Question Period Note: Vaping-Associated Lung Illness

Beginning the week of August 19, 2019, news media began reporting on a series of severe lung illnesses in the United States linked to the use of vaping products.

As of November 20, 2019, the U.S. Centers for Disease Control and Prevention are reporting 2,290 cases of e-cigarette, or vaping product, use-associated lung injury in 49 states, the District of Columbia, and 2 US territories. A total of 47 deaths have now been confirmed in 25 states. The US investigation has not identified any specific e-cigarette or vaping product (devices, liquids, refill pods, and/or cartridges) or substance that is linked to all cases. The latest national and regional findings suggest products containing THC play a role in the outbreak – specifically THC products containing the additive Vitamin E acetate.

As of December 3, 2019, a total of 13 cases of vaping-associated lung illness have been reported to the Public Health Agency of Canada from British Columbia (3), New Brunswick (2), Ontario (3) and Quebec (5). Health Canada posted an Information Update for Canadians on December 5, 2019 and updates its vaping-associated lung illness web page on Canada.ca regularly.

Health Canada posted an Information Update for Canadians and updates its vaping-associated lung illness web page on Canada.ca regularly.

• What is the Government doing to address vaping-associated lung illness?

• Our Government is concerned about the emergence in Canada of vaping-associated lung illness.

• We advise Canadians to avoid purchasing vaping products from outside the legal market as these products are unregulated, therefore posing a greater risk to health and safety. In addition, our government recommends that any Canadian who has health concerns following the use of a vaping product promptly seeks medical attention.

• Our Government is committed to protecting the health and safety of Canadians. Regulatory controls are in place to help safeguard the health of Canadian consumers and to enable Health Canada to respond to emerging health issues in a timely manner.

• We will continue to monitor all available data sources and surveillance systems in Canada to identify incidents of lung illness that could be related to vaping and refer these to the appropriate province or territory for investigation.

IF PRESSED ON THE PROCESS FOR IDENTIFYING CASES AND CAUSES…

• National guidance has been shared by the Public Health Agency of Canada on identifying possible cases of vaping-associated lung illness. Provincial and territorial public health officials are responsible for reporting probable and confirmed cases in their jurisdictions.

• A federal, provincial and territorial task group on vaping-associated lung illness has been established to maintain a uniform, national approach to identifying and reporting cases.

• As of November 5, 2019, the U.S. Centers for Disease Control and Prevention are reporting findings that suggest products containing THC play a role in the outbreak – specifically THC products containing the additive Vitamin E acetate, a substance prohibited in both nicotine and cannabis vaping products in Canada.

• At this time, no specific product, substance or device has been linked to all cases of vaping-associated lung illness in Canada. Health Canada is actively obtaining and testing samples of vaping products.

• We are closely monitoring the situation both at home and in the United States.

IF PRESSED ON THE LONDON-MIDDLESEX CASE IN ONTARIO AND THE CANADIAN MEDICAL ASSOCIATION JOURNAL PAPER ON “POPCORN LUNG”-TYPE ILLNESS RELATED TO VAPING IN THIS CASE

• We are aware of the case report recently published in the Canadian Medical Association Journal and we welcome the information brought forward by the authors. It will contribute to the body of scientific knowledge on lung illnesses related to vaping. We are reviewing the report in the publication carefully.

• Vaping-associated lung illness is a broad term that describes lung illnesses and injuries that may have a variety of clinical presentations. From the information presented in the article, this patient’s illness is consistent with the national case definition of vaping-associated lung illness. This was affirmed by the Government of Ontario, which officially reported this case to federal officials.

IF PRESSED ON WHY CANADA IS REGULATING ACCESS TO CANNABIS VAPING PRODUCTS GIVEN THE LINK BETWEEN VAPING THC AND SOME VAPING-ASSOCIATED LUNG ILLNESS CASES IN THE UNITED STATES

• Parliament established a deadline of October 17, 2019 for the new cannabis products to be permitted for legal sale.

• Parliament recognized that providing legal access to quality-controlled products can help protect those who choose to consume cannabis from the inherent risks and harms of the illegal market, where there are no standards or oversight for quality control or safety.

• Strict regulations have been put in place to protect consumers. Cannabis vaping products must be produced in licensed facilities that are subject to Health Canada inspections and according to strict requirements.

• Cannabis vaping products cannot contain anything that may cause injury to the health of the consumer. For example, they are not permitted to contain any added colouring agents, mineral nutrients or vitamins, including vitamin E acetate, a chemical of concern in the US cases.

• Licensed processors are responsible for making sure that all their products meet the strict requirements set out in the Cannabis Act and it Cannabis Regulations and do not cause injury to the consumer.

IF PRESSED ON THE RISKS OF VAPING…

• The Government of Canada recognizes that vaping products present their own unique health and safety risks. The potential long-term effects of vaping remain unknown.

• That is why Parliament put in place the Tobacco and Vaping Products Act which aims to prevent uptake by youth and non-smokers. It prohibits the sale of vaping products to persons under 18 and restricts the promotion of vaping products across all media channels, including social media.

• We have also put in place strict regulatory controls to help safeguard the health of Canadian consumers and enable Health Canada to respond to emerging issues in a timely manner.

• My officials are accelerating work on regulatory proposals to address the rise in youth vaping. Proposed regulations on vaping product promotion, and vaping product labelling and packaging will be brought forward as soon as possible.

• Health Canada also has a national public education campaign to inform youth and their parents on the health risks associated with nicotine vaping. The campaign includes advertising and hands-on learning events in high schools, middle schools and community settings across Canada. A recent evaluation of the advertising campaign found that 26% of teens who reported having seen the ads decided not to try vaping as a result.

The regulation of vaping products in Canada
Vaping products that contain nicotine are regulated separately from those that contain cannabis.

The Tobacco and Vaping Products Act (TVPA), which became law on May 23, 2018, regulates the manufacture, sale, labelling and promotion of both tobacco and vaping products (other than those that contain cannabis).

The manufacture, sale and promotion of vaping products containing certain ingredients such as vitamins and minerals, caffeine and colouring agents are prohibited. Regulatory authorities to further restrict ingredients are also provided for in the Act.

Vaping products regulated under the TVPA are also subject to the Canada Consumer Product Safety Act (CCPSA). That Act prohibits the manufacture, import, advertisement or sale of any consumer product that is a “danger to human health or safety” and requires mandatory incident reporting by manufacturers, importers and sellers of consumer products, and mandatory document retention by any person who manufactures, imports, advertises, sells, or tests a consumer product for commercial purposes.

Both the TVPA and the CCPSA contain regulatory authorities to restrict how vaping products are manufactured (e.g., ingredients) and labelling to protect human health or safety.

The regulation of cannabis vaping products
Vaping products containing cannabis are regulated under the Cannabis Act and its regulations. The Cannabis Act came into force on October 17, 2018, and establishes the framework for controlling the production, sale and possession of cannabis across Canada. While inhalable cannabis extracts, such as vaping products, are now legal for sale in Canada as of October 17, 2019, following the coming into force of amendments to the Cannabis Regulations, new cannabis products will not be available for purchase until mid-December 2019, at the earliest. The amended Cannabis Regulations establish regulatory controls for legally produced vaping products containing cannabis to help safeguard the health of Canadian consumers and to enable Health Canada to respond to emerging health issues in a timely manner.

Vaping-associated Lung Illness (VALI) is characterized by the patient having a history of vaping in the preceeding 90 days and symptoms similar to those associated with influenza or other respiratory infections (e.g. fever, cough, headache, fatigue, etc). There is no specific test that can be used to diagnose this illness, rather VALI is diagnosed by exclusion of other plausible causes. It is important to note that the case definition is a tool to help clinicians identify and report cases to public health authorities, who use this information to monitor and analyze the situation. It is not used for clinical diagnosis.

As of December 3, 2019, a total of 13 cases of vaping-associated lung illness have been reported to PHAC from British Columbia (3), New Brunswick (2), Ontario (3) and Quebec (5).

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