LETTER: Council of Chief Medical Officers of Health on vaping in Canada concerned with hazards of vaping

We are increasingly concerned by the substantial rise of vaping among Canadian youth. As nicotine in any form is highly addictive, non-smokers who vape products containing nicotine are at risk of going on to use tobacco products such as cigarettes.

As we stated in April 2019, Canada has seen the rates of youth smoking decline significantly in recent years, but youth are now turning to vaping in large numbers. We are very concerned that a new generation of youth addicted to nicotine will lead to a resurgence in smoking—reversing decades of progress and creating new public health problems.

Youth are particularly susceptible to nicotine’s negative effects, which can include altering their brain development and affecting their memory and concentration.

While the harms of vaping products are starting to emerge, researchers are still gathering data on their potential effectiveness as a means of helping smokers quit smoking. What we do know is that, regardless of a person’s age, vaping can lead to nicotine addiction and can increase exposure to harmful chemicals for people who are non-smokers.

Individuals who use vaping products breathe in a mixture of chemicals, which include harmful and potentially harmful substances such as nicotine, solvents, cancer-causing chemicals (e.g., formaldehyde), heavy metals and flavourings. It is also not clear what underlying risk there may be from inhalation of ultra-fine particles created by the mechanism of vaping technology that permits inhalation deep into the lung.

Some chemicals (e.g., flavourings) in vaping products may be safe to eat, but have not necessarily been tested for safety when inhaled. Limited information is available on the health effects of inhaling glycerol (a common vaping diluent) and the majority of flavourings used in vaping liquids.

We cannot stand by and watch a new generation of Canadians become dependent on nicotine or be exposed to products that could have significant negative consequences for their health.

We are also very concerned about the emergence of severe pulmonary illness related to vaping in the United States and now in Canada. We have been working together to monitor the situation closely, to identify potential cases in Canada, and to support the investigation into the cause(s) of the illnesses.

To date, the investigation into severe pulmonary illness in the United States suggests that products containing tetrahydrocannabinol (THC) play a role in the outbreak. The suspected cause is a chemical exposure, but the specific chemical or chemicals remain unknown at this time. No single product or substance has been linked to all cases, and more information is needed to know whether a single product, substance, brand or method of use is responsible for the outbreak.

While the severe pulmonary illnesses related to vaping are under investigation, we recommend to all Canadians that:

  • You consider refraining from using e-cigarettes or vaping products, particularly any products that have been purchased illegally, including any products that contain THC. Cannabis use has risks, some of which remain unknown and can have short- and long-term harms to your health, including dependence.
  • You see a healthcare provider immediately if you have recently used vaping products and you have symptoms of pulmonary illness (e.g., cough, shortness of breath, chest pain) like those reported in the outbreak.
  • You not return to smoking cigarettes if you are using nicotine-containing vaping products as a means of quitting cigarette smoking.

Even in the absence of the severe pulmonary illnesses related to vaping, Canadians should remember that:

  • If you don’t smoke, don’t vape.
  • Vaping is not recommended for youth, pregnant women, or adults who do not currently use tobacco products.
  • Youth who vape should seek support to quit completely.
  • Youth and adults currently vaping nicotine should NOT switch to smoking tobacco products.
  • If you use vaping products, do not buy them from illegal or unregulated sources, including products containing THC. Products obtained from the illegal market are not subject to any controls or oversight and may pose additional risks to your health and safety.
  • You should never modify vaping products or add any substances to these products that are not intended by the manufacturer.
  • You should let your health care provider know about your vaping history, especially if you have respiratory symptoms.

Adults and youth needing support to deal with nicotine addiction, whether they are using tobacco or vaping products, should speak to their health care provider and seek out proven cessation therapies, such as medication, or approved nicotine replacement therapies, such as gums, patches and lozenges. Canadians can also access supports from trained specialists who can help them develop a quit-smoking plan and provide referrals in their community.

We reiterate our call from April: We need to create environments that prevent youth vaping by strengthening regulatory frameworks and policies that restrict the accessibility and availability of vaping products and reduce the appeal of such products to youth. This includes plain packaging, health warnings and regulating the sale and marketing of vaping products and flavourings, and putting in place school and community policies that reduce use and encourage positive youth development.

In Canada, we have seen the first cases of pulmonary illness related to vaping and a number of other incidents are under investigation. Together with colleagues in the United States, we are all doing our part to find out what is causing these illnesses. Until more is known, we repeat our call for Canadians to consider refraining from vaping.

Dr. Theresa Tam
Chief Public Health Officer of Canada

Dr. Bonnie Henry
Provincial Health Officer, British Columbia
Chair, Council of Chief Medical Officers of Health

Dr. Brendan E. Hanley
Chief Medical Officer of Health, Yukon
Vice-Chair, Council of Chief Medical Officers of Health

Dr. Janice Fitzgerald
I/Chief Medical Officer of Health, Newfoundland and Labrador

Dr. Heather Morrison
Chief Public Health Officer, Prince Edward Island

Dr. Robert Strang
Chief Medical Officer of Health, Nova Scotia

Dr. Jennifer Russell
Chief Medical Officer of Health, New Brunswick

Dr. Horacio Arruda
Director of Public Health and Assistant Deputy Minister
Ministry of Health and Social Services, Québec

Dr. David Williams
Chief Medical Officer of Health, Ontario

Dr. Brent Roussin
Chief Public Health Officer, Manitoba

Dr. Saqib Shahab
Chief Medical Health Officer, Saskatchewan

Dr. Deena Hinshaw
Chief Medical Officer of Health, Alberta

Dr. Michael Patterson
Chief Medical Officer of Health, Nunavut

Dr. Kami Kandola
Chief Public Health Officer, Northwest Territories

Dr. Evan Adams
Chief Medical Officer, First Nations Health Authority, British Columbia

Dr. Tom Wong
Chief Medical Officer, Public Health, Indigenous Services Canada

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