As the e-cigarette debate in Ontario heats up, is the whole point of smoking cessation being lost in the shuffle?

This is bound to be an exciting year for anti-tobacco advocates in Ontario.

On one hand, the national smoking rate is at an all-time low, with only 15 per cent of Canadians choosing to light up. On the other hand, one should also consider the skyrocketing popularity of electronic cigarettes (or e-cigarettes), products that—depending on who you talk to—could potentially revolutionize the way people kick the habit for good.

Kayleigh Holden, a second-year criminology student from the University of Ottawa, knows about this  first hand.

Since high school, Holden was a pack-a-day smoker, a habit that left her in mental and physical disarray.

“It affected everything. It affected my health, it definitely affected my bank account, my motivation, my ability to have any kind of patience with people. I was completely unable to deal with stressful situations unless I had a cigarette or I was able to go out for a cigarette.”

After several failed attempts to butt out over the years, Holden finally found salvation in October of 2015 by switching over to e-cigarettes. While these battery powered devices still contain nicotine, they are completely lacking in tobacco, tar, polonium-210, or any of the other thousand harmful ingredients that are responsible for the death of around 37,000 Canadians every year.

According to Holden, the switch from smoke to vapour has made a noticeable difference in her day-to-day life, even over a short period of time.

“When you’re a smoker your smell, your taste is completely desensitized, and with the e-cigarette you get that back,” she said. “I still do feel a little bit of tightness in my chest, but it’s nowhere near compared to the pain, the chest pain, and the heart pain you get when you are smoking cigarettes.”

Despite testimony from users like Holden, the prospect of utilizing e-cigarettes as an aid to quit smoking is a divisive subject among lawmakers and health care professionals. Many are uneasy about the fact that the long-term effects of using e-cigarettes are not known, since these devices have only been on the market since 2004.

In this light, the Ontario government is looking to play it safe when it comes to this issue, as they are currently in the process of trying to ban vaping in public places through the Making Healthier Choices Act.

But is this move justified? Should e-cigarettes be treated the same as your typical over-the-counter smokes? Or should the provincial government recognize them as a “healthier” or—at the very least—less dangerous alternative to the world’s leading cause of preventable death?

Fear of the Unknown

It’s easy to see where this apprehension surrounding e-cigarettes comes from.

After all, even though these products have been circulating in the North American market for barely a decade, the e-cigarette industry has been growing wildly and is now worth $140 million in the Canada market alone. Some even predict that e-cigarette sales will eventually surpasses that of tobacco products.

As with most rapidly expanding technologies, e-cigarettes are shaking up the status quo—a situation which has left politicians scrambling to come up with federally mandated laws and regulations.

Aside from a totally impotent ban issued by Health Canada in 2009, e-cigarettes are regulated from province to province—and sometimes city to city— leading some to refer to Canada as “the Wild West” for vaping manufacturers and retailers.

This “Wild West” mentality even extends to information about these products, as the scientific community grapples with conflicting studies and information, mostly stemming from the fact that they only have access to short-term data about the benefits and drawbacks of e-cigarettes.

This lack of long term research is particularly concerning to medical professionals like Dr. David Stewart who, as the Head of the Division of Medical Oncology at the Ottawa Hospital, is expected to make decisions based on empirical scientific evidence to ensure his patients’ safety.

When asked if he would ever recommend an e-cigarette to a patient to help them quit smoking, Dr. Stewart said he wouldn’t without having more data that proves it is more likely to be successful.

“I’d be willing to guess that cigarette smoke itself is more harmful, but the nicotine itself can drive tumour cell growth,” said Stewart. “So… it’d be better still if people quit completely rather than going to e-cigarettes.”

Even those who benefit from e-cigarettes are wary of the potential long terms effects.

Holden comments that she’s in favour of the Ontario government’s proposed ban, at least when it comes to vaping indoors.

“Regardless of whether it’s ‘bad’ for you or not, it still smells. It smells like whatever flavour you have,” she said. “So I’m in favour of it just purely because of the fact that if I was not a smoker I would not want my personal space intruded upon like that.”

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Photo: Spencer Murdock

Some health websites also point to the four ingredients that are typically found in e-cigarette liquid as a point of contention.  Most of the attention is paid to one ingredient in particular, propylene glycol, since it is a main ingredient in antifreeze and a known irritant when inhaled.

There are also concerns that vaping attracts more of a younger crowd, especially since a recent national survey revealed that 20 per cent of Canada’s youth have tried e-cigarettes (compared to the 15 per cent smoking rate).

“I have friends who bought vapes with no nicotine in them just to practice smoke tricks,” said Holden, reflecting on this concern. “And then they hit their friends’ vape that has two milligrams or four milligrams of nicotine and you get… a bit of a throat kick, like a little feeling in your chest and a little buzz.”

“The addiction starts from there,” she said.

The Ontario government is using these kinds of sentiments to fuel their latest legislation, an act that will largely put e-cigarettes on the same legal standing as the combustible variety.

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Photo: Kim Wiens

Harm Reduction

One of most vocal opponents of this ideology in Canada is David Sweanor, an adjunct professor of law from the U of O and a member of the university’s Centre for Health Law, Policy and Ethics.

Sweanor laughs off his critics who say that he holds any kind of sympathies towards Big Tobacco, since he has been a renowned and leading expert in tobacco control for the past 30 years.

As such, his main reason for supporting the growth of the e-cigarette industry stems from his belief in its value as a method of harm reduction.

He likens e-cigarettes to public health staples like condoms or seat-belts, products that are designed to lessen the damage that could be done in potentially dangerous situations.

“The death rate on our roads now, per mile driven, is down by over 80 per cent since the time I was a teenager. We did that, and we did that on a range of products,” he said, referring to automobile safety innovations such as collapsing steering columns and safety glass. “We change things. We didn’t ban (cars). We facilitated a change to less hazardous products.”

Sweanor also points to the fact that an “abstinence only” approach to smoking cessation is not realistic for the majority of the smokers who are addicted to nicotine, as studies have shown that only four to seven per cent of people are capable of quitting without additional help. Instead, Sweanor believes that  e-cigarettes provide a weaning off effect that is much more effective.

This is largely the same method that allowed Holden to lower her nicotine intake and kick her pack-a-day habit.

“My e-cigarettes still contain nicotine, because the way I’m doing it is that I’m slowly cutting back. Every time I go buy a new bottle of juice I go down between two and four milligrams, so I have been able to be more tolerant towards people, be more patient, be able to deal with stress a little bit better.”

Derek Young, the manager of the local e-cigarette outlet Sir-Vape-A-Lot, frequently observes this kind of behaviour in his returning customers, stating that they don’t necessarily like the taste of tobacco.

Young’s survey of his clientele also challenges the pervasive fear of e-cigarettes acting as a gateway to real cigarettes for minors.

“I would say 99 per cent of the people who walk through that door are smokers,” he said, mirroring a recent report by Public Health England that found that most e-cigarette users are conventional smokers rather than curious newcomers.

“Yes, there are the one per cent who… may not smoke and we usually try to suggest that they may not want to pick up some sort of habit like this.”

Even discounting the potential health benefits surrounding vaping, former smokers like Holden will tell you that e-cigarettes are also much cheaper than traditional cigarettes.

Holden is already reaping the rewards from this economic reality, claiming to save $60 every week after switching to e-cigarettes. Sources like Time and Nerd Wallet back up this claim, calculating that packet-a-day smokers like Holden could potentially save an average of up to around $1,200 a year.

So, while figures like Sweanor, Holden, and Young don’t pretend that e-cigarettes are the equivalent of an hour-long workout at the gym, they do recognize their potential to cushion the blow of a dangerous habit, especially when it comes to your body, your nerves, and your wallet.

Moralistic vs. Practical

However, in Sweanor’s mind, the government’s plans to put e-cigarettes on the same level as regular cigarettes is not just uninformed, it could be downright dangerous.

By reinforcing the social stigma that e-cigarettes are just as bad as the real thing, Sweanor believes that Ontario lawmakers are betraying the very idea of public health and harm reduction.

“The vast majority of those people who are going to die this year have been saying for a long time ‘I wish I didn’t smoke.’ They’ve been trying to quit. Many of them are addicted to nicotine to the point that they’re not going to be able to quit,” he said, referring to the fact that nicotine, despite not causing cancer, is still one of the most addictive drugs in the world outside of heroin and crack cocaine.

“Why are we trying to make it harder for them to do what they want, rather than trying to find a way to facilitate it?”

This stance echoes a pattern of behaviour that he has observed amongst many of his anti-smoking colleagues in the field of public health over the years, where they “decided it was a moral issue rather than a public health one.”

“So it was no longer about ‘I want to reduce death and disease’. It was no longer about reducing smoking as a way to achieve that, it was a matter of saying, ‘we want to attack anything this industry makes or anything made by anybody who even looks like this industry.’”

“Sadly, the collateral damage from that is the lives of the untold thousands of smokers who could have otherwise been helped through the application of the sort of harm reduction principles that we apply on every other health issue.”

New Year’s Resolution

Ironically, while the passing of the Making Healthier Choices Act aims to create consistent legislation for tobacco-related products, it’s already starting to make things more complicated for Ontario lawmakers.

Sweanor points out that the province’s plans for vaping are already butting heads with the Trudeau government’s federal mandate to decriminalize recreational cannabis, a factor that caused the proposed vaping ban to be moved from Jan. 1, 2016 to later in the year.

“How can you be advising people who are using marijuana to vape it while trying to prevent people who are smoking from vaping to get their nicotine? There’s a huge inconsistency there,” said Sweanor.

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Photo: Kim Wiens

In terms of the e-cigarette business, Young is concerned about the economic ramifications of this vaping ban, but remains convinced that his business has room to grow.

“We have a great clientele, we get feedback every day that people love our service, we’re friendly, we’re helpful… we fully expect to expand.”

Between all these talks of regulation and harm reduction, hopefully most lawmakers and health care advocates can at least keep one goal in mind—the goal that a former smoker, like Holden, might be working towards.

“I do want to stop vaping eventually, because my goal is to not be smoking anything.”