 (on desktop version) 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.

download

download

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.

download

download

Papers

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.

This paper 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.

download

download

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.

download

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.

download

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.

download

download

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.

download

Slide shows

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.

download



Make a difference

Every contribution ensures we can

continue providing quality learning materials.

make a donation
Buy a pin on the map

to edit slide shows

by Kellie Ann Forbes | Feb ,Sat, 2020 | education

Downloads

slide shows

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.

Slide shows

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.

download

Make a difference

Every contribution ensures we can

continue providing quality learning materials.

make a donation
Buy a pin on the map

to edit papers

by Kellie Ann Forbes | Feb ,Sat, 2020 | education

Downloads

papers

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.

Papers

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?

download

download

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.

download

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.

download

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.

download

download

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.

download

Make a difference

Every contribution ensures we can

continue providing quality learning materials.

make a donation
Buy a pin on the map

to edit infographics

by Kellie Ann Forbes | Feb ,Sat, 2020 | education

Downloads

infographics

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.

Infographics

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.

download

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.

download

download

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.

download

download

Make a difference

Every contribution ensures we can

continue providing quality learning materials.

make a donation
Buy a pin on the map

to edit business cards

by Kellie Ann Forbes | Feb ,Sat, 2020 | education

Downloads

business cards

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.

Business cards

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!

download

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.

download

Make a difference

Every contribution ensures we can

continue providing quality learning materials.

make a donation
Buy a pin on the map

to edit Rack cards

by Kellie Ann Forbes | Feb ,Sat, 2020 | education

Downloads

rack cards

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.

Rack cards

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.

front

back can

back usa