Harm reduction can help play a critical role in changing behaviour and should form part of any strategy to reduce tobacco dependence. Tobacco harm reduction is based on the assumption that since certain unhealthy behaviours are addictive and, in many instances, extremely difficult to quit, safer technologies or practices must form a part of an effective control regime.
This harm reduction argument is motivated in a paper released earlier today titled “Where there’s smoke, is there still fire? Ethical aspects of tobacco harm reduction.
Commissioned by the African Harm Reduction Alliance (AHRA), the review focuses on the need for more robust behaviour changing models, especially the inclusion of harm reduction mechanisms in helping curb tobacco use in South Africa and globally.
“Simply put, tobacco harm reduction is defined as anything that decreases the risks from using combustible tobacco, for example through vaping,” says Dr Delon Human, co-founder of the Africa Harm Reduction Alliance (AHRA) and President of Health Diplomats, a specialised health, nutrition and prevention consulting group operating worldwide.
Smokers have limited quitting options. Currently, smokers can use Nicotine Replacement Therapy (NRT) and related products, or go “cold turkey.” Tobacco harm reduction, however, offers a slightly different route out of tobacco addiction, by focusing on reducing the harm of chemicals associated with the burning of tobacco without having to stop the nicotine intake. In other words, the approach relies on prevention of harm rather than focusing on the substance itself or cold quitting.
“Tobacco harm reduction has been referred to as a third option for smokers who have traditionally been confronted with the binary choice of continuing or quitting altogether,” says Dr Daniel Malan, leading academic and author of the report.
A Norwegian case study is evidence of the impact of how harm reduction can change the market. In less than 30 years cigarettes lost 27% of market share to snus – smokeless moist tobacco powder that is placed under the lip. The loss of market share of combustible tobacco to snus demonstrates that consumer choice for reduced harm products cannot be ignored.
Increasingly, global evidence-based research is proving that vaping is a safer alternative to smoking. A Public Health England Evidence update concludes that e-cigarettes are 95% less harmful than smoking. Furthermore, recent research by University College London found that only consuming e-cigarettes resulted in very low exposure to toxins whereas a recent New Zealand study found that e-cigarettes were more effective than nicotine patches for those looking to quit smoking.
“Vaping and e-cigarettes have the potential to prevent tobacco-related disease and save hundreds of millions of lives from premature death. For the sake of population and individual health, it is imperative that vaping is recognised as an alternative to combustible tobacco products, within the broader context of tobacco harm reduction,” says Dr Human.
The Framework Convention on Tobacco Control (FCTC) by the World Health Organisation came into effect in 2005 with the objective of protecting present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke. Measures in curbing tobacco usage which are especially focused on regulation have had limited impact. With more than 80% of the world’s smokers currently living in developing countries, it is imperative that governments fully understand harm reduction and its usage as part of their broader strategies in combatting substance usage and abuse
The lack of consensus within the medical fraternity regarding the health implications of vaping has led many health ministries around the world to demonise vaping without taking into account evidence indicating that it is a safer alternative to smoking.
This confusion has filtered into the global regulatory environment with national health department’s often viewing vaping as a gateway to smoking – especially amongst youth. However, this view is not supported by the evidence.
“A key aspect of harm reduction includes education and there remains an extensive need to share views as it allows for consumers to make their own decisions,” adds Dr Malan. “Technically, it is correct to argue that it is better to quit altogether than to reduce harm by 95%, but such a puritan approach will do more harm than good”.
Regulators need to act pragmatically to avoid the current hype and hysteria. A good starting point would be to restrict vaping to under 18s, much along the lines of traditional combustible tobacco legislation. This would address concerns around vaping acting as a gateway to youth smoking. Putting in the necessary safeguards to prevent new addiction, while making the product generally available – and affordable to South Africa’s 7 million smokers – would have a profound positive impact on addiction levels in the country. Moreover, reducing the impact of tobacco addiction on South Africa’s unsustainable non-communicable disease burden also has profound positive implications for national health policy – and spend – in South Africa.
Dr Malan indicates, “The cautious approach by the South African Department of Health is noted given the fact that should e-cigarettes be classified as a cessation device then it will be scheduled as such and will only be allowed to be sold in pharmacies.”
As we celebrate annual World No Tobacco Day on 31 May 2017 it must be acknowledged that while progress in curbing tobacco usage globally has been partially successful in the developed West, it has had limited success in the developing world which is where, today, the bulk of the world’s smokers reside.
“Despite the best efforts of global tobacco control, we have had limited results. Even WHO predicts that there will still be 1 billion cigarette smokers by 2050. It is now time to seriously consider harm reduction as a way to prevent tobacco-related disease and premature death. Tobacco control and harm reduction are not mutually exclusive. In fact, it is mutually reinforcing. Both are essential tools society and public health should use to avoid or minimize harm associated with substance abuse,” concludes Dr Human.