As vaping products and promoting them become prevalent, health professionals warn that e-cigarettes are not as safe as many people believe.
"I think there's a general belief out there that if you switch from smoking to vaping that your problems are solved," said Michael Glogauer, a professor at the University of Toronto's Faculty of Dentistry.
"That's a big misconception."
Nicotine vaping products became legal in Canada in recent months, and last week, the Ontario government released proposed changes to legislation on vaping products in convenience stores that would allow companies to display and advertise their products — something banned in seven other provinces.
Meanwhile, a 2017 report from the University of Waterloo's Propel Centre for Population Health Impact shows e-cigarette use is increasing, especially among young people.
E-cigarette and other vaping devices heat liquid into an inhalable vapor that often contains nicotine. (Steven Senne/Associated Press)
"It's pretty dramatic. I think the rates among young people have tripled," said Rob Schwartz, executive director of the Ontario Tobacco Research Unit.
"All of the data we've seen so far in Canada is showing substantial increases each year."
Still, many experts believe vaping is less harmful than cigarettes, but there are some significant health concerns they believe consumers should be aware of.
When a new drug comes to Canada, it must pass a number of tests, according to Schwartz. E-cigarettes aren't considered a drug, so they've been left mostly unregulated since they appeared on the market about a decade ago, he said.
"If we had pre-market approval, then any device like this, any product like this that might be harmful to your health would have to first be approved for use. "
The federal government's amendments to the Tobacco and Vaping Products Act earlier this year provided a framework for the sale of vaping products, including requiring bottles to be clearly marked with the toxicity hazard symbol and clear warnings. But they did not create regulations for the manufacturing of "e-juice," the liquid in e-cigarettes.
The only limitation is that nicotine in amounts greater than 66 milligrams per gram is prohibited for sale.
Vincent Abou-Jaoude, who owns Cold Turkey Juice Inc., runs retail shops and an e-juice manufacturing plant in Burlington, Ont.
"Anybody can just go and make e-liquid and sell it, which is terrible," he said.
"There's no standard operating protocol that's ever been created for anything like this … It's a niche market, but it's also very new, so we don't know. Technically nobody knows how to make e-liquid."
In an email, a spokesperson with Health Canada said the department is conducting research and reviewing available studies to better understand the health impacts of vaping products.
"Except for nicotine, vaping products typically only contain a fraction of the 7,000 chemicals found in tobacco or tobacco smoke, and at lower levels. Switching completely from tobacco cigarettes to vaping products will reduce a person's exposure to many toxic and cancer-causing chemicals," the spokesperson said.
Unknown effects of chemicals
Abou-Jaoude said his e-juices are generally made of vegetable glycerin, artificial flavours, nicotine and propylene glycol, a common food additive and flavouring. The health risks of inhaling it are unknown.
Abou-Jaoude said they try to follow reports on the "safe" amounts of each component to add, but he's particularly skeptical of the artificial flavouring.
According to Rob Schwartz, executive director of the Ontario Tobacco Research Unit, e-juice now comes in more than 7,000 flavours. (Dondi Tawatao/Getty)
"We're not really sure what the long-term effects are of inhaling artificial flavouring," he said.
Dr. José Lança, an assistant professor specializing in pharmacology at the University of Toronto, said when people vape, "they are also ingesting or breathing in other chemicals, including hydrocarbons" that can cause cancer with repeated use.
"They [hydrocarbons] are very similar, some of them are exactly the same, as you find in cigarettes," he said.
Nicotine in many e-cigarettes creates many of the same oral health problems as regular cigarettes, according to Glogauer.
"What it does is it causes the blood vessels in the tissues to shrink inside so less blood gets delivered to the tissues," he said.
The process causes gum recession, bad breath and increases teeth grinding, he said, and the heat from smoking causes a dry mouth.
Glogauer said nicotine also reduces the typical inflammation and discolouration caused by cigarettes, and that can hide gum disease.
The amount of nicotine in a particular e-juice can vary, but Glogauer said there are also harmful chemicals in e-juice smoke that are not present in cigarette smoke.
"So diethylene glycol, we actually don't know what it does and that's bad," he said. "That's scary for us as clinicians.
As well, the menthol in e-juices, Glogauer said, can lead to the breakdown of skin cells, the primary protective barrier that protects tissues.
"These chemicals that are present may be causing a whole new set of problems that we're not aware of, and that won't become apparent for the next five or 10 years," he said.
"It's really these sort of patients who are acting as their own sort of guinea pigs."
Health Canada said it is reviewing data and testing vaping liquids.
"Current information indicates that diethylene glycol is rarely detected in vaping liquids and, when it is found … it is likely a contaminant and not intentionally added," the statement said.
Still, many experts believe those who cannot quit smoking should use vaping as an alternative. Health Canada agrees vaping is a less harmful source of nicotine than smoking.
The provincial government is proposing changes to the Smoke-Free Ontario Act, which would allow convenience stores to display and promote e-cigarettes. (Regis Duvignau /Reuters)
Abou-Jaoude says he uses vaping products to curb his smoking habit, and believes consumers should educate themselves about vaping products and use them when needed.
"It's inorganic to be putting anything into your lungs," he said, but added that vaping might help curb the "epidemic" of tobacco-related illnesses.
Still, Schwartz offered a warning.
"If you're not a smoker, don't vape. The reason is that vaping of particularly nicotine e-cigarettes … can create dependence."
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