Given the recent announcement in Nova Scotia that flavoured vaping products will be banned as of next April, as well as the spate of vaping-related illnesses (largely in the United States), there’s no shortage of concern and confusion around vaporizers.
Is vaping a safe way for lifelong smokers to get off cigarettes or does the technology represent a new health crisis? Will certain types of vaping be banned here in Ontario, too?
To see if we could shed a little light on the topic, I asked Dr. Martin Kolb, director of the Division of Respirology at McMaster University’s department of medicine, as well as Ontario’s Chief Medical Officer of Health, Dr. David Williams, to help clear up some of the confusion. Sadly, one of the first things both experts said is that there are still a lot of UNANSWERED questions out there. Vaping is so new and takes on so many forms, nobody’s had a chance to do a comprehensive assessment of all the variables.
To start, vaporizers can be used to inhale a wide range of plant-based substances, but the two main legal uses are for nicotine or cannabis compounds — two largely separate markets. The coming Nova Scotia ban will now apply to both. At first, though, it took aim only at banned flavoured nicotine products, which suggests the legislation initially grew out of concern for young people who, many think, are being targeted by companies offering fruit and candy-flavoured e-cigarettes.
Given that Canada started banning flavoured tobacco a decade ago, a good question to start with is why nicotine vape flavours came to exist in the first place? Part of the answer is likely connected to Canada’s relatively high allowable nicotine levels. In Europe, the legal limit of nicotine is 20 milligrams per millilitre, whereas Canada’s is over three times higher — 66 mg/ml.
“When you go above 20 milligrams, it gets rather unpalatable to inhale it, so you have to put other chemicals in with it to make it inhalable by including some flavour,” says Williams.
The only medical use for vaping that most doctors accept as reasonable is as a smoking cessation product. Since burning tobacco is carcinogenic, a heavily-addicted smoker might reduce their risk of cancer through vaping and, ideally, break their habit. Since a heavy smoker might want a high nicotine level — above 20 mg — flavour is often added. The flavours available on the market now, however, include grape pop, candy floss and even glazed doughnut, which both experts believe are aimed at a younger market — one that likely never smoked cigarettes in the first place.
“The thing is that this kind of flavoured electronic cigarette would never be attractive to a lifelong smoker who just wants the nicotine,” says Kolb, “They don’t want bubble gum but, if you talk to a teenager of 14, they really like the bubble gum. And this is really where I think the news that there’s a move to disallow these flavours in Nova Scotia is truly welcome.”
This brings us to the safety of the added flavours. Few, if any, are natural infusions. These are chemical formulas designed in a lab to mimic the taste of fruit and/or candy. Since there are so many different ones on the market, no scientific or government body has had a chance to evaluate the safety of the various different flavour solutions. This all gets even more complicated, says Williams, when you consider that a chemical that’s transformed from a liquid into a vapour may revert to liquid form — or possibly even solid — once it settles in the tissues of the lung.
This cocktail of variables also appears to be making epidemiological science harder at the Center for Disease Control in the United States, where teams of people are trying to determine what, precisely, is causing the potentially fatal lung illnesses (or injuries) associated with vaping. For the large part, those problems aren’t closely tied to nicotine inhalers but, instead, to cannabis vaporizers. Again, though, what’s complicating matters is the plethora of cannabis vaping solutions on the market — and some of the affected patients used more than one.
“They had to identify some likely things that the illnesses are clustering around and so they looked at Vitamin E acetate, an oil-type thing that’s being used in some solutions,” says Williams, “But the CDC (Center for Disease Control in the United States) says they’re not convinced that that’s the only thing.”
That’s another reason the medical community is applauding the Nova Scotia ban: It simplifies future scientific inquiry by removing a bunch of unwanted wild-cards — chemical flavours, stabilizers, oils and other additives. Can we expect similar actions in Ontario?
“I would say ‘stay tuned,’ ” says Williams, “I think we’re going to have to look at whatever we can do to try to discourage youth from taking it up.”
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Recently, the Ontario Ministry of Health announced it, too, was considering some kind of ban. And, while we wait, what’s the takeaway for staying safe?
From Kolb’s point of view, that’s pretty simple. For smokers looking to cut back on a pack-a-day habit, there are plenty of alternatives to vaping, including nicotine gum, sprays and lozenges. Similar alternatives — extracts and edibles — exist in the cannabis space.
“A lot of the argument for e-cigarettes is they’re not as harmful as cigarettes,” says Kolb. “But you wouldn’t eat a poison that kills you in 20 days over a poison that kills you in 10 days,” he adds.
“And I think, when it comes to teenagers who have never smoked, vaping might not be as bad as cigarettes, but it shouldn’t be measured against that. It should be measured against the best thing to breathe in, which is fresh air,” Kolb says.
