Fifteen years after they were introduced in Canada, e-cigarettes made headlines in 2019 with a spike in vaping-related illnesses and soaring rates of youth vaping.

If 2019 was the year of the vaping scare, observers and critics are hoping that 2020 will be the year in which Canada gains some control over the issue.

Before the year was over the federal government began taking steps in that direction by announcing a ban on promotion of vaping products in spaces where young people could see them, including on social media. It also announced that e-cigarettes must carry mandatory health warnings and must be child resistant.

Critics want to see the government go much further when it comes to reducing teen vaping.

The mandate letter to newly appointed federal Health Minister Patty Hajdu suggests the government could go further. The letter, released in mid-December, tells the health minister to “tackle the rapid increase in vaping among young people,” in collaboration with other levels of government by taking regulatory action to “reduce the promotion and appeal of vaping products to young people and by educating the public to raise awareness of health risks.”

The federal government and others have their work cut out.

In recent years, vaping has gone from a phenomenon to a crisis among Canadian teens and young adults, researchers say.

In groundbreaking research, Professor David Hammond of the University of Waterloo found that between 2017 and 2018 vaping increased by a stunning 74 per cent among Canadian teens between the ages of 16 and 19. His ongoing research suggests there has been a similar increase in youth vaping in 2019 and Hammond believes numbers of youth vaping could go higher yet.

The Canadian Student tobacco, Alcohol and Drugs survey for 2018-2019 found e-cigarette use by students doubled between 2016-17 and 2018-19. Twenty per cent of students surveyed (approximately 418,000) had used e-cigarettes in the past 30 days, an increase from 10 per cent the last time the survey was done in 2016-17.

The figures are shocking, but likely no surprising to those who have been seeing the first-hand evidence in schools and other places teenagers frequent.

In Ottawa and elsewhere, schools have taken the doors off bathrooms to try to control vaping, without much luck. Teachers report students vaping in class — exhaling into the sleeves to try to hide it and vaping wherever they can.

The huge spike in teen vaping is likely related to high rates of nicotine in Juul e-cigarettes and other popular products.

Before Juul came along, there were almost no e-cigarette brands with more than 20 mg of nicotine for each millilitre of e-liquid. That is the limit in Europe. But in North America, Juul contains 57 mg of nicotine. The federal government only limits nicotine to 66 mg or below.

The biggest change in the market, said Hammond, is that Juul designed a product that could deliver higher amounts of nicotine while remaining smooth tasting. The result has been high rates of nicotine addiction, mainly among youth.

Along with spiking teen vaping rates, dramatic and deadly cases of vaping-related illnesses have been in the news, especially in the U.S. where 52 people have died and more than 2,400 have been hospitalized. In Canada, 14 cases of vaping related illness have been reported.

The acute illnesses and deaths in the U.S. have been linked to the additive Vitamin E acetate in THC in most cases.

A study published in December, found e-cigarette users were significantly more likely to develop long-term chronic lung disease than non-smokers.

The issues have occurred against a backdrop of weak or non-existent federal regulations in Canada, which has been consulting on tougher regulations. Some provinces have toughened their laws, including a ban on the sale of flavoured vaping liquid in New Brunswick and a reduction in nicotine levels in British Columbia.

Hammond said Health Canada has failed to properly regulate the product and as a result has failed both the adult smokers who could use them to quit cigarettes and the teenagers who have become addicted to nicotine.

E-cigarettes, he noted, are less harmful than cigarettes, but they are also highly addictive: “It might not make sense to sell them beside the chips and chocolate bars.”

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Meanwhile, many of the adult smokers who could reduce their harm by switching to e-cigarettes are no longer interested. “Adults don’t want to go near them. Everyone sees this as something 15-year-olds grab on the way to a party.”

Ottawa’s Dr. Andrew Pipe said the federal government needs to step up with tougher regulations. The existing regulations are tepid, he said, and have left a regulatory vacuum. Even the changes announced at the end of the year do not come close to what he and others want to see — notably banning flavoured e-cigarettes.

Pipe, who is considered the country’s foremost expert on smoking cessation, was instrumental in developing the Ottawa Model for Smoking Cessation at the University of Ottawa Heart Institute. He wants to see flavoured e-cigarettes banned and limits on nicotine, in addition to the restrictions on where they can be sold and mandatory health warnings, which have been announced.

One of the sad ironies of the lack of regulation, Pipe said, is that the potential of e-cigarettes to be used as harm reduction “has now essentially been squandered. No responsible clinician is now going to entertain the use of e-cigarettes as a harm reduction aid. Their potential for harm reduction has gone out the window.”

Pipe urged the new federal minister of health to act strongly to turn around soaring youth vaping rates buy using emergency powers to expedite changes while longer-term regulations are being developed.

“We are dealing with an urgent, emergent public health issue which many have labelled a crisis.”

epayne@postmedia.com

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