Is Tobacco Harm Reduction A Viable Option To Curb Smoking? Here's What The Experts Say
From healthcare professionals to industry players, these experts share their opinions on topics surrounding regulation, scientific research, and accessibility to reduced-risk products.
By Shiffa Aziz — 18 Jul 2023, 10:30 AM
With smoking-related diseases on the rise, many countries are desperate to help smokers kick the habit as soon as possible
Smoking accounts for about 90% of lung cancer deaths, and it is responsible for a handful of non-communicable diseases, since cigarette smoke contains over 6,000 harmful chemicals, some of which cause cancer.
Countries worldwide have been carrying out concentrated efforts to curb smoking prevalence for the past few decades, such as introducing higher taxes on tobacco products, creating awareness programmes on the dangers of smoking, banning smoking in public places, and more.
While there's no doubt that quitting is the best case scenario for smokers, there has been much discussion about implementing tobacco harm reduction (THR) strategies to help them adopt less harmful products.
The Global Forum on Nicotine (GFN) 2023, which took place in Warsaw, Poland from 21 to 24 June, sought to explore the use of reduced-risk alternatives to smoking to ensure a smoke-free future.
Here are the key takeaways:
1. The Vaporized Nicotine and Non-nicotine Products (VNNNPs) Regulation Act came into effect in the Philippines last year, which regulates vaping products, including e-cigarettes and heated tobacco products (HTPs)
Undersecretary Sharon Garin, one of the co-authors of the vaping law, said that the main objectives were for minors to not consume VNNNPs, and for smokers to adopt a less harmful habit.
"So, the stance was, 'Let's reduce the attractiveness of these products to minors'. For instance, it's prohibited to have packaging which is attractive to children, so cartoon characters are not allowed.
"The second point is to keep the flavours so that those who opt to switch [from cigarettes] to a healthier product have more options available. While the flavours are not restricted, the way you can name them is, so they cannot have flavours with names such as 'bubble gum' that might attract children," she said.
Cardiologist Dr Rafael Castillo said that while he initially had misgivings about e-cigarettes as a solution, they wanted to carry out their own research to see if these products could help.
"And, after conducting studies ourselves, we were convinced that, although more data were needed, the use of VNNPs were definitely less harmful [than smoking combustible cigarettes] and could be considered to be a pragmatic middle ground to which we should bring our current adult cigarette smokers," he shared.
2. Australia's implementation of prescription-only nicotine vapes was unsuccessful, as it led to a thriving black market
Under the prescription-only model, the sale of nicotine e-liquid is prohibited in vape shops and retail stores in Australia. Instead, a doctor's prescription is required to obtain vapes legally. Unfortunately, only 5% of doctors can prescribe these vapes and most of those are private practitioners.
As a result, an estimated 100 million disposables have been imported into Australia, of which it is believed nine in 10 are illegal.
During the 'Regulation Case Study — Australia' panel discussion, general practitioner and educator Dr Carolyn Beaumont emphasised that the current model has only made it difficult for smokers to obtain vaping products. The challenges range from geographical barriers (e.g. no easy access to clinics in rural areas) to administrative barriers (e.g. doctors aren't taught about THR).
Hence, the panelists agreed that vape should be regarded as a consumer product, instead of a medicinal product. By introducing proportionate taxation and restricting youth vaping, an improved policy may work better for Australia.
3. On the issue of nicotine, it is believed that perception surrounding this chemical is changing, as there are studies being carried out between the role of nicotine in Alzheimer's disease and dementia
According to Dr Konstantinos Farsalinos, a physician and senior researcher at the University of Patras and the School of Public Health-University of West Attica in Greece, the therapeutic applications of nicotine are still in its beginning stages.
"But imagine what will happen if an effect is observed in Alzheimer's disease and what the effect is going to be on society. People are terrified of Alzheimer's disease and dementia, because of course they are conditions that largely affects human dignity and are really torturing the patients. So, imagine how the perception of nicotine is going to change if an effect on Alzheimer's disease is found, especially for primary prevention," he said.
Mark Oates, the director of We Vape and the Snus Users Association, said, "People talk about how vaping is just there for people who smoke. But I see reduced-risk nicotine products a bit like the electric car. It's a revolution in which there are going to be people who drive electric cars and have never damaged the environment with a combustion engine vehicle. We shouldn't say to them, 'You weren't damaging the environment before so you should just not drive'. So, there are going to be people who never smoked who want to use nicotine. It's much better if you use a safer version."
4. In countries such as Japan and Korea, there was a high and rapid adoption of HTP, along with a decline in sales of conventional cigarettes
"Several studies have found that the sales of cigarettes declined 4-5 times faster in the few years following the launch of heated tobacco in Japan," said Philip Morris International (PMI)'s Global Vice President of Communications, Tommaso Di Giovanni.
He further explained that over 35% of Japanese smokers had adopted HTP, with a vast majority of them abandoning cigarettes, and in Korea it was about 10 to 12%.
One such study from 2020 shows that the accelerated decline in cigarette sales in Japan corresponds to the introduction and growth in the sale of HTPs.
5. It was acknowledged that in low- and middle-income countries, the burden of smoking is on the rise
Kasia Kowalczyk, who supports and builds connections between third-sector organisations in public health, shared that she sees an inequality of access to services for marginalised populations.
"One of my key messages would be that we are not utilising the third sector as much as we should. There are many reasons for this, one being how third-sector organisations are financed, often through grant funding which restricts their activities to their core purpose, and does not allow flexibility to act beyond their primary issues.
"Finally, another major issue is a lack of knowledge — and this is not just about tobacco harm reduction, but about harm reduction in general," she said.
As for Dr Le Dinh Phuong, an intensive care and internal medicine doctor from Vietnam, he compared the situation with the country's very first successful harm reduction programme, where people who use heroin received methadone under the supervision of healthcare professionals.
"If we can use methadone for harm reduction, why can't we use HTP to reduce the harm for my patients who smoke? I have read a lot of research, studies, and medical papers showing a large evidence base that HTPs can reduce the risk of chronic obstructive pulmonary disease (COPD) and cardiovascular disease. That’s why, as a physician and an educator, I have been spreading awareness about them among young doctors, my colleagues, and my patients," he said.
In a nutshell, the implementation of a robust THR framework must take into consideration evidence-based regulation, better involvement of healthcare professionals, and providing access to reduced-risk products for smokers in marginalised communities
Imperial Brands Group Science and Regulatory Affairs Director Joe Thompson said when developing the framework for harm reduction, countries must start by asking themselves, 'How do we help the consumer?'
"There are a billion smokers on a billion different journeys. That framework needs to be robust, it needs to be repeatable, it needs product standards that are not a barrier to entry but that guarantee safety, quality, and efficacy, and it needs enforcement to prevent youth access," he concludes.
