What is Tobacco Harm Reduction?

About Tobacco Harm Reduction

 Re-posted from CASAA.org

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 Health11 (6): 6459–71.doi:10.3390/ijerph110606459PMC 4078589PMID 25003176A 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 Behaviors39 (3): 507–511. doi:10.1016/j.addbeh.2013.11.002PMID 24290207The 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 Journal3: 37. doi:10.1186/1477-7517-3-37PMC 1779270PMID 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. J6: 29. doi:10.1186/1477-7517-6-29PMC 2776004.PMID 19887003Hiding 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 Health6: 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