Canada Health Chiefs Warn on Vaping During Smoke-Free Week

Although significant progress has been made in the past several decades in reducing smoking rates in Canada, the Council of Chief Medical Officers of Health (CCMOH)^{Footnote 1} want to highlight that smoking continues to pose a significant risk to the health of Canadians, with over 46 000 people dying from smoking-related causes each year. This National Non-Smoking Week, from January 19-25, we recommend that Canadians needing support to deal with nicotine addiction should speak to their health care provider and seek out proven cessation therapies, such as medication, or approved nicotine replacement therapies. There are also actions municipal, provincial/territorial, and federal jurisdictions can take, outlined below.

In August 2024 the federal government introduced a Ministerial Order requiring certain nicotine products, including nicotine pouches, to only be sold behind the counter in pharmacies, along with other restrictions. This is an important and necessary step towards protecting youth; however, the Order did not address nicotine vaping products and their risks.

At this time, we continue to remain significantly concerned by the continued high rates of nicotine vaping among Canadian youth. In follow up to our previous position statements on this issue (July 2014; April 2019, October 2019 and January 2020), we provide the following as updated regulatory and policy recommendations that we believe are necessary to be taken by federal, provincial/territorial and municipal governments to address this ongoing public health threat. We acknowledge that governments have already taken steps to implement some of these recommendations.

The overarching objectives of these recommendations are to protect young people from encouragements to use nicotine vaping products by regulating such products as equivalent to tobacco products, and to encourage people who smoke and are seeking assistance to reduce or end their use of tobacco products to use approved cessation methods.

Population level risks of nicotine vaping for youth and those who do not smoke are a primary concern and should be a key focus in regulatory action.

Therefore, the main goal for the regulatory approach to nicotine vaping products should be reducing the access to, and appeal of, these products among young people. This should entail strategies such as strengthened restrictions on marketing, limiting flavoured products to tobacco flavour only, preventing underage youth access via online purchases, and increased penalties and stronger enforcement for sales to minors and of flavoured products.

Population level messaging should continue to focus on approved and evidence-based smoking cessation methods, including greater emphasis on unassisted cessation. Nicotine vaping product manufacturers should be encouraged to submit their products for review and possible approval as smoking cessation aids.

Note: This statement pertains only to nicotine vaping products as CCMOH has released a related statement on cannabis vaping on January 6^th, 2020.

Opportunities for Federal and Provincial/Territorial jurisdictions

Federal action would be preferred to create national consistency, but provinces/territories can consider individual action

• ban all flavoured nicotine vaping products as has been done in PEI, NS, NB, NWT, Nunavut and Quebec. Regulatory exemptions for a minimum set of flavours could be provided for products regulated as cessation aids through the Food and Drug Act
• ban the sale of disposable nicotine vaping products
• building on the federal regulations regarding maximum nicotine concentration, adopt other appropriate standards regarding nicotine delivery (e.g. temperature/wattage, use of nicotine salts) as evidence on vaping products evolves
• regulate all constituents of nicotine vaping product liquids based on potential to cause harm when inhaled rather than ingested
• Ensure clarity of jurisdiction and oversight for novel nicotine vaping products including novel delivery mechanisms to ensure that they are appropriately regulated
• continue to tax vaping products in a manner consistent with maximizing youth protection while providing some degree of preferential pricing as compared to tobacco products. In addition, implement an oversight mechanism to ensure tax stamped products are incompliance with the Tobacco and Vaping Products Act
• consider making age 21 the minimum sales age for both tobacco and nicotine vaping products
• assess options to regulate on-line sales of nicotine vaping products such as:
  • ban the online sale of nicotine vaping products
  • limit the online sale of nicotine vaping products to retailers who have a Canadian vendors license
  • create requirements for age-verification of internet purchases of nicotine vaping products that are the same as those required for cannabis
• enhance surveillance and reporting of nicotine vaping product use and population health impacts

Opportunities for Federal Jurisdiction

• consider a ban on the advertising/marketing/promotion/sponsorship of nicotine vaping products that have not been approved as cessation products. As this is being considered, ensure strong enforcement of federal restrictions on the advertising/marketing/promotion/sponsorship of nicotine vaping devices
• Population level messaging should continue to focus on unassisted cessation, as well as approved smoking cessation methods, which at this time does not include nicotine vaping products. Manufacturers should be encouraged to submit their products for review and possible approval as smoking cessation aids
• require plain and standardized packaging along with health risk warnings for nicotine vaping products, as well as plain and standardized design of nicotine vaping products
• Further limit mechanisms and pathways for online advertising of nicotine vaping products, and require any advertising is not appealing to children/youth
• enhance compliance, enforcement and public reporting of the provisions of the Tobacco and Vaping Products Act and its regulations

Opportunities for Provincial/Territorial Jurisdictions

• Ban all point-of-sale advertising of nicotine vaping products with an exception for specialized vaping product stores accessible only to those of minimum age
• require a vendor's licence for those selling nicotine vaping products
• include vaping as part of provincial smoke-free restrictions
• routinely use youth test purchaser programs for all tobacco and nicotine vaping product retail locations
• ensure compliance with restrictions on flavoured nicotine vaping products through strong inspection and enforcement
• restrict the density of tobacco and nicotine vaping product retail sites and ban the sale of nicotine vaping products and devices within at least 250m of a school

Opportunities for Municipal Jurisdictions

• include vaping as part of municipal smoke-free restrictions, and include all public recreational spaces within their smoke-free zones
• restrict the density of tobacco and nicotine vaping product retail sites and ban the sale of vaping products and devices within at least 250m of a school

Along with these policy and regulatory actions we recommend that federal, provincial and territorial governments continue to work collaboratively to:

• enhance public awareness and educational initiatives on the risks of nicotine vaping products targeted at youth, parents, educators and health care professionals
• establish comprehensive cessation initiatives for people with nicotine addiction (smoking and/or vaping), especially for youth
• continue to monitor and research the short and long-term health effects of nicotine vaping products
• continue to support research on the effectiveness of nicotine vaping products in supporting smokers to end or reduce their use of all nicotine-containing products
• research the effectiveness of policy approaches to address youth nicotine vaping
• explore partnerships with First Nation, Inuit, and Métis communities to achieve mutual objectives related to a reduction in smoking and nicotine vaping rates

The Council of Chief Medical Officers of Health includes the Chief Medical Officer of Health from each provincial and territorial jurisdiction, Canada's Chief Public Health Officer, the Chief Medical Officer of Public Health of Indigenous Services Canada, the Chief Medical Officer from the First Nations Health Authority, and ex-officio members from other federal government departments.