The CMA has taken a strong stand against the sale of electronic cigarettes by endorsing a series of recommendations from its Committee on Health Care and Promotion. Currently, e-cigarettes are not regulated or approved for sale in Canada.
However, they are readily available here, despite a 2009 Health Canada notice stating that "persons who may be importing, advertising or selling electronic smoking products without the appropriate authorizations are asked to stop doing so immediately."
The recommendations approved by the CMA Board state:
- in the absence of "solid evidence" of harms or benefits, the sale of e-cigarettes containing nicotine should not be allowed;
- there should be a ban on the sale of all e-cigarettes to minors (some e-cigarettes contain no nicotine);
- there should be ongoing research into the potential harms and benefits of e-cigarettes.
E-cigarettes have been growing in popularity because they are seen as an alternative to tobacco, with supporters arguing that the products are safer than tobacco because they do not contain tar or other toxic ingredients. In the US, where the products can be sold legally, sales are expected to approach $2 billion this year.
However, opponents are concerned that the use of e-cigarettes is addictive and may serve as a gateway to the use of tobacco. "The CMA is urging caution, and with good reason," says CMA President Louis Hugo Francescutti. "As physicians we have come too far in the fight against smoking and tobacco use in general to suddenly say, 'Here's a new nicotine product that's totally safe and won't encourage tobacco use.' Frankly, we don't know."
In a recent editorial, CMAJ called for e-cigarettes to be regulated in the same way as drug-delivery devices.
Dr. Matthew Stanbrook, CMAJ's deputy editor, said the growing popularity of the liquid nicotine products, which are converted into vapour by electronic devices that resemble cigarettes, raises several issues.
"[Their rising popularity] is paralleled by growing controversy over whether e-cigarettes represent a highly promising therapeutic intervention for smoking cessation or a Trojan horse that will allow the tobacco industry to reverse decades of global progress in reducing smoking prevalence," he wrote.
Stanbrook, a respirologist at the University of Toronto, concluded: "We must not be so easily lured by the illusion of a safe substitute for cigarettes that we yield precious ground in the war against tobacco."