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About Tobacco Harm Reduction

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Tobacco harm reduction (THR) is a public health strategy to lower the health risks associated with using nicotine, as an example of the concept of harm reduction, a strategy for dealing with the abuse of other drugs. Smoking tobacco is widely acknowledged as a leading cause of illness and death.[1] However, nicotine itself is not very harmful, as inferred from the long history of use for nicotine replacement therapy products.[2] Thus, THR measures have been focused on reducing or eliminating the use of combustible tobacco by switching to other nicotine products, including:

  • Cutting down (either long-term or before quitting smoking)
  • Temporary abstinence
  • Switching to non-tobacco nicotine containing products, such as pharmaceutical nicotine replacement therapies or currently (generally) unlicensed products such as electronic cigarettes
  • Switching to smokeless tobacco products such as Swedish snus
  • Switching to non-combustible organic or additive-free tobacco products

It is widely acknowledged that discontinuation of all tobacco products confers the greatest lowering of risk. However, approved smoking cessation methods have a 90% failure rate, when used as directed.[1] In addition, there is a considerable population of smokers who are unable or unwilling to achieve abstinence.[3] Harm reduction is likely of substantial benefit to these smokers and public health.[1][2] Providing reduced-harm alternatives to smokers is likely to result in lower total population risk than pursuing abstinence-only policies.[4]

The strategy is controversial: proponents of tobacco harm reduction assert that lessening the health risk for the individual user is worthwhile and manifests over the population in fewer tobacco-related illnesses and deaths.[3][5] Opponents have argued that some aspects of harm reduction interfere with cessation and abstinence and might increase initiation.[6][7] However, surveys carried from 2013 to 2015 in the UK[8] and France [9] suggest that on the contrary, the availability of safer alternatives to smoking is associated with decreased smoking prevalence and increased smoking cessation.

  1. Nitzkin, J (June 2014). “The Case in Favor of E-Cigarettes for Tobacco Harm Reduction”. Int J Environ Res Public Health. 11 (6): 6459–71.doi:10.3390/ijerph110606459. PMC 4078589. PMID 25003176. A carefully structured Tobacco Harm Reduction (THR) initiative, with e-cigarettes as a prominent THR modality, added to current tobacco control programming, is the most feasible policy option likely to substantially reduce tobacco-attributable illness and death in the United States over the next 20 years.
  2. Fagerström, KO, Bridgman, K (March 2014). “Tobacco harm reduction: The need for new products that can compete with cigarettes”.Addictive Behaviors. 39 (3): 507–511. doi:10.1016/j.addbeh.2013.11.002. PMID 24290207. The need for more appealing, licensed nicotine products capable of competing with cigarettes sensorially, pharmacologically and behaviourally is considered by many to be the way forward.
  3. Rodu, Brad; Godshall, William T. (2006). “Tobacco harm reduction: An alternative cessation strategy for inveterate smokers”. Harm Reduction Journal. 3: 37. doi:10.1186/1477-7517-3-37. PMC 1779270. PMID 17184539.
  4. Phillips, CV (November 2009). “Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments”. Harm Reduct. J. 6: 29. doi:10.1186/1477-7517-6-29. PMC 2776004.PMID 19887003. Hiding THR from smokers, waiting for them to decide to quit entirely or waiting for a new anti-smoking magic bullet, causes the deaths of more smokers every month than a lifetime using low-risk nicotine products ever could.
  5. “Harm reduction in nicotine addiction: Helping people who can’t quit” (PDF). Tobacco Advisory Group of the Royal College of Physicians. October 2007. Retrieved 21 April 2012.
  6. Sumner W, 2005. Permissive nicotine regulation as a complement to traditional tobacco control” BMC Public Health 5:18. 
  7. Tomar, SL; Fox, BJ; Severson, HH (2009). “Is smokeless tobacco use an appropriate public health strategy for reducing societal harm from cigarette smoking?”. Int J Environ Res Public Health. 6: 10–24. doi:10.3390/ijerph6010010.
  8. Action on Smoking and Health, May 2016, Use of electronic cigarettes (vapourisers) among adults in Great Britain http://www.ash.org.uk/files/documents/ASH_891.pdf
  9. Résultats de l’enquête cigarette électronique ETINCEL – OFDT, 2014

Text above provided under Creative Commons Attribution-Share Alike License – excerpted from: Tobacco harm reduction. (2016, July 7). In Wikipedia, The Free Encyclopedia. Retrieved 05:13, August 10, 2016, from https://en.wikipedia.org/w/index.php?title=Tobacco_harm_reduction&oldid=728767066