More than one way to help smokers

There is currently much attention being paid to the need to update the regulation of tobacco and nicotine products in Canada. The main debates centre around non-combustible innovations in tobacco and nicotine products — particularly e-vapour technology or “vaping” as it is commonly referred to and a proposed law designed to provide a regulatory framework for vaping being deliberated in Parliament this month.

Vaping has gained tremendously in popularity in recent years, with some studies suggesting e-vapour use is as much as 95-per-cent less harmful than smoking combustible cigarettes. Governments everywhere are grappling with e-vapour technology and how best to regulate it, and Health Canada is presently conducting consultations.

The problem with the consultations (and the Canadian approach in general) is that the larger public health opportunity presented by reduced-risk tobacco products is being overlooked. As the federal government has stated on several occasions, effective regulation must be science- and evidence-based. Science and evidence clearly demonstrate that it is the pro- cess of setting tobacco on fire, combustion, that is responsible for many of the harms associated with smoking. Yet it must be recognized that there is no single non-combustible product that appeals to all adult smokers. While switching to e-vapour could help some smokers seeking a potentially reduced-risk alternative to cigarettes, switching to other non-combustible tobacco products like oral smokeless tobacco could be another alternative.

It’s time for some innovative thinking on tobacco regulation. The Canadian government should allow adult tobacco consumers to receive accurate information about the relative risks of different tobacco products under an established, science-based regulatory framework. The House of Commons has scheduled committee hearings in the next two weeks to examine legislation, Bill S-5, already adopted by the Senate, which doesn’t allow tobacco manufacturers to tell adult smokers if their products are proven to be less harmful than combustible cigarettes. It does, however, create this framework for e-vapour manufacturers – implying that e-vapour is the only potentially reduced-risk product that adult smokers should consider switching to.

We are encouraged to see the government recognize that there is a role for reduced-risk products as part of a national effort to reduce the harm caused by smoking. However, the goals of tobacco harm reduction can only be achieved if smokers actually know about the relative risks of tobacco products and, as a result, choose to use products that present lower risk than cigarettes.

Despite the overwhelming scientific consensus that smokeless tobacco products like the ones sold in Canada are substantially less harmful than cigarettes, a recent study shows that Canadian smokers continue to hold misconceptions regarding the relative risks of tobacco products. Bill S-5 must be amended to allow manufacturers of tobacco products that may be proven to be less harmful than cigarettes — like smokeless tobacco — to communicate accurate, government-authorized relativerisk information to adult consumers.

Elsewhere, attitudes are changing. On July 28, 2017, the U.S. Food and Drug Administration released a policy statement that articulated a continuum-of-risk for tobacco and nicotine across different product categories. FDA Commissioner Scott Gottlieb stated: “we must acknowledge that there’s a continuum of risk for nicotine delivery. That continuum ranges from combustible cigarettes at one end, to medicinal nicotine at the other.” He continued, “We must recognize the potential for innovation to lead to less harmful products, which under FDA’s oversight, could be part of a solution.”

Of course cessation and prevention efforts should remain the cornerstone of tobacco-control efforts. Yet there is a segment of the adult population that will not quit smoking, or simply chooses to use tobacco products. Canada has an opportunity to reduce tobaccorelated harm by helping individuals who would otherwise continue to smoke cigarettes move to demonstrably less harmful products. Canadian regulators should seek inspiration from the FDA and adopt a comprehensive tobacco harm-reduction strategy that acknowledges the risk differential between combustible and non-combustible tobacco products, including smokeless tobacco, if authorized by the government. Alongside existing prevention and cessation strategies, this kind of approach might encourage smokers to switch to less harmful products, and thereby reduce smoking-related disease and death in Canada.