Risks of alternative tobacco and nicotine products

Risks of alternative tobacco and nicotine products

Last Updated: March 12, 2024
HealthLinkBC File Number: 30b
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What kinds of alternative tobacco and nicotine products are sold in B.C.?

When people think of tobacco products, they usually think of cigarettes. However, there are many tobacco and nicotine products sold in B.C. We call these "alternative tobacco products."

Alternative tobacco and nicotine products include:

  • E-cigarettes (also called vapes). They are battery-powered devices that heat vaping liquid into a vapour. The user inhales this vapour. These are not tobacco products, but they do contain nicotine. Nicotine is the chemical that makes tobacco addictive
  • Nicotine pouches. They are another new product that do not contain tobacco but do have nicotine in them. These are like smokeless tobacco products. The user places the pouch in their mouth and it slowly releases nicotine
  • Smokeless tobacco. These include chewing or spit tobacco, snuff or snus. These products are placed in the mouth or inhaled through the nose
  • Heated tobacco products. Like e-cigarettes, they are electronic devices. They heat tobacco to a very high temperature so that the user can inhale nicotine without smoke
  • Cigars, cigarillos and pipe tobacco. Cigars and cigarillos are rolls of tobacco wrapped in a tobacco leaf. It can also be wrapped in a substance that contains tobacco. Pipe tobacco is a loose-leaf tobacco that is burned in a traditional smoking pipe
  • Bidis. These are hand-rolled cigarettes of tobacco. They are wrapped in leaves and tied with strings
  • Hookah. This is a form of water pipe used to smoke tobacco or tobacco-free herbal shisha

In this article, the term "tobacco use" refers to the use of commercial products. It does not include the use of tobacco in traditional cultural practice.

Are there any safe tobacco or nicotine products?

No. All tobacco and nicotine products carry health risks and are highly addictive. The best thing you can do for your health is to avoid tobacco and nicotine use altogether.

How can I reduce the health harms associated with tobacco or nicotine use?

Quitting is the only way to avoid potential health risks from tobacco and nicotine. B.C. offers several free resources and supports to help you reduce or quit any tobacco or nicotine product. These include:

  • 12 weeks of nicotine replacement therapy (NRT) or prescription medication coverage. This is available through the BC Smoking Cessation Program
  • Behavioural coaching and other supports through QuitNow
  • Culturally appropriate support for Indigenous community members through Talk Tobacco

For more information, talk to your health care provider, pharmacist or visit the QuitNow website.

If you smoke and are struggling to quit, switching to vaping may be helpful. Current evidence shows that vaping poses less health harms compared to smoking cigarettes. It can reduce the amount of toxins you are exposed to. However, vaping is not risk free. We need more research to confirm if vaping is a useful smoking cessation aid.

There are proven safe methods for quitting smoking. They include nicotine replacement therapy (NRT), prescription medication and behavioural coaching. These should be considered before you try vaping.

While vaping is a less harmful option than cigarettes, it still has health risks. Vaping is more risky for youth and people who have never smoked. Vaping may damage your lung function and increase your risk of heart disease and cancer. Most vapes contain nicotine and are as addictive as cigarettes. There is a lot we do not know about the long-term health risks of vaping.

If you choose to vape:

  • Buy your vaping products from a legal source. In B.C., only products containing nicotine, nicotine salts or cannabis may be sold. The maximum legal amount of nicotine in a vaping product is 20mg/mL. It’s illegal to sell vapour products that only contain flavours. Any vapour product not meeting these criteria is not regulated. They may contain ingredients that could put you at risk
  • Do not vape around others. The second-hand vapour from an e-cigarette might be harmful. The long-term health risks are still being studied. Ensure you vape outdoors. Avoid vaping around children, people with asthma and other breathing challenges, and pregnant people
  • Switch completely from smoking to vaping. Using both may cause more health damage
  • If you are vaping to quit smoking, combine it with behavioural coaching from QuitNow or Talk Tobacco. This will increase your chances of quit success

Are heated tobacco products (HTPs) a lower-risk alternative to cigarettes?

Emissions from heated tobacco products (HTPs) generally contain lower levels of harmful ingredients than smoke from cigarettes. HTPs do not burn tobacco, so they don’t make carbon monoxide. However, as these products are relatively new, we don't have a lot of information on their safety. There is not much research on how effective HTPs are for quitting smoking. If you smoke and want to lower your health risks, you should consider vaping rather than HTPs. There is more information on the safety of vaping than there is for HTPs.

What are the risks of using nicotine pouches?

Nicotine pouches are a relatively new product on the Canadian market. There is not a lot of evidence about their safety and potential risks are not yet clear. Nicotine pouches do not contain tobacco, but the nicotine they contain is highly addictive. If you do not currently smoke or use other tobacco products, you should avoid the use of nicotine pouches due to the potential for addiction.

In Canada, nicotine pouches are approved as a cessation aid. As they are new products, very little evidence is available about their effectiveness as a cessation aid. If you are looking to quit smoking or vaping, you should use NRT or prescription medication. These cessation aids are safe and proven to help you quit smoking.

Are other combustible tobacco products safer than cigarettes?

All combustible tobacco products contain the same cancer-causing chemicals as cigarettes. They are all highly addictive and can have additional health hazards. They are highly risky products to consume.

Cigars, cigarillos and pipe tobacco

One cigar can contain as much tobacco as an entire package of cigarettes. Users who inhale when smoking a cigar have higher health risks, including:

  • Various cancers
  • Pulmonary heart disease
  • Chronic obstructive pulmonary disease

Even if users do not inhale, they are still exposed to toxic chemicals in the tobacco smoke.


Bidis have higher concentrations of nicotine, tar and carbon monoxide than cigarettes. They increase the risk of:

  • Heart disease
  • Emphysema
  • Chronic bronchitis

What are the risks of using a hookah or water pipe?

Many believe that the water vapour in a hookah means there are fewer chemicals in the smoke. However, smoking a water pipe exposes you to many of the same cancer-causing chemicals as cigarettes, at similarly high levels.

Hookah smoking leads you to inhale more smoke compared to cigarettes. The tobacco also contains more nicotine than cigarettes. The amount of nicotine in one head of unflavoured tobacco is equal to 70 cigarettes.

The charcoal used to heat the tobacco or shisha causes additional health risks. It produces high levels of carbon monoxide, metals and cancer-causing chemicals.

What are the risks of using smokeless, chew or spit tobacco?

Smokeless tobacco products are addictive. They contain the same cancer-causing chemicals as cigarettes, as well as nicotine.

Using smokeless tobacco puts you at higher risk of:

  • Mouth cancer, including cancers of the lip, tongue and cheeks
  • Cancers of the throat, sinus and stomach
  • Heart disease, stroke and high blood pressure
  • Dental diseases, including receding gums and tooth decay

Are tobacco products that are labelled "natural," "organic" or "additive-free" safe to use?

Some tobacco products may be labelled as natural, organic or additive-free (for example bidis). This wording is used for marketing purposes. These tobacco products are not safer than regular cigarettes. As they contain tobacco, they carry the same health risks. Tobacco products labelled as natural, organic or additive-free still have tobacco in them and are harmful to your health.