E-cigarettes are often described as a less dangerous alternative for regular smokers who can't or don't want to kick the habit. The battery-powered devices use a liquid to produce vapour, which is then inhaled. Some of the vapours are infused with nicotine, some aren't.
In Canada, however, there are no e-cigarettes with nicotine that are legally approved for sale. Electronic cigarettes that do not contain nicotine are legal and readily available, in many places to minors as well, as long as they make no health claim.
Under-the-counter nicotine products for e-cigarettes are easy to purchase at vape shops, says Melodie Tilson, policy director at the Non-Smokers' Rights Association, who adds:
"We want to make sure these products don’t undermine the success we’ve had in reducing smoking rates."
E-cigarettes split health community
The main argument made by e-cigarette proponents is that they have the potential to save lives.
As e-cigarettes don't contain tobacco and produce vapour instead of smoke, they can potentially help smokers quit, either by providing an alternative oral fixation or a substitute nicotine source.
Banning them would be "a really stupid idea," says e-cigarette supporter David Sweanor, a law professor at the University of Ottawa.
"If we look at Canada, for instance, we know that in the next 25 years, based on current trends and consumption, a million of our fellow Canadians are going to die as a direct result of cigarette smoking," he says.
With projections that e-cigarettes will outsell regular cigarettes within a decade, "people are saying that you need to allow an e-cigarette with nicotine in Canada, because smokers want to use them and they are trying not to die from smoking," says David Hammond, associate professor at the School of Public health at University of Waterloo.
"But," he cautions, "many consumers don’t even know if the e-cigarettes they are smoking contain nicotine or not."
Health questions unanswered
E-cigarette skeptics and even Health Canada agree that e-cigarettes are safer than tobacco cigarettes.
"Are e-cigarettes less harmful than cigarettes? Yes, because the products contain no tobacco, nor tobacco smoke," the Canadian Cancer Society says. "At the same time, the long-term health effects are not yet known, and effects may vary depending on a particular e-cigarette."
It’s the potential long-term effects — and lack of regulation — that have critics shouting the loudest.
Whether they contain nicotine or not, e-cigarettes may pose health risks when consumed in large doses or over long periods of time.
E-liquid contains propyleneglycol (PG), a common food additive and flavouring. While PG is considered safe for oral consumption, the health risks of inhaling PG deep into the lungs is unknown.
"We know e-cigarettes are significantly less harmful than smoking. But we also know e-cigarettes aren’t going to be safe for long-term use," says Hammond.
"Inhaling any chemical, nicotine or otherwise, deeply into lungs there is going to be some risk. We have very little information about what’s in that liquid."
PG is the main ingredient in theatre fog, but that is only inhaled occasionally, not a dozen times a day over months or years as an e-smoker might.
"It is a major health question to which we won't have an answer for probably decades," says Tilson at the NSRA.
"E-cigarettes are expected to be dramatically safer, but that doesn’t mean they are safe, or as safe as they should be."
Electronic cigarettes are evolving in terms of their product design. Some are disposable, some are refillable, and some are rechargeable.
But due to an inability to ensure quality controls, e-cigarettes and e-liquid cartridges are not manufactured to approved consumer safety standards.
"If the battery is too high, you can get combustion. And as soon as you get combustion then you get a different set of chemicals, which starts to look closer to what’s in actual smoke," says Hammond.
Some health advocates warn that the flavoured liquid solutions could contain harmful chemicals.
"We are not quite sure what the long-term impact of inhaling e-cigarette liquid is," said Lesley James, a senior health policy analyst for the Heart and Stroke Foundation.
"To date there is not sufficient evidence that the potential benefits of e-cigarettes in helping Canadians to quit smoking outweigh the potential risks," said Health Canada spokesman Gary Holub.
Anti-smoking campaigns gone bust?
Public health advocates say they're concerned that e-cigarette use is "normalizing" cigarette smoking for minors, giving a dangerous habit that's widely restricted a whole new image, and acting as a gateway to nicotine addiction or to smoking.
"Until we have the evidence on electronic cigarettes, all we’re saying is ‘Let’s not get our kids started on this,’" said Dipika Damerla, Ontario associate minister of health and long-term care.
"We’re re-normalizing the act of smoking," said André Beaulieu, spokesman for the Canadian Cancer Society. "We want to avoid a new generation of smokers."
Some health advocates also worry that e-cigarettes will just be used to supplement smoking in places where smokers aren’t allowed to light up.
E-cigarette industry ‘like the wild West’
In Canada there has been a significant rise in the use of e-cigarettes by young people, and a recent survey found e-cigarettes have surpassed regular smoking by U.S. teens.
In the 2012-2013 school year, a third of secondary school students reported already having used e-cigarettes, according to research commissioned by the Canadian Cancer Society in Quebec.
It also found that for the 2012-13 school year, nine per cent of students in Grade 6 had tried e-cigarettes. And among Grade 11 students, 41 per cent had tried e-cigarettes.
"The electronic cigarette industry has really succeeded in positioning its product as something attractive for children. That’s far from being a quit-smoking aid. It’s reprehensible," says Mélanie Champagne, director of public issues at the Canadian Cancer Society in Quebec. "Vaping is not a game for schoolyards."
Newfoundland and Labrador Federation of School Councils president Peter Whittle says, "Right now, the sale to minors is a grey area. That needs to change."
Lack of federal or provincial regulations around the sale and use of e-cigarettes makes policing the issue "like the wild West," he said.
Though now provinces are increasingly legislating non-nicotine e-cigarettes, banning their sale to kids, banning the promotion of flavours popular with kids and banning their use where cigarette smoking is not allowed.
A range of jurisdictions, from provinces like Ontario and Nova Scotia to cities and school boards, have banned or are proposing to ban or limit the use and sale of e-cigarettes.
"I think we’ll see a lot more activity on this front next year," said Tilson. "We’re just beginning to see action.
"The provinces and territories have been pushing for collaborative action across the country. They don’t want to see a patchwork quilt of different approaches."
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