HALIFAX - As the debate continues over who's puffing on e-cigarettes and why, another controversy is heating up: where should they be used?
Some say the electronic devices should be tightly controlled and kept out of certain public spaces — as Nova Scotia is considering — until more is known about them. But proponents say they are a safer alternative to tobacco-laden cigarettes and there's no need to hide them.
"Keeping e-cigarettes out of the sight of the public is like camouflaging the fire exits," says Paul Bergen, a researcher in tobacco harm reduction and a consultant for the Electronic Cigarette Trade Association, a national organization representing retailers.
Dr. Robert Strang, chief public health officer for Nova Scotia, says e-cigarettes have their merits as a cessation tool, but they don't belong everywhere. In some cases, Strang says e-cigarettes are being used by smokers to get around widespread smoking bans, allowing them to sustain their hand-to-mouth habit in restaurants, shopping malls and other public areas.
But what worries Strang and other health officials the most is the possibility of e-cigarettes, with their futuristic glow and candy-like flavours, getting youth hooked on nicotine and acting as a gateway to tobacco products.
"We have made in the last decade ... significant decreases in smoking rates, especially amongst youth," says Strang, noting the percentage of Nova Scotia youth who are regular smokers has dropped to 12 per cent from 30 per cent in the last 10 years.
"The last thing we need to do from a public health perspective is have a product like e-cigarettes renormalize smoking behaviours."
E-cigarettes are battery-powered devices meant to simulate the act and sometimes the taste of smoking traditional cigarettes. They contain cartridges filled with flavouring or nicotine that is heated into a vapour and inhaled by the user, a process known as vaping.
Though readily available online and in shops across the country, Health Canada says it is illegal to import, advertise or sell e-cigarettes that contain nicotine or make a health claim, such as asserting the device can help a person quit smoking or is safer to use than tobacco cigarettes.
Health Canada says e-cigarettes that are sold with nicotine or in packaging that makes a health claim fall under the jurisdiction of the Food and Drugs Act. Under that act, a manufacturer must apply to Health Canada for authorization to bring a new product to market. To date, Health Canada has not approved any e-cigarettes under the Food and Drug Act.
Some proponents of e-cigarettes contest Health Canada's assertion, suggesting e-cigarette juice containing nicotine is governed instead by the Consumer Chemicals and Containers Regulations of 2001.
Gary Holub, a spokesman for Health Canada, says the department's approach to enforcement is "complaint-driven and risk-based, and can include issuing stop-sale requests, warning letters, customers refusals and seizures." However, the department says no charges have ever been laid under the Food and Drugs Act for the sale of unauthorized e-cigarettes.
Experts on both sides of the debate agree the law is not being strictly enforced, which is why Nova Scotia is stepping in to crack down on the use of e-cigarettes in public places.
Regulations restricting smoking in the province have been in effect in one form or another since 2003. Currently, smoking is prohibited in workplaces, indoor public areas and outdoor eating and drinking establishments.
Provincial Health Minister Leo Glavine said last month that legislation will be brought forward this spring to bring the use of e-cigarettes in line with the non-electronic kind.
Strang, who also chairs the federal-provincial Tobacco Control Liaison Committee, says other provinces are watching closely.
"We've had a lot of discussion about e-cigarettes at that table," says Strang. "One province needs to go first and that seems to create the momentum that then allows other provinces to fairly quickly move in behind that."
Bergen says the kind of restrictions proposed by Nova Scotia aren't necessary. He argues that e-cigarettes should be more accessible than regular cigarettes to encourage smokers to make the switch.
"They're a great advertisement for an alternative," he says. "It's like saying, 'Look at me. You can't smoke here but I can vape.'"
Bergen says members of the Electronic Cigarette Trade Association don't advertise to youth and are in favour of more rigorous testing of e-cigarettes to ensure the health and safety of users, the vast majority of whom he says are already smokers, not new users.
But he dismisses concerns about renormalizing smoking as largely unwarranted. "You can't really mistake them for cigarettes. They certainly don't smell like them," he says.
The Non-Smokers' Rights Association is calling on Health Canada to strengthen its regulations in response to the growing demand for e-cigarettes in the marketplace.
If, through further study, health concerns turn out to be unfounded and smoking rates don't increase, proposed bans on using e-cigarettes may be relaxed, says policy director Melodie Tilson. Until then, Tilson says there are too many unknowns about what is still a relatively new device.
"We don't really know what the trajectory is for these products," she says. "Let's not make the mistake of having too lax a regulatory regime and then find out 10 years from now that we've this generation of young people for whom this has become a bridge to nicotine addiction or smoking."