Warning against vaping products with or without nicotine

"Vaping products with or without nicotine" means any electronic device that diffuses a liquid solution in the form of vapour that is inhaled by the user, reproducing the action of smoking. For the purposes of this warning, the term also includes other equivalent products such as cigarettes, cigars, e-boxes and pipes as well as liquid cartridges. Vaping products can contain many chemicals. Most vaping substances available on the market are flavoured and contain nicotine.

Since vaping products came onto the market in Québec, the Ministère de la Santé et des Services sociaux has been monitoring their evolution closely. As early as 2012, the national director of public health warned the population against these products, asking them to refrain from using them until more is understood about their health effects. Several other actions have been taken since then to better regulate vaping products, inform and protect the population. These products are now subject to the same rules as tobacco products under the Tobacco Control Act, youth vaping prevention campaigns have been carried out, tools and projects on the ground have been developed, etc.

The situation has changed rapidly in recent years and data from recent surveys reveal that vaping products are becoming increasingly popular, especially among young people. In Québec, in 2016-2017, 26% of high school students reported ever using an e-cigarette and 10% of high school students reported using one in the past 30 days according to the Canadian Student Tobacco and Drugs Survey. This situation is very worrying, especially considering that young people are particularly vulnerable to nicotine, a substance found in most vaping devices. Indeed, nicotine can alter brain development, impair memory and concentration, in addition to creating addiction.

Meanwhile, in recent months, more than 2000 cases of vaping-associated lung illness (VALI) have been reported in the United States, and several dozen deaths have been confirmed. A large proportion of those affected are under 35 years of age. The vast majority (86%) of those affected reported using products containing cannabinoids and a large number (64%) reported using nicotine-containing products. Some used both substances, while others used one type of product exclusively. In Québec, three cases of VALI have also been confirmed more recently. These cases are associated with the use of legal nicotine vaping products. The cause of these illnesses remains unknown. No product, ingredient or component seems to emerge as the sole cause and the causes could be multiple. Many substances and products are being studied at the moment. A situation update on vaping-associated lung illness can be found on the page Vaping-associated lung illness.

Some studies argue that e-cigarettes could help manage withdrawal symptoms and make it easier to quit smoking. However, the limited number of rigorous studies does not make it possible to decide on the effectiveness of using vaping products to quit smoking. For a product to be officially recognized as a smoking cessation aid, it must be approved as such by Health Canada. To date, no vaping product manufacturer has obtained the federal authorities’ approval. Remember that combining vaping products and conventional tobacco products is not recommended. Indeed, there is no safe threshold for using conventional tobacco products. Furthermore, the short- and long-term health effects of vaping products on users and those who breathe in aerosols is poorly documented.

Considering recent very worrying events and based on the credible scientific data available, Québec’s national director of public health warns the public against vaping products. He asks Quebecers to refrain from using vaping products, whether or not they contain nicotine. More specifically, he recommends:

• that young people, pregnant women, non-smokers, including former smokers, refrain from using vaping products, whether or not they contain nicotine
• that smokers who are in the process of quitting smoking use the pharmacological aids recognized by Health Canada and the free national support services available:
  • I QUIT NOW helpline: 1-866-527-7383
  • I QUIT NOW website
  • Smoking cessation centres (SCCs)
  • Smoking cessation text messaging service (in French only)
• that vaping product users:
  • not start smoking cigarettes again if they are using nicotine vaping products to quit
  • make quitting vaping products their next step
  • contact a health professional for advice on quitting vaping,
  • avoid modifying or using vaping devices and liquids in a manner not intended by the manufacturer
  • watch for the appearance of symptoms of lung illness such as coughing, shortness of breath or chest pain and seek medical attention promptly if necessary

The situation regarding vaping products is likely to evolve and will continue to be monitored closely by the Ministère de la Santé et des Services sociaux.

Annie Montreuil and Michèle Tremblay. Mesures règlementaires visant à réduire l’accessibilité et l’attrait des produits de vapotage pour les jeunes. Institut national de santé publique, 2019, pp. 1-42. In French only.

Lori Diemert, Dina Bayoumy, Hayley Pelletier, Robert Schwartz and Shawn O’Connor. E-Cigarette Use for Smoking Cessation: Scientific Evidence and Smokers’ Experiences. Ontario Tobacco Research Unit, 2019, pp. 1-15.