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CAMH Stories Centre for Addiction
and Mental Health

Taming the e-cigarette Wild West: latest research informs legislation

March 16, 2016 - In the current Wild West of e-cigarette products and effects, and as vaping continues to increase, a partnership of the Ontario Tobacco Research Unit (OTRU) and CAMH is providing expert advice on e-cigarette policy.

“What we know now of the possible range of toxicants in e-cigarettes is sufficient to advise that a non-smoker should not start vaping,” says Dr. Robert Schwartz, CAMH Senior Scientist in Social and Epidemiological Research, and Director of OTRU. At the same time, e-cigarettes may help some tobacco smokers quit in certain situations, he says.

Man smoking e-cigarette
Dr. Schwartz presented the latest key messages developed by a global expert panel to policymakers – including Ontario’s Chief Medical Officer of Health -- at Public Health Ontario Grand Rounds earlier this year. The province banned sales of e-cigarettes to those under age 19 in January, and is expected to release further regulations on their sale and use in public places this spring.

The Ontario government has continued to consult directly with OTRU as it advances public policy. The huge variation in devices, mechanisms and contents presents a challenge to both researchers and law makers, says Dr. Schwartz.

The latest expert advice tackles both e-cigarette use generally, and the use of e-cigarettes for tobacco cessation. These key messages were developed as part of the comprehensive Research on E-cigarettes (RECIG) study and draw upon the latest research from its global panel:

  • Non-smokers should not vape: There are no standards for acceptable levels of toxicants in e-cigarette vapours. Toxicants such as carbonyls and TSNAs vary widely, and many potential health effects are not yet studied. Some e-cigarettes deliver as much nicotine in 10 puffs as a regular tobacco cigarette, and nicotine may affect brain development.
  • Some tobacco smokers using certain kinds of e-cigarettes in certain ways may quit smoking. At the same time, research shows that most tobacco smokers who try vaping do not become vapers, and do not quit tobacco. There are pros and cons of promoting e-cigarettes as a cessation aid. They may work as an alternative to other cessation aids, but promotion may also encourage up-take by non-smokers. In general, vaping is likely far less harmful than tobacco smoking.

RECIG is funded by the Ontario Ministry of Health and Long-Term Care, Health System Research Fund. With the latest RECIG key messages in mind, how can governments focus their efforts on e-cigarettes?

Making e-cigarettes less harmful

“We’ve recommended that policy could do more to prevent non-smokers, in particular youth, from starting,” says Dr. Schwartz. “Also, governments can look at ways to make e-cigarettes less harmful for smokers through product and content standards, for example.”

Another key question: “What is the cleanest e-cigarette possible in terms of toxicant levels, and can that be addressed through policy?’ Dr. Schwartz asks. “We know that the UK is taking some steps in that direction.”

Dr. Robert Schwartz 
Dr. Robert Schwartz


E-cigarette image courtesy of U.S. Food and Drug Administration. This type is known as a “cigalike” as it resembles a tobacco cigarette. Other e-cigarette types look more like small metal pipes ( see photo above)

Enhancing the harm reduction potential for tobacco smokers

When it comes to cessation, there is an equally important question: Can e-cigarette products be designed to be more effective as tobacco cessation aids?

Dr. Peter Selby, CAMH’s Addictions Division Chief, points out the harm reduction potential of e-cigarettes for some tobacco smokers.

“Electronic delivery devices that do not combust tobacco but can deliver nicotine in sufficient quantities to smokers who do not or will not quit is a promising harm reduction innovation,” he says. “What we need is clear regulation of quality. That needs to be coupled with policies that deter children and youth from using e-cigarettes, while making them available for adult smokers for whom standard cessation treatments have failed.”

Learn more about RECIG on the OTRU web site.

CAMH’s Ontario Student Drug Use Survey results show e-cigarette use is beginning to eclipse tobacco use among student.

Read about how CAMH continues to lead on smoking research, client care, and a tobacco-free hospital site.

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