The CMAJ editorial, in which Stanbrook1 calls for e-cigarettes to be regulated as drug-delivery devices, raises important issues about this controversial new product.
Stanbrook1 asserts that Health Canada’s laws governing e-cigarettes are “among the most restrictive in the world.” Yet, tobacco companies promote e-cigarettes to youth in Canada as much as they do in the United States, and e-cigarettes that contain nicotine are openly sold at retailers.
Having strict regulations but turning a blind eye to violations sends a mixed message and does a disservice to both smokers and health practitioners seeking guidance on smoking cessation products. So, too, do misleading assertions from the health community, such as Stanbrook’s1 statement that a recent randomized controlled trial of e-cigarettes published in The Lancet “ … failed to show superiority over a nicotine patch …”2 Equally true is the assertion that e-cigarettes were found to be as effective as the patch in helping smokers quit.2
Support for e-cigarettes is not predicated merely on “ … the assumption that their availability will lead to cessation of tobacco use,”1 but rather on a growing body of research evidence that includes two published randomized controlled trials.2,3
The most effective way to maximize the potential of e-cigarettes as cessation aids, while minimizing the risks they pose to successfully denormalize tobacco use, is to regulate all e-cigarettes as tobacco products. The federal, provincial and territorial governments should impose the same restrictions on all e-cigarettes (i.e., those that contain nicotine and those that do not) that they impose on tobacco products. This would mean that e-cigarettes could not legally be sold to minors; could not be marketed via prominent retail displays, lifestyle advertising or celebrity endorsements in magazines and on television; would be subject to limits on youth-friendly flavourings and to meaningful warnings on relative risk; and could not be used in schoolyards, workplaces and other public places where smoking is banned.
It will be some years before we have definitive answers regarding e-cigarettes. In the meantime, Health Canada needs to enforce basic consumer safety standards to reduce risks from faulty products. Governments need to finance more research on safety and efficacy of e-cigarettes as cessation aids; and, critical tobacco-control gains must be protected by subjecting e-cigarettes to the same regulatory controls as tobacco products.