Recently, there has been controversy surrounding policies that ban vaping in hospitals. David Sweanor, professor at the Faculty of Law and the Centre for Health Law, Policy and Ethics at the University of Ottawa, thinks that policies on vaping need to be based on a solid understanding of science and a recognition of individual rights. In a recent article published in the Canadian Journal of Public Health, he explains why policies should be seen in a broader public health context of innovative alternative nicotine delivery systems playing a key role in ending the immense devastation of combustible cigarettes.
Q: What are your concerns about new policies that ban vaping in health care organizations?
A: They fail to distinguish between products with massively different risks. It would be like treating clean and dirty needles the same. Cigarettes are, very simply put, an incredibly “dirty” drug delivery system. The evidence tells us that the risks associated with vaping are massively less than those from smoking, and the risks from second-hand exposure to the vapour from such devices is virtually non-existent. Good public health policies should distinguish on the basis of relative risks.
Q: How can vaping be beneficial, or at least less harmful, than cigarettes?
A: Nicotine itself, at the dosage levels smokers seek, is not particularly hazardous. But when obtained by inhalation of smoke it is causing roughly 37,000 Canadian deaths a year. The substitution of far less harmful and less addictive alternatives can be ranked as among the really simple but really dramatic breakthroughs in public health history, comparable to vaccinations. Vaping products are “proof of concept” that cigarettes can be made obsolete, their epidemic of diseases relegated to history books rather than hospital wards. We have numerous advantages in seeking a viable endgame for cigarettes.
Q: There is a certain stigma associated with vaping. Why do you think that is, even though it is less risky than cigarettes?
A: Public health efforts to pragmatically and compassionately reduce the risks of nicotine use are being constrained by the presence of a “war on nicotine,” wherein nicotine use is treated like a sin rather than a public health issue. Among the millions of smokers in Canada, there is a very high proportion of people who are already marginalized, and further stigma merely adds to their burdens, when a caring society should instead be seeking to assist them to give up smoking.
Q: What are some of the dangers of treating vaporizers the same way we treat cigarettes?
A: Treating non-combustion product use in public areas the same as cigarettes will reassure smokers that the restrictions on smoking are not based on health concerns. What we see in our environment shapes attitudes. It used to be that the information on the enormous risks of smoking was undermined by ubiquitous lifestyle advertisements, glamourous packaging, enticing retail displays, etc., and now we run the risk of undermining health information by conveying that smoking is no more hazardous than vaping.
Q: What you would recommend policy-makers take into consideration when crafting regulations for cigarette alternatives?
A: They need to accept that abstinence-only approaches on nicotine use are both ineffective and unethical. If we were to craft regulations to tilt the market to alternative products, to respect the stated desires of smokers to get off cigarettes, to facilitate rather than threaten the existence of alternatives to cigarettes, the innovation we have witnessed to date would be greatly accelerated. It can be a self-financing public health breakthrough.
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