About 3.5 million Canadians smoke tobacco, part of the 1.3 billion people who do so worldwide.Carlos Jasso/Reuters
Remember when vaping was all the rage, hailed as a safe alternative to smoking tobacco?
In the decade or so since, use of vapes and e-cigarettes has come to be seen as just another menace to health, and denounced with as much zeal as cigarettes.
But that’s a wrong-headed and deadly approach, argues Dr. Mark Tyndall, former director of the BC Centre for Disease Control, in his new book Vaping: Behind The Smoke and Fears.
“Vaping is the very definition of harm reduction,” Dr. Tyndall writes in the taut 202-page treatise. “It’s a brilliant way to reduce the devastating global harm caused by cigarette smoking.”
Based on 2017 data, there are about 48,000 tobacco-related deaths every year in Canada, and more than 7 million die from it worldwide.
How many have died of vaping? Zero, or close to it.
About 3.5 million Canadians still smoke tobacco, part of the 1.3 billion people who do so worldwide. Every one of them is at risk of a broad range of health problems: Lung cancer, chronic obstructive pulmonary disease, and an increased risk of heart diseases and cancer.
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Vaping, on the other hand, does not cause any of those conditions. Smokers who switch see their health risks plummet. One well-publicized study found that vaping super-heated liquids was 95-per-cent safer than smoking combustible tobacco.
The key word there is safer. It is not 100-per-cent safe, absolutely. But as Dr. Tyndall writes, the “relative safety of vaping is not debatable.”
Canada has embraced harm reduction policies in many areas. Take alcohol, for instance. It’s a product that causes much harm to everything from individual health to social order – but instead of banning it, we regulate it. We even widely license safe consumption sites, which we call bars.
We also have implemented harm reduction policies for hard drugs, with needle exchanges, supervised consumption sites, safer supply programs, distribution of naloxone kits, and more. Again, drugs like fentanyl are not safe, but we can keep users safer with compassionate public policies.
Harm reduction is also a commonplace approach in medicine. We routinely prescribe drugs with all manner of side effects because the benefits are seen as outweighing the harms.
But for some reason, applying this approach to tobacco is a non-starter. Instead, public health embraces a prohibitionist mindset.
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A 2022 Lancet Commission report, for example, called for “prohibiting all kinds of smoking, including – but not restricted to – cigarette smoking, water-pipe smoking, e-cigarette smoking (vaping), cannabis smoking, and smoking of other combustible substances.”
Yet history has proven, time and time again, that prohibition doesn’t work.
People put harmful products into their bodies, mostly because it gives them pleasure or succor. From a public health perspective, the best we can do is to try to reduce the harm, without denying the enjoyment or relief.
There’s an old adage that people smoke for the nicotine, but die from the tar. E-cigarettes and vapes deliver the nicotine without the tar and most other carcinogens.
Nicotine is undeniably addictive. But it’s also relatively harmless.
The moral panic around vaping has largely been driven by a desire to protect youth, out of a belief that younger generations will be hooked on nicotine and turn to smoking.
Some research suggests young people who vape are more likely to smoke. But aren’t they the same kids who would have smoked anyhow? Vaping has been mainstream for decades, and smoking rates among young people continue to fall. And for those who do, having them vape instead would be better.
Regardless, concerns about youth vaping don’t justify denying long-time smokers an important harm reduction tool.
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The focus on protecting youth and the embrace of myths and conspiracy theories – vaping is as dangerous as smoking because e-liquids are poison; Big Tobacco is trying to hook everyone on nicotine – have blinded politicians, policy-makers and public health officials to the benefits of vaping as a safer alternative for existing smokers.
In his book, Dr. Tyndall says vaping should be regulated and viewed differently than smoking. He argues that we should allow vaping in non-smoking areas, tax vapes differently than tobacco, end the ridiculous restrictions on flavours, provide e-cigarettes to groups with high smoking rates, such patients with mental illness and prisoners, and view “dual users” (people who vape and smoke) not as a failure, but a partial victory.
In other words, we should treat vaping like a therapeutic treatment for smoking the way we view antidepressants for those with depression: not as a cure-all, but as a health benefit.
We shouldn’t deny an effective smoking cessation tool to smokers because of abstinence-only dogma. Rather, we need to recognize vaping for what it is: a disruptive technology that can substantially reduce the burden of illness and death in smokers.