July – Tobacco Endgame Could End “Hallway Healthcare”

Written by Communications, July 10, 2018

In the early days of May 2018, the Ontario government released its long awaited Smoke Free Ontario strategy. Its opening sentence reminds readers that “Every day tobacco kills more Ontarians than alcohol, illicit substances, accidents, suicide and homicides combined.” And for those whose bottom line may be dollars and cents: “Over two billion dollars a year are spent by Ontario to treat and care for people with smoking-related health concerns. The provincial economy loses over five billion dollars a year in lost productivity or missed days of work because of smoking-related health issues.”

In my career as first a Family Doctor and then a Public Health provider, I have personally seen progress made in reducing the commercial use of tobacco, but the game is far from over. Although provincial smoking rates have dropped to about 16%, the third lowest in the country, rates in Peterborough are much higher, at about 26%. Each day, we estimate that 44 Ontarians die from tobacco-related disease. The strategy released in May aims to reduce rates of use to 10% over the next five years if our newly elected government chooses to proceed with implementation. It sets a worthy goal to reduce the number of tobacco-related deaths provincially by 5,000 each year.

The strategy accompanied recent changes to the Smoke Free Ontario Act (SFOA) – it was amended to include the vaping of any substance as well as the smoking of both tobacco and medical cannabis. The regulations were due to come into effect July 1 with “Smoke free” applied to both vapour from e-cigarettes as well as the smoke from combustion. We received word late in the afternoon of June 29 that these are being held for further review.

To achieve its ambitious targets, and support the changes in the SFOA, the Smoke Free Ontario strategy proposes a three-pillared approach: increase the number of smokers who successfully quit; prevent the onset of tobacco or vapour product use and reduce it for those already using; and reduce second-hand exposures for non-smokers. If supported by Premier Ford’s government, we would see a greater investment in prevention for populations with higher rates of use, like people living with low incomes, persons with mental health and addictions, rural and Indigenous populations. It would create a seamless and easy-to-access smoking cessation system through-out the province, with hospitals fully deployed to help admitted smokers quit so that they reduce their risk of readmission and death. Fewer re-admissions of smokers means more beds for others in our already busy Emergency Departments. The strategy commits to explore additional methods to reduce the supply of tobacco to make it even less accessible to children and youth.

It’s important to clarify that commercial tobacco use, whether it is by smoke, chew or vape, is actually a nicotine-delivery system. Nicotine is probably one of the most addictive substances we’ve encountered. Inhalation, by smoking or vaping, rapidly raises blood and brain levels of the drug. It doesn’t take long for users to become hooked.

As of this fall, Ontarians will have two legal substances to burn or inhale: tobacco and cannabis. The new provincial Cannabis Act will allow adults 19 years and older to purchase and consume cannabis, but not in public places. Recreational consumption will be restricted to private residences.

I was hoping that this month we would have seen a ban on the use of e-cigarettes and smoking of tobacco or medical cannabis in all public spaces and enclosed work places. The strategy included three new smoke-free spaces: public areas within 20 meters of the grounds of a school, the outdoor grounds of a community recreation facility, and public areas within nine meters of a restaurant or bar patio. We will now need to wait and see what our new Minister of Health will decide to do with the proposed changes.

As our newly-elected provincial government pauses, it is great to see the federal government back in the game, with new regulations on vaping products as well as stronger restrictions on tobacco packaging. The federal tobacco strategy promises to provide an additional $330 million over five years to provinces like Ontario. This infusion of resources could go a long way towards ensuring the newly released provincial strategy, and long-awaited updates to legislation help clear the air and save lives.