Ontario has become the first Canadian province to regulate e-cigarettes, as debate over their potential role in tobacco harm-reduction continues.
On Tuesday, members of provincial parliament from all three political parties overwhelmingly voted to pass the Making Healthier Choices Act. Along with banning the sale of flavored tobacco products and requiring that chain restaurants include calorie counts on their menus, Bill 45 will place electronic cigarettes under a regulatory regime very similar to the one that governs tobacco.
The omnibus bill was carried with a vote of 99-1 and has received praise from several prominent heart health and anti-smoking advocacy groups. But it has also been met with concern by vapers (e-cigarette enthusiasts) and public health activists who see e-cigarettes as a powerful tool in the fight against tobacco.
Associate Health Minister Dipika Damerla said that regulation is needed to keep e-cigarettes out of the hands of children, but emphasized that the Act was not a ban on vaping.
"The balance we need to strike is: Yes, we want to make [e-cigarettes] available to smokers as a harm-reduction tool, but we don't want to make it available to a whole group of teenagers who don't already smoke," Damerla told VICE News.
Bill 45 allows adults to purchase and use e-cigarettes, but makes it illegal to sell them to anyone under the age of 19 and bans vaping in spaces where smoking a cigarette is not allowed.
Tuesday's legislation also restricts how e-cigarettes are sold and marketed, making it illegal to sell them in places where the sale of tobacco is against the law and prohibiting their display and advertisement in vape shops and other stores.
The bill amends the Smoke-Free Ontario Act, extending the power of provincial inspectors and forbidding the sale of flavored tobacco products, although menthol will be allowed for two more years. It also requires that restaurants and other food vendors with 20 or more locations in Ontario provide calorie counts for their fare along with contextual information about dietary requirements.
France Gélinas, the Health Critic for the New Democratic Party and the representative for Nickel Belt, said that Bill 45 was an important step against youth smoking. She has been fighting for a ban on flavored tobacco since her 2007 bill banning flavored cigarillos was found to contain loopholes that the tobacco industry exploited.
"The flavors in tobacco make it a whole lot easier to get addicted to nicotine," Gélinas told VICE News. "And that's all the tobacco industry wants: to get you addicted."
The sole vote against Bill 45 came from Progressive Conservative Randy Hillier. At a press conference Tuesday morning the MPP for Lanark-Frontenac-Lennox and Addington brandished the e-cigarette that he says has helped him smoke less and argued that restrictions on vaping hurt smokers who are trying to quit.
Hillier believes that, by placing e-cigarettes out of sight and limiting the information that vendors can provide, Bill 45 will make it more difficult for smokers to make the switch to a tobacco and tar-free nicotine fix.
"It was only by trying different flavors [of e-liquid] that I've now found a flavor that has really helped me reduce my smoking," Hillier told VICE News. "Under this law I would not be able to try those different flavors in a vape shop because they wouldn't be able to display them and I wouldn't even know to ask."
Hillier intends to continue fighting Bill 45 and suggested that it may face a court challenge.
Vaping has grown in popularity in Canada since the mid-2000s, but until yesterday there was no federal or provincial law specifically governing the use and sale of e-cigarettes. Several other provinces and the federal government are in the process of evaluating the best way to regulate the devices.
In the United States, federal regulation of e-cigarettes has faced legal challenges since 2010 and the Food and Drug Administration's new proposal is under review. In the absence of a national policy, some states have adopted regulations similar to those Ontario passed on Tuesday. Hawaii, New Jersey, North Dakota, and Utah place e-cigarettes under the purview of their smoke-free laws, many states ban the sale of e-cigarettes to minors, and most restrict vaping indoors to some degree.
Meanwhile, last February, the European Union revised the Tobacco Products Directive, adopting e-cigarette policy significantly stricter than the Making Healthier Choices Act. Although country-to-country implementation varies, the directive broadly forbids advertising of e-cigarettes, limits the concentrations of nicotine in e-liquids, requires child-proof packaging, sets standards for the purity of ingredients, and enacts other more technical regulations.
In Canada and abroad, a growing number of doctors believe that e-cigarettes represent a substantially safer alternative to tobacco. But a great deal remains unknown about the long-term health effect of vaping.
The e-cigarette section of Bill 45 does not have an implementation date. Gélinas explained that, while the ban on sales to minors will begin immediately, how other vaping regulations are put into effect will depend on the findings of medical research about the effectiveness of e-cigarettes for smoking cessation.
"As the scientific body of evidence becomes more robust, we'll see how those parts of the bill are rolled out," she said.
Follow Jake Bleiberg on Twitter: @jzbleiberg