Why the EVALI case doesn’t involve legal nicotine in Canada

The 2019 health crisis, dubbed EVALI (E-cigarette or Vaping product use-Associated Lung Injury), cast a shadow over the world of vaping. Images of hospitalizations and discussions about “popcorn lung” sowed doubt, including among Canadian smokers considering electronic cigarettes as a less harmful alternative. This fear is understandable but rests on a fundamental confusion: the conflation of two completely different worlds. On one side, a chaotic and unregulated American black market, where tainted THC cartridges caused devastation. On the other, a Canadian nicotine vaping market, one of the most regulated in the world.

The common misconception is that “vaping” as a whole is dangerous. However, the real key to understanding lies not in the act of vaping, but in the substance vaped and, above all, its source. This article is not a simple compilation of facts. It is an investigation into the heart of the safety architecture implemented by the Canadian government. We will break down, point by point, the regulatory mechanisms, tests, and safeguards that make the legal nicotine circuit hermetically sealed against the contaminants responsible for the American tragedy. By understanding this impassable line between the legal and the illicit, you will have the facts to evaluate the real risks, far from alarmist headlines.

This article will guide you through scientific and regulatory facts to understand the crucial distinction between markets. The summary below provides an overview of the key points we will examine to shed light on this subject.

Why is vitamin E acetate used in illegal THC cartridges?

At the heart of the EVALI crisis lies a clearly identified chemical culprit: vitamin E acetate. This substance was not added by chance. On the black market, where profitability takes precedence over safety, traffickers seek to “cut” their cannabis extracts (THC) to increase volume and therefore profits. Vitamin E acetate became the cutting agent of choice for purely economic and visual reasons. As highlighted by Angelo Servedio, president of the Association québécoise de l’industrie du cannabis, in an interview with La Presse, this substance offers a formidable advantage to counterfeiters.

Vitamin E has a viscosity very similar to that of cannabis extracts and has no taste. People who use it to manufacture vaping liquids, mainly on the black market, do so to reduce costs while giving the impression that their product is pure.

– Angelo Servedio, La Presse

A very viscous and thick THC e-liquid is often perceived as a sign of high concentration and purity. By using this oily additive, illegal producers deceive consumers into buying a diluted product that maintains a “premium” appearance. This commercial subterfuge is the direct cause of the crisis. It is crucial to note the difference in the scale of the problem: an analysis by the Public Health Agency of Canada reports 20 cases of VALI in Canada (or 0.9 per million inhabitants) compared to 8.5 per million in the United States, illustrating the impact of strict regulation versus a flourishing black market.

Lipoid pneumonia: why you should never vape essential oils or syrups

Inhaling oily substances like vitamin E acetate causes a disastrous reaction in the lungs, known as lipoid pneumonia. Our lungs are designed to exchange gases (oxygen and carbon dioxide) via tiny air sacs called alveoli. They are absolutely not equipped to handle lipids (oils). When an oily substance is vaporized and inhaled, it re-condenses inside the lungs and coats the alveoli with a thin greasy layer. This lipid film physically prevents normal gas exchange, causing severe respiratory distress, coughing, and massive inflammation, which are characteristic symptoms of EVALI.

This mechanism explains why it is extremely dangerous to attempt to vape products not designed for that purpose. Essential oils, syrups, cooking oils, or any other substance containing lipids must never be introduced into a vaporizer. The pulmonary alveoli, which should be clean and functional, find themselves clogged, as shown in the illustration below of healthy alveoli.

Faced with this danger, the Canadian government acted preventively and decisively. The country’s safety architecture is clear: the addition of vitamin E acetate is formally prohibited in all legal vaping products, whether they contain nicotine or cannabis. This ban is a fundamental pillar that protects Canadian consumers from the risk of lipoid pneumonia linked to this additive. The rule is simple: if the product is purchased through the legal circuit, it does not contain this substance.

Authorized shop vs. Snapchat seller: where is the risk of contamination zero?

The line between safety and mortal danger is not found in the type of vaping device, but at the point of sale. The EVALI crisis was born and flourished on informal platforms like Snapchat, Instagram, or parking lot meetups, where traceability is non-existent and products are adulterated. Conversely, the risk of contamination is zero when purchasing a vaping product (nicotine or THC) from a specialized boutique or an authorized retailer in Canada. Why? Because these businesses are the final link in an entirely regulated and controlled supply chain.

A seller on Snapchat has no legal obligation, no accountability, and no guarantee to offer. An authorized shop, however, is subject to strict federal and provincial laws. As confirmed by Daffyd Roderick of the Ontario Cannabis Store, provenance is key: “All of our products are supplied by Health Canada licensed producers and all products that are sold must go through a certification process with Health Canada“. This statement summarizes the essence of the Canadian safety architecture: a hermetically closed circuit, from production to sale.

For a consumer, distinguishing a legitimate point of sale from a black market seller is therefore an essential skill. A legal business does not hide; it displays its obligations and respects the law. The signals are clear and non-negotiable.

How does the government test products to guarantee the absence of contaminants?

The safety guarantee for legal vaping products in Canada does not rely on trust, but on a multi-level control and verification system. This regulatory architecture is designed to actively prevent contaminants like vitamin E acetate from entering the legal supply chain. The government, via Health Canada, deploys a proactive rather than reactive strategy.

First, the law itself grants extensive powers to authorities. Under the Tobacco and Vaping Products Act, Health Canada can designate certified inspectors. These agents have the power to enter manufacturing sites at any time, seize samples, and submit them for laboratory analysis. They verify not only the composition of e-liquids but also compliance with labeling standards, nicotine concentration, and packaging safety. This is active, on-the-ground surveillance that ensures ongoing manufacturer compliance.

Secondly, control is not only retrospective. There is a robust preventive mechanism, particularly for cannabis vaping products, which has served as a model.

This combination of proactive surveillance and pre-market validation creates a regulatory fortress. It is this system that assures consumers that every legally purchased product has been scrutinized and validated long before they hold it in their hands.

The error of associating 2019 American cases with standard vaping today

One of the greatest perception errors is drawing a direct line between American Intensive Care Units in 2019 and a Canadian vape shop in 2024. Epidemiological data show unequivocally that these two realities are disconnected. The EVALI crisis was not a “vaping disease” in general, but mass poisoning caused by a specific, contaminated black market.

Data from the American Centers for Disease Control and Prevention (CDC) are telling. A comparative analysis published by Health Canada reveals that 82% of American EVALI patients reported using products containing THC, and among them, an overwhelming majority of 78% admitted obtaining them via informal sources (friends, family, street or online sellers). The cause is therefore not the device, but the illicit content. Thinking that this crisis applies to regulated nicotine e-liquids is like blaming the entire pharmaceutical industry for counterfeit drugs sold on the internet.

The regulatory environment has also radically changed since 2019. Canada has strengthened its legal framework, explicitly banning the most dangerous ingredients and implementing full traceability for legal products. The illustration above symbolizes this transition: we have moved from a shadow zone of uncertainty (the black market) to a space of clarity and safety (the legal and regulated market). Associating today’s vaping with the 2019 crisis ignores five years of regulatory progress and the consolidation of a robust safety architecture that did not exist in the same way at the time, especially in the United States.

Why is the absence of the THC logo on a nicotine product suspicious?

In an environment where the black market tries to blur the lines, legal product packaging is designed to be a tool for instant clarification for the consumer. Canadian regulation imposes such a clear visual distinction between vaping products containing THC and those containing nicotine that confusion is almost impossible, provided one knows what to look for. The presence or absence of the standardized THC logo is the most revealing indicator.

A vaping product containing THC and sold legally in Canada must mandatory carry the universal cannabis symbol: a red cannabis leaf in a red triangle on a black background. Additionally, the THC and CBD concentration must be clearly indicated. Conversely, a vaping product containing only nicotine must never bear this logo. Consequently, if a seller offers you a product allegedly containing nicotine but bearing the THC logo, or worse, a product without any clear labeling but with exotic flavors, it is a major warning signal indicating illicit origin.

The table below, based on Health Canada regulations, summarizes the mandatory legal markers that allow for distinguishing a legal product from a suspicious one at a glance.

Mandatory legal markers: nicotine products vs. THC products

Feature	Legal Nicotine Products	Legal THC Products
Mandatory THC logo	Never present	Mandatory with standardized cannabis symbol
Health warning	Bilingual mandatory	Message developed by Health Canada
Packaging	Child-resistant	Plain, child-resistant packaging
Ingredient list	Mandatory	Mandatory THC/CBD concentration

This visual segregation is an essential component of the safety architecture. It gives consumers the power to verify the authenticity and nature of the product even before purchase, thus protecting them from cross-contamination or deliberate deception.

The error of thinking your lungs become “new” instantly

Switching from smoking to vaping is a risk reduction step, but it is crucial to maintain a realistic perspective. The idea that lungs, after years of smoking, would become “new” overnight thanks to vaping is a myth. The body needs time to repair itself from the thousands of toxic chemicals present in cigarette smoke. Vaping, while considered less harmful, is not a magic potion for instant regeneration.

Confusion on this point is often fueled by poor framing of the debate. The EVALI case, with its more than 2800 cases and 60 deaths in the United States between 2019 and 2020, highlighted an acute and immediate danger linked to poisoning. Smoking cessation, on the other hand, is part of a long-term healing process. When you stop smoking, your lungs begin a slow cleaning process. The coughing that may occur is often a sign that the cilia, paralyzed by tar, are functioning again to clear debris.

Legal vaping fits into this context as an alternative that avoids combustion and its most dangerous by-products (tar, carbon monoxide). Health Canada takes a pragmatic stance on this. The government agency does not present vaping as a miracle solution, but as a lesser evil for a specific population group.

If you are an adult who currently smokes, switching completely to vaping is a less harmful option than continuing to smoke.

– Health Canada, Risks of Vaping – Canada.ca

This harm reduction approach is the heart of the public health strategy. It is not about claiming that vaping is risk-free, but recognizing that for a smoker who cannot or will not quit, it represents an exit route away from the proven and much greater dangers of traditional cigarettes.

What is the official position of the Canadian government on vaping as a cessation tool?

The position of the Canadian government, led by Health Canada, is pragmatic and nuanced. It is based on a key principle in public health: risk reduction. On one hand, the agency recognizes unequivocally that vaping is a preferable alternative to smoking for adult smokers. On the other hand, it maintains a clear line: vaping is not an approved health product and is not without risks, especially for non-smokers and youth.

The main message is consistent and addresses smokers directly: “If you are an adult who currently smokes, switching completely to vaping is a less harmful option than continuing to smoke“. This statement, repeated on official Health Canada platforms, recognizes that tobacco combustion is public enemy number one. By eliminating combustion, vaping exposes the user to far fewer toxic and carcinogenic substances. The goal is therefore to divert current smokers from the most dangerous product available on the market.

However, this recognition comes with an important warning. Health Canada specifies that, to date, no vaping product has been approved as a therapeutic aid for smoking cessation in Canada. This means that, unlike patches, gums, or prescription medications, electronic cigarettes have not passed the rigorous approval process of a drug to be officially sold as a “treatment.” It is considered a consumer product that happens to be less dangerous than tobacco, but not as a health product in itself. This distinction is crucial: the government encourages the transition to reduce harm but does not endorse vaping as a benign practice or a certified medical treatment.

Ultimately, making an informed choice as a consumer relies on understanding this safety architecture and practicing simple discipline: turning exclusively to authorized sales channels in Canada, which alone guarantee products that are controlled, traceable, and free from the contaminants that caused the American crisis.