How Smoking Rooms for Patients Existed in Canadian Hospitals

For most of the 20th century, smoking in hospitals was not only permitted — it was expected. Doctors and nurses smoked at their stations. Visitors lit up in waiting rooms. Patients smoked in their beds, sometimes while receiving oxygen therapy (with predictably disastrous results).

• 📜 No health warnings: Before the 1964 Surgeon General’s report linking smoking to lung cancer, hospitals had little reason to restrict smoking. Cigarettes were seen as a comfort, not a hazard.
• 🚬 Cigarette vending machines: Many Canadian hospitals had cigarette vending machines in lobbies and cafeterias. The Jewish General Hospital in Montreal only banned tobacco sales on its premises in March 1969 — making it one of the rare hospitals to take such a step at the time [citation:1].
• 🔥 Fire hazards: The first restrictions were not about health — they were about fire safety. Patients smoking while using oxygen caused numerous fires and deaths, prompting initial limited bans [citation:2][citation:7].
• 👩‍⚕️ Staff smoking: Healthcare workers smoked alongside patients. A 1976 study of Canadian hospitals found that 66% had some form of smoking policy — but enforcement was lax, with 56% reporting policies were only “partially enforced” [citation:3].

By the 1980s, the medical evidence against smoking was overwhelming, and public pressure was mounting. But hospitals faced a dilemma: how do you ban smoking for addicted patients, especially in psychiatric wards, without causing withdrawal symptoms or aggression? The compromise was the designated smoking room (DSR).

• 🔧 Specially ventilated rooms: Smoking rooms were typically small, poorly ventilated spaces where patients and sometimes staff could smoke. They were often located at the end of wards [citation:4].
• 🛏️ Exceptions for bedridden patients: Even as smoking was banned in most patient rooms, exceptions were made for bedridden patients. At St. Joseph’s Hospital in Sarnia in 1986, hospital leadership admitted that “the hospital will make an exception to the policy in the case of a bedridden patient” — the cigarette would come to them [citation:8].
• 😤 The problem of smoke leakage: Despite ventilation systems, smoke leaked out of DSRs when patients and staff entered and exited. Non-smoking staff were exposed when they were obliged to enter the rooms to provide patient care or clean. A test with a carbon monoxide detector confirmed this hazard [citation:4].

Psychiatric and forensic hospitals were the last holdouts for indoor smoking in Canada. For decades, administrators argued that patients with serious mental illness could not tolerate smoking bans — that cigarettes were a “necessary coping mechanism” and a “behavioural incentive.”

• 📋 The 1994 Ontario Tobacco Control Act: When this act banned smoking in all government buildings, large psychiatric facilities (including the Mental Health Centre Penetanguishene) sought and received special dispensation to allow patients and some staff to smoke in specially ventilated rooms [citation:4].
• 💨 Smoking gazebos: The Penetanguishene hospital constructed seven “smoking gazebos” outside various buildings for patients and staff to use as an alternative to indoor smoking rooms [citation:4].
• 💰 The cost of accommodation: Between 60-80% of patients at Penetanguishene had to be escorted outside by staff to smoke — at least five times per day. The annual cost was estimated at $500,000 for the maximum-security building alone [citation:4].
• ⚖️ The ethical question: As one hospital administrator asked: “Can a healthcare facility ethically favour a harmful activity (smoking) over beneficial therapies such as recreation and education?” [citation:4]

By 1991, the Canadian Medical Association (CMA) had taken a clear stance. In its annual “Smoking and Health” update, the CMA made the following recommendations for hospitals and other health care institutions:

• 🏥 Hospitals should prohibit smoking by staff and visitors.
• 🚬 Smoking by patients should be discouraged and allowed only in designated areas.
• 🩺 Physicians should prohibit smoking in patient areas, including waiting rooms.
• 🚭 The CMA advocated for the prohibition of all forms of tobacco advertising and promotion in Canada [citation:5][citation:9].

This marked a turning point: the medical establishment was no longer ambivalent about smoking in healthcare settings. The question shifted from “Should we restrict smoking?” to “How quickly can we eliminate it entirely?”

As indoor smoking was phased out, many hospitals created outdoor designated smoking areas (DSAs) — typically a bench, a few butt receptacles, and often a heated shelter for winter months. These were controversial from the start.

• 🚫 Proximity to entrances: Many DSAs were located near hospital entrances, forcing non-smoking patients and visitors to walk through clouds of smoke to access care [citation:2].
• 💪 Poor enforcement: A 2008 British study found that most nursing and medical staff would not enforce no-smoking policies with patients for fear of aggression. A 2017 Australian study similarly found low enforcement rates (60.9%) [citation:2].
• 🍁 The “coffee card” approach: In Medicine Hat, Alberta, hospital security offered coffee cards to smokers when informing them of smoke-free policies to lessen confrontations [citation:2].
• 🛡️ The Calgary pilot (2019): Foothills Medical Centre created a designated smoking area away from the main entrance as a pilot project. There was no signage — “partly not to undermine the overall policy measures on our sites that are smoke-free” [citation:2].

Looking back, it seems obvious that hospitals — institutions dedicated to healing — should be smoke-free. But the transition took decades for several reasons:

• 🚬 Addiction is powerful: Hospitalized smokers, especially those in long-term or psychiatric care, experience severe nicotine withdrawal. Administrators feared that banning smoking would lead to patient aggression, elopement, or non-compliance with treatment [citation:2][citation:4].
• 💉 Lack of cessation support: In the 1970s and 80s, nicotine replacement therapy (NRT) was not widely available. Hospitals had few tools to help addicted patients cope with withdrawal.
• ⚖️ Fear of legal challenges: Some hospitals worried that patients might have a “right to smoke” or that bans would violate human rights codes (particularly for psychiatric patients). These fears largely proved unfounded [citation:6].
• 😔 Staff complicity: Many nurses and doctors themselves smoked. It was difficult to enforce rules against patients when staff smoked in the same spaces [citation:4].
• 📉 Incremental change: Most hospitals moved slowly — from unrestricted smoking, to restricted areas, to DSRs, to outdoor areas, to complete bans. Each step faced resistance.

While you cannot smoke anywhere in Canadian hospitals today, many smokers have turned to affordable native cigarettes (Playfare, Canadian, DuMont) for their daily use. A carton costs $35-50, compared to $140-180 for commercial brands.

• 💰 Cost savings: For smokers who have not quit, native cigarettes save $5,000-7,000 per year.
• 🚭 Hospital policy reminder: Native cigarettes are still cigarettes — they cannot be smoked on hospital grounds, in hospital parking lots, or within 9 metres of hospital entrances in most provinces.
• 🩺 If you are a patient: Many hospitals offer free nicotine patches and gum to help you cope with withdrawal during your stay. Ask your nurse.
• 📦 Order before admission: If you know you will be hospitalized, consider ordering native cigarettes in advance for after your discharge — but never try to smoke them in your hospital room.