April 22, 2024
VIA ELECTRONIC MAIL
The Honourable Doug Ford
Premier of Ontario
Legislative Building
Queen's Park
Toronto ON M7A 1A1
Dear Premier Ford:
Re: Recommendations for Government Regulation of Nicotine Pouches
In July 2023, Health Canada gave approval to Imperial Tobacco Canada to sell Zonnic under the Natural Health Product Regulations as a Nicotine Replacement Therapy (NRT) product. Consequently, Zonnic is sold under the Health Canada approval without adhering to the restrictions of the Federal Tobacco and Vaping Products Act, 1997 and the Smoke-Free Ontario Act, 2017.
Since this time, nicotine pouches have become widely available to youth. These flavoured pouches can be legally purchased by those under 18 years of age in Ontario. The unrestricted sale, display, and promotion of nicotine pouches contribute to accessibility, normalization, and potential health hazards. Nicotine is highly addictive and its use, in any form, is unsafe for children1 and youth2. Exposure to nicotine can have adverse effects on the developing brains of children and youth and increases the likelihood of initiation and long-term use of tobacco2.
In March 2024, Public Health Sudbury & Districts released an advisory alert to local health system partners sharing concerns related to nicotine pouches. Additionally, letters were sent to education directors, educators, and parents to increase awareness of the availability and risks of nicotine pouches to children and youth.
At its meeting on April 18, 2024, the Board of Health for Public Health Sudbury & Districts took further action and carried the following resolution #26-24:
WHEREAS Health Canada approved nicotine pouches for sale under the Natural Health Product regulations providing no restrictions on advertising or sale to children and youth; and
WHEREAS the unrestricted sale, display, and promotion of nicotine pouches contribute to their accessibility, the normalization of nicotine use, and potential health hazards; and
WHEREAS nicotine is highly addictive and its use, in any form, is unsafe for children and youth; and
WHEREAS exposure to nicotine can have adverse effects on the developing brains of adolescents and young adults and increases the likelihood of initiation and long-term use of tobacco products; and
WHEREAS the emergence of nicotine pouch products occurred rapidly without requiring adherence to the restrictions of the federal Tobacco and Vaping Products Act, 1997, and the Smoke-Free Ontario Act, 2017; and
THEREFORE BE IT RESOLVED THAT the Board of Health for Public Health Sudbury & Districts strongly encourage Health Canada to take immediate action to close the regulatory gap that permits the sale of nicotine pouches to youth under 18 years of age; and
FURTHER THAT the Board of Health urge Health Canada to strengthen regulations to restrict the sale of new and emerging tobacco and nicotine products, ensuring that nicotine availability to children and youth never occur again; and
FURTHER THAT the Board of Health for Public Health Sudbury & Districts strongly encourage the Government of Ontario to exclusively sell nicotine pouches from behind pharmacy counters, limit their display in retail settings, and restrict their promotion, especially to youth; and
FURTHER THAT the Government of Ontario expand the Smoke-Free Ontario Strategy to create a comprehensive, coherent public health-oriented framework for the regulation of vaping and all nicotine-containing products.
We strongly encourage the Government of Ontario to follow immediately the Government of British Columbia and the Government of Québec to exclusively sell nicotine pouches in pharmacies, specifically behind the counter. This decision reduces product availability, restricts their promotion, and limits their display in retail settings.
Until tighter restrictions of nicotine pouches are implemented, the widely available and accessible product will continue to expose children and youth to nicotine. The Board of Health for Public Health Sudbury & Districts strongly encourages the Government of Ontario to expand the Smoke-Free Ontario Strategy to create a comprehensive, coherent public health-oriented framework for the regulation of vaping and all nicotine-containing products.
We thank you for your speedy attention to this important issue, and we continue to look forward to opportunities to work together to promote and protect the health of Ontarians.
Sincerely,
René Lapierre
Chair, Board of Health
M. Mustafa Hirji, MD, MPH, FRCPC
Acting Medical Officer of Health and Chief Executive Officer
cc: Honourable Mark Holland, Minister of Health of Canada
Honourable Sylvia Jones, Deputy Premier and Minister of Health
Honourable Ya’ara Saks, Canada’s Minister of Mental Health and Addictions and Associate Minister of Health
Honourable Michael Parsa, Minister of Children, Community and Social Services
Yasir Naqvi, Parliamentary Secretary to the Minister of Health, Honorable Mark Holland
Dr. Kieran Moore, Chief Medical Officer of Health of Ontario
France Gélinas, Member of Provincial Parliament, Nickel Belt
Jamie West, Member of Provincial Parliament, Sudbury
Michael Mantha, Member of Provincial Parliament, Algoma-Manitoulin
Viviane Lapointe, Member of Parliament, Sudbury
All Ontario Boards of Health
Association of Local Public Health Agencies
- U.S. Department of Health and Human Services. (2014). “The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General.” https://www.ncbi.nlm.nih.gov/books/NBK294308/#ch5.s2
- National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2016). “E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.” Retrieved on January 30, 2024 from www.cdc.gov/tobacco/sgr/ecigarettes/pdfs/2016_sgr_entire_report_508.pdf.