With a decline in cigarette smoking rates consistently observed since 1965, Canada’s smoking cessation story has predominantly been one of success.
Despite significant strides made in decreasing tobacco consumption nationally, for many Canadians, achieving a “Total Quit” – the total cessation of tobacco and nicotine – continues to remain out of reach.
Recently, there has been an influx of alternative nicotine products into the Canadian market – both recreational, including nicotine vaping devices, and non-traditional nicotine replacement therapies (NRTs) such as nicotine pouches.
“There are undoubtedly key regulatory gaps that inevitably occur in such a rapidly evolving nicotine market,” says Dr. Milan Khara, physician lead of the Smoking Cessation Clinic at St. Paul’s Hospital in Vancouver, BC.
A closer look at the current state of play
Canada’s Tobacco Strategy (CTS), implemented in 2018, set an ambitious target of reducing tobacco use prevalence to less than 5% by 2035, supported by $66 million in annual investment in smoking cessation initiatives.
While an increasing number of Canadians are favouring vaping devices over cigarettes, 10.1 million Canadians remain unaware of the addiction and health risks associated with using a nicotine vaping device, according to the most recent Canadian Tobacco and Nicotine Survey (CTNS).
CTS has played a critical role in reducing cigarette smoking, however its original focus on traditional tobacco products did not fully anticipate the pace at which alternative nicotine products would enter the market. As a result, gaps in public education, awareness, and regulatory oversight have emerged around unconventional nicotine and tobacco delivery devices now widely accessible to Canadians.
Rising illicit sales and youth exposure raise concerns
Nicotine pouches, while intended as NRTs to support smoking cessation efforts, are increasingly being used recreationally alongside alternative nicotine products such as nicotine vaping devices. To address this issue, the federal government has restricted the sale of nicotine pouches to pharmacies, and to adults aged 18 or over, with flavouring limited to mint and menthol.,
Despite these restrictions, recent news investigations have revealed that nicotine pouches are frequently sold illegally in stores across Canada. An absence of consistent regulatory enforcement has resulted in violations of age restrictions and the sale of nicotine pouches containing doses of up to 15 milligrams – over three times Health Canada’s 4-milligram authorized limit – as well as prohibited fruit-flavoured varieties.
“We need mandatory retailer training alongside licensing and compliance testing to ensure stores are in compliance with age restrictions and compliance of product,” says Dr. Leslie Phillips, pharmacist and clinical associate professor in the School of Pharmacy at Memorial University in St. John’s, NL, and a nicotine cessation specialist with its Medical Therapy Services Clinic Quit Smoking and Vaping Program.
At the same time, research from the University of British Columbia indicates nicotine pouches are increasingly being glamourized on social media platforms, portrayed as discreet lifestyle products with little to no mention of associated health risks, including dependence on a highly addictive substance.
This regulatory and enforcement gap has direct implications for youth and young adults. In recent years, Canada has seen a rapid rise in youth vaping, alongside increasing exposure to alternative tobacco and nicotine product marketing. According to Nova Scotia’s 2024 Youth & Young Adult Vaping Survey Summary Report, specialty vape shops are where the majority of 16- to 18-year-olds in the province are able to illegally access and purchase nicotine vaping devices.
According to the Heart and Stroke Foundation of Canada, not only is nicotine highly addictive, it also affects adolescent brain development and is associated with an increased risk of future addiction to other drugs.
“Policymakers should be highly concerned by the normalization of nicotine use on social media platforms that target youth,” notes Dr. Khara.
The solution – effective policy, regulation, and enforcement
To address what has now become an epidemic of alternative tobacco and nicotine product use, policymakers and governments must adapt and modernize existing regulations to reflect today’s evolving landscape.
Deeply embedded in the community as frontline health professionals, pharmacists are uniquely positioned to play a central role in national cessation efforts. “Pharmacist-led cessation interventions are both clinically effective and cost-effective, further reinforcing their strategic importance in population-level quit initiatives,” says Dr. Phillips.
There is an opportunity to further expand community-level supports and ensure resources reach Canadians who need help quitting. This includes universal public health coverage for well-tested, traditional NRT products and cessation medicines across all provinces, expanded education for care providers, and targeted interventions for priority populations, including youth, people living with mental health conditions, low-income individuals, and Indigenous communities.
However, clinical guidelines and community engagement alone will not address the wider issue of recreational nicotine use. Canada’s experience with successful tobacco reduction strategies offers a clear roadmap for action.
“The most effective policies historically have included tax increases, health warnings, comprehensive marketing restrictions, and smoke-free environments, with evidence also supporting plain or standardized packaging as a way to reduce product appeal,” says Dr. Khara. “This Canadian approach to tobacco control can be seen as a triumph for public health and will now need to be applied to new nicotine products, but with adaptations to keep pace with an evolving product landscape.”
Initiatives such as Total Quit™ build on this foundation by defining what it means to achieve freedom from both tobacco and nicotine and bringing together evidence and expert perspectives to explore how tobacco and nicotine use is evolving in Canada. By taking a holistic view that considers prevention, public education, and access to effective cessation supports, Total Quit™ aims to inform broader discussions and identify pathways that better support sustained quitting in a rapidly changing tobacco and nicotine environment.
With Canada at a crossroads, policymakers must act with urgency. We already have the evidence and experience needed to build a sustainable path toward a tobacco- and nicotine-free future for Canadians.
Learn more about the Total Quit™ initiative in Canada at www.totalquitjourney.com/ca.
Sponsored by Kenvue Canada Inc. This article is for educational purposes only. Total Quit™ is developed and funded by Kenvue Canada Inc.
