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Nov 22 Update: The war on vaping

As the incidences of EVALI continue to plummet in the U.S., and despite the CDC's formal identification of Vitamin E acetate as the main culprit, we continue to face attacks on vaping in Canada from recycled old news that has been debunked multiple times over the past 6 years. First, some helpful stats:

Does anyone remember popcorn lung?  Since news has been slow on the THC-related vaping illnesses, some news outlets are now taking the first patient in Canada from London Ontario back in September and reporting they think it's possible this patient may have popcorn lung despite the lack of this diagnosis, and they continue to ignore the fact that he was adding his own THC solutions to his vape.  They are also continuing to ignore that the CDC has confirmed Vitamin E acetate, which is ONLY used as a thickener in THC vape liquids, is back to being chemical suspect number 1.  The patient also purchased his products from the States; ground zero for Vitamin E acetate tainted THC.  We've been quite familiar with "popcorn lung" since 2013, so we're happy to educate.  Here are the facts:

Popcorn factory workers that are exposed to a variety of chemicals (often heated) won lawsuits against the factories when they became ill with bronchiolitis obliterans (aka popcorn lung).  The claim was that it was caused by a flavouring chemical called "diacetyl."  Anyone that knows the story of "caution hot" on coffee cups from McDonalds knows that you can pretty much sue any big company in the States for just about anything and win millions of dollars.  To be certain though, popcorn lung is in fact very serious and causes irreversible damage to the lungs.  However, there are a few problems with the story.

Of course we dove right into the scientific literature as soon as we became aware of the supposed link. 

  1. This supposed link has been studied, but nowhere in the current body of scientific literature does such a link actually exist.  
  2. Cigarettes contain hundreds of times more diacetyl than an average eliquid, but as heavily as cigarettes have been studied, not one single person in history has ever developed popcorn lung from smoking.
  3. Most eliquid manufacturers know to avoid diacetyl because of the optics of the link and actually test their juice for the presence of diacetyl to keep the levels well within established safe exposure limits.  The Electronic Cigarette Trade Association, with input from subject matter experts, set the testing limits conservatively at 100 parts per million.

What is Diacetyl? 

It's a chemical found naturally in many foods, but is especially known for giving butter its characteristic flavour.  It was commonly used in creamy dessert flavours like butter, butterscotch, custard, etc.  Even though diacetyl does not cause popcorn lung, most manufacturers have opted to switch to flavourings that do not contain diacetyl or contain very minimal amounts to achieve these same flavours without the perceived risk.

Why then is this being brought back into the spotlight?  Since we hate when people make false claims and accusations, we'll try to avoid doing the same.  Instead, let's just follow the money for a second and we'll let you make your own conclusion.  At best, this is just a lack of education combined with poor journalism.  At worst, on a whole, this is to protect big business interests that have existed long before vaping came to disrupt the cigarette/cancer/pharma market.

Tobacco Companies

In the U.S., there is the Tobacco Master Settlement Agreement that has directly tied state revenue and securitized bonds to tobacco revenue, thus creating a perverse incentive for the States involved.  It was a settlement to protect large tobacco companies from future litigation arising from healthcare costs.  Those bonds are at risk of defaulting because of the unanticipated slowdown in tobacco sales due to vaping and the states spent the money (in many cases on things they weren't supposed to like infrastructure).  Financially, it's in their best interests to prop tobacco sales back up, which is exactly what has happened since the scare-tactics started back in August.  Bond holders will rejoice.

In Canada, there is currently no such master settlement agreement yet.  Quebec recently won a landmark case against Imperial Tobacco, JTI, and Benson & Hedges for $15B.  All three have since been granted creditor protection in Canada and now that the precedent has been set, 10 other provinces are coming for their cut to the tune of $120B in total.  This is exactly the scenario that led to the American MSA.  In the States, tobacco company settlements total $206B US over the last two and a half decades.  Similarly, after 4 years of stable sales, their revenue started to decline again in Canada since the introduction of vaping (31.5B units in 2013 to 27.1B units in 2017) and so they decided to enter the market with products like JUUL, which currently does most of its business in convenience stores.

With all the reports of increasing youth vaping uptake, policy makers are looking for answers.  The surveys are showing (if you abuse the data: "ever tried" is not the same as a "vaper") that this happened as JUUL entered the market in North America, but the UK did not experience the same trend, where there is a 20mg/mL cap.  The conclusion being made is that 50mg/mL and by association, JUUL, is to blame.  The problem, though exaggerated by misrepresenting survey data (only 1% of youth actually vaped more than 15 of the last 30 days), is mainly to do with access points.  The main culprits are friends/family, convenience stores, and online.  Canadian vape websites are required by their payment processor service providers to use Canada Post age verification to curb this, but youth circumvent this easily by ordering from China or the U.S.  Secret shopper reports from Ontario show that convenience stores largely are to blame.  For example, in the Durham region, 98%-100%, depending on the timeframe, infractions for selling to minors are occurring in convenience stores and only 0%-2% come from vape shops (mainly due to multiple infractions from the same stores...)  

Convenience Stores

In response to this, Ontario is leading the way by banning the marketing of flavoured vaping products in convenience stores.  The Convenience Store Industry Council of Canada is now trying to demonize specialty vape shops by attempting to show that we collectively market to children and have no track record of carding minors like they say they do, contrary to the data.  If they can't have flavours in c-stores, they certainly don't want specialty shops to have them either it seems.

Pharmaceutical Industry

Tortoise to the hare (Tobacco industry), the pharmaceutical industry has been slow to react to their decline in smoking cessation products since the rise of vaping.  Products like Zyban, Chantix/Champix, and NRTs represent a large chunk of their portfolios and provincial programs offer reimbursements for patients prescribed these "approved" drugs to quit smoking.  The risks with some of these drugs are well documented.  Pfizer has paid out 273M in lawsuit settlements for Champix in the USA over claims of suicidal thoughts and other psychiatric problems.  For a peek into the future of these companies, just look to England, where the last 10 years showed a massive decline from 2,500,000 prescriptions for smoking cessation drugs in 2008 to just 740,000 in 2018.  

A recent study from the New England Journal of Medicine showed that 1 year abstinence rates with vaping was 18% vs. 9.9% for the nicotine patch, which makes vaping a threat to their bottom line.  Drug companies like Astra Zenica fund health organizations such as the Canadian Lung Association.  The American Lung Association is also supported by Merck and Pfizer.  These same health orgs are the ones now calling for flavour bans on life-saving harm reduction technology, even though vaping is unlikely to exceed 5% of the harm of cigarettes.  It's clearly working judging by the competitors' sales numbers and recent studies on heart health (American College of Cardiology recently found that just 1 month of smokers switching to vaping, with or without nicotine, significantly improved cardiovascular health) and cessation rates.  Shouldn't we be on the same side here?  

Bloomberg

Mike Bloomberg is reported as having helped fund what may become the first FDA approved vaporizer device for smoking cessation treatment.  Because of its path to market, it would be exempt from "vaping" flavour bans.  He recently pumped $160M into a vaping attack campaign, employing the use of organizations like Campaign for Tobacco Free Kids.  Bloomberg News articles tend to appear to be biased against vaping in general.  If the flavour ban happens in the U.S. and forces the closure of nearly all vaping companies today, what effect does that have for your product when you're the only one left?

Harm reduction and abstinence

Abstinence policy takes shape in the form of prohibition.  First they tried it with alcohol, then with cannabis.  Now it's vaping.  After decades of failed prohibition, it really begs the question "why, in 2019, are we still trying to go down this path?"  Only this time, it's a harm reduction tool and nicotine, which by itself, is no more harmful than caffeine.  For the first time in history, people can get their nicotine in a satisfying way, without the deadly tar and 4000+ other chemicals that have killed billions.  The science (at least around 400 studies) overwhelmingly support that vaping is least 95% less harmful than cigarettes, with rapidly appearing cardiovascular improvements for former smokers.  It shows that the gateway effect is non-existent.  It also shows that more than 90% of adult vapers do not choose tobacco flavours.  Flavours are paramount to vaper success in quitting cigarettes.  

Stigmatization of smokers has led to their needs going largely unheard.  They have come to be viewed as financial burdens on society, but they suffer from addiction and they need help.  The help is here and it's working, but it's under attack.  In the UK, vaping has been welcomed with open arms.  Their government is engaging in positive awareness campaigns and have reversed in-hospital vaping bans.  In fact, you can now buy vapes IN hospitals there.  The science was allowed to speak more loudly than competing financial interest groups and they're leading the way globally for the ultimate reduction in smoking.  Grassroots movements created this industry and it's up to grassroots efforts now to protect it.  We'll continue to fight for you.

So what's your conclusion?

We'd love to hear from you.  Tell us your thoughts and share your concerns.  We're here to help and we've got the data to do so.



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