We are always playing catch-up when dealing with substance-related epidemics. The opioid epidemic, showing no signs of abating, might have seen a different course had our regulatory authorities reigned in the pharmaceutical industry involvement in continuing medical education and physician training with regards to opioids and pain management. Industry officials proclaimed that opioids were entirely safe in managing pain and were "nonaddictive". Unfortunately, opioids are not effective for chronic pain conditions, and often exacerbate, and sometimes trigger substance use disorders in vulnerable individuals. Lawsuits may be putting Oxycontin's creator Purdue Pharma in a difficult position now, but so many lives have been lost, it's almost a case of too little... too late.
On the other hand, the highly addictive compound nicotine has seen a sharp decline in its use in cigarettes and loose tobacco smoking pipes for several decades. Smoking rates in the 1960s were roughly 60% for males, and 40% for females. Due to various public health interventions over the last several decades, cigarette smoking rates in Canada have been reduced to less than 20% for males, and 15% for females.
Unfortunately this positive public health trend is now seeing a dangerous counter-strike from the techno-cousin of the traditional cigarette, also known as the electronic cigarette, or simply e-cigarettes.
As early as 2008, the World Health Organization disputed claims by e-cigarette manufacturers that their products were effective in assisting in smoking cessation for smokers of standard cigarette products. Various conflicting studies have been conducted over the years, some finding evidence for harms related to e-cigarettes, and others either ending up inconclusive, or showing some benefit in reducing cigarette smoking.
The rise in popularity of e-cigarettes has been largely bolstered by the arrival of the e-cigarette manufacturer Juul onto the market about 10 years ago. Juul has largely targeted its marketing towards youth. In fact, I was asked about Juul a few years back when giving a Cannabis presentation to high school youth in Toronto. The student stated that her friends were already trying Juul, and that "it seemed to be a cool thing to do". Though underage, these students had no problem purchasing Juul products from various vendors, or simply obtaining it from older friends or siblings. With slick marketing campaigns targeting the youth, Juul sales skyrocketed over 700% in 2016. Juul had become so successful, it was encroaching on standard tobacco companies stock profits by 2017.
The shifting success raised alarm bells in public health circles, as more people became dependent on e-cigarette nicotine.
One of the first countries to regulate Juul was Israel in August 2018. Israel definitively banned e-cigarettes due to their high nicotine content, citing "a great risk to public health."
Somehow, this kick started the United States Food and Drug Administration (FDA) to investigate e-cigarettes further. The process has been ultimately accelerated in July 2019, when reports of e- cigarette users affected by severe respiratory disease and seizures emerged in the United States. The first confirmed person in Canada with e-cigarette -related illness has been recently identified in Québec.
According to Health Canada, e-cigarette -related illness (also known as vaping-related illness) is related to:
- Symptoms such as shortness of breath, cough, chest pain, with or without vomiting, diarrhea, abdominal pain, fever.
- History of vaping or dabbing (using THC concentrates like oil or wax) 90 days prior to symptom onset.
- Pulmonary infiltrate, which is a substance denser than air, such as pus, blood, or protein in the lungs.
- Negative results on tests for a lung infection.
- No evidence in medical records of alternative plausible diagnoses
Our southern neighbours In the U.S. have already seen more than 800 cases and 13 deaths due to vaping-related illnesses in 2019. The cases in Canada will likely increase as healthcare providers become aware of the case definition, and report cases public health authorities. And while scientists investigate possible causative factors behind vaping-related illnesses, the clear association of e- cigarettes to the severity of the illness morbidity and mortality from their use south of the border must behoove Canada to take action on regulating e-cigarettes to protect the public.
Our youth are most at significant risk due to aggressive marketing campaigns by e-cigarette companies, and the rapid uptake by younger people. A study published in the British Medical Journal last June found that the number of Canadian teens who said they had use electronic cigarette products in the last month had grown 74 per cent, from 8.4 per cent in 2017 to 14.6 per cent in 2018.
The long-term effects of e-cigarette use is unknown. E cigarette-related illnesses, which can occur with even with short-term use are still being studied.
It would be tragic and shameful if we allow e-cigarettes to seriously injure, render ill, or kill our society's youth when we could have done something to intervene. Health Canada, federal and provincial governments must act immediately to regulate e-cigarettes, inform and educate the public about the dangers of vaping in order to prevent a full-blown e-cigarette vaping epidemic. We must ensure that our federal politicians pay close attention to these issues, and enact legislation regulating e-cigarettes. Our youth deserve better.
https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html
https://www.cbc.ca/news/canada/montreal/vaping-related-illness-quebec-1.5299487
http://www.casaa.org/historical-timeline-of-electronic-cigarettes/
https://www.cbc.ca/news/canada/the-decline-of-smoking-in-canada-1.829017
https://www.cnn.com/2019/09/27/perspectives/vaping-epidemic-juul-e-cigarettes-fda/index.html