Tobacco Harm Reduction: The new frontier in support of public health

Tobacco Harm Reduction (THR) is a public health strategy aimed at reducing the negative health impact of conventional cigarettes. It recognizes the importance of alternative sources of nicotine with lower health risks that offer smokers who may not want or choose to give up an option to reduce their risk. 

It is no secret that smoking is a leading cause of illness and death, and reducing smoking is vital to public health.  THR measures have been focused on reducing or eliminating the use of combustible tobacco including:

• Cutting down (either long-term or before quitting smoking)
• Switching to non-combustible tobacco products e.g. vaping
• Switching to non-tobacco nicotine containing products, such as pharmaceutical nicotine replacement therapies

Quitting all tobacco products definitively reduces risk the most. However, quitting can be difficult, and even approved smoking cessation methods have a low success rate.   In addition, some smokers may be unable or unwilling to achieve abstinence.   Harm reduction is likely of substantial benefit to these smokers and public health. Providing reduced-risk alternatives to smokers is likely to result in lower total population risk than pursuing abstinence-only policies.

Trinidad and Tobago’s tobacco industry is clear that it is shifting towards expanding its reduced-risk portfolio, built on quality  products, informed consumer choice, and underpinned by world-class science.

It recognizes that while nicotine is addictive, it is not necessarily a harmful addiction and use of nicotine replacement therapy products such as patches have been successful.

These products can effectively and sustainably deliver nicotine without smoke and have the potential to be less harmful than smoked tobacco.

Another alternative that has gained popularity are vapour products. These, are handheld, battery-powered electronic devices that heat a liquid to create a vapour that is inhaled. Unlike conventional cigarettes, vapour products do not contain tobacco and do not involve combustion.  They are marketed as consumer products and have become  more popular than Nicotine Replacement Therapy as a substitute and competitor for tobacco cigarettes. 

The progressive approach adopted by the United Kingdom’s (UK) Government has proven to be very effective in achieving Tobacco Harm Reduction.   According to the UK Office for National Statistics (ONS), the number of adult smokers in the UK decreased from 14% in 2020 to 12.9% in 2022, reaching the lowest level since 2011 (when comparable records began).  The ONS has also previously said that vaping devices had played a “major role” in reducing the smoking incidence across the UK, adding that the new data is “consistent with the continuing trend towards a decline in smoking prevalence over recent years.”

New Zealand’s Government has stated that its intent is to “better support smokers to switch to regulated products that are less harmful than smoking.” In April 2021, the Ministry of Health published its proposals for a ‘Smoke free Aotearoa’, which explicitly aims to “encourage smokers to quit or switch to vaping or smokeless tobacco products.” Their Ministry of Health had previously launched a smoking cessation website, ‘Vaping Facts’ in June 2018 which informed smokers that “Vaping is a way to quit cigarettes by getting nicotine with fewer of the toxins that come from burning tobacco”.  A press release from the Department of Health and Social Care on January 28 stated that “Vapes should only be used by adults as a tool to quit smoking. They contribute to an extra 50,000 to 70,000 smoking quits a year in England”.

“New Zealand’s ambitious goal of becoming smoke-free by 2025 is well underway, with comprehensive tobacco control legislation, targeted interventions, and a focus on tobacco harm reduction products playing a crucial role”, said Nancy Loucas, a public health policy expert and passionate advocate for tobacco harm reduction and executive coordinator of The Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA).  “This shift towards less harmful nicotine products is a key part of New Zealand’s world-leading approach to tobacco harm reduction”, said Ms. Loucas.

Undoubtedly THR is proving itself to be a very feasible approach to supporting public health objectives and reducing health risks stemming from combustible tobacco use. Vapour products appear to be more effective when used by smokers as an aid to quit smoking.  While the UK and NZ have been highlighted as success stories other countries are actively exploring its potential and moving in that direction.

References

 Number of smokers drops as vaping rises, data shows. BBC (2022). Retrieved 24 January 2023, from https://www.bbc.co.uk/news/uk-63873747

https://consult.health.govt.nz/tobacco-control/vaping-regulations-consultation/

Proposals for a Smokefree Aotearoa 2025 Action Plan. New Zealand Ministry of Health (2021). Retrieved 24 January 2023, from https://www.health. govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan 

The Facts of Vaping. Health Promotion Agency and New Zealand Ministry of Health (2019). Retrieved 24 January 2023, from https://www.vapingfacts.health.nz/

New Zealand Celebrates Significant Reduction In Smoking Rates, Leading The World In Tobacco Harm Reduction | Scoop News