What is Tobacco Harm Reduction?

The most dangerous way to consume nicotine when it is inhaled in a cigarette. The method of burning nicotine ‘created a matrix of thousands of chemicals which are toxic to living tissue’. [21] Celebrated public health advocate Dr Michael Russell explained that, ‘people smoke for nicotine but they die from tar’ [22]. In 2015, organisations such as Public Health England [23] and the UK Royal College of Physicians [24] both estimated after comprehensive scientific reviews, that e-cigarettes are 95% less harmful than cigarettes. Following this the UK Royal College of Physicians  determined that ‘the risks associated with e-cigarettes are unlikely to exceed 5% of those associated with smoking tobacco products, and may well be substantially lower.’[25] This sentiment was echoed by the US National Academies of Sciences, Engineering and Medicine stating that ‘the evidence suggests that while e-cigarettes are not without health risks, they are likely to be far less harmful than conventional cigarettes’.[26]

According to Dr Alex Wodak in his report  ‘Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia’, ‘numerous studies have shown far lower concentrations of toxicants in E-cigarette vapour than cigarette smoke.’ [27]

“Many studies have shown partial improvement in physiological measures (such as improvement in blood pressure, asthma outcomes, weight gain, lung function and COPD exacerbations) when smokers have switched to ‘vaping’ Electronic Cigarettes. It is hard to understand the extremely hostile attacks on E-cigarettes and their advocates until the history of other harm reduction interventions is returned into focus. Mandatory car seat belts, the distribution of condoms to reduce teenage pregnancy and Sexually Transmitted Infections, needle syringe programs to reduce the spread of HIV among and from people who inject drugs, and methadone for treating heroin dependence are some of the other harm reduction interventions which were met with skepticism and hostility at the time of their introduction and for many years later. E-cigarettes (and snus) are examples of harm reduction” [28]
Dr Alex Wodak

According to Dr Wodak, the concept of ‘harm reduction’ has been part of Australia’s National Drug Strategy since 1985 and is also included in Australia’s National Tobacco Strategy and in the World Health Organisation Framework Convention on Tobacco Control. [29]

Harm reduction is centred on the notion of eliminating harm as opposed to being solely focussed on eliminating usage. We have seen the detrimental effects of implementing policy based solely on eliminating usage as opposed to harm with many wasted years fighting a ‘war on drugs’. The elimination of all smoking is the ultimate goal but it completely dismisses the potential positive outcomes in developing policy and practice based on evidence. Developing policies that meet people where they are as opposed to blanket-rule legislation will be of incredible benefit to our community.

The implementation of a robust regulatory legislation that is centred on the principles of harm reduction will clearly aid the cessation of cigarette smoking. At present many Australian consumers are accessing nicotine in various concentrated forms via a range of overseas markets. It is our contention that this is far more unsafe as the importation of these goods is not regulated. Furthermore the mixtures of regulations across state and federal jurisdictions in relation to the importation of these goods is varying and complex and deters people who are wanting to switch from cigarettes to heated tobacco products.

There are opponents that argue that any nicotine usage is a gateway to cigarette smoking. Evidence contradicts this, showing that very few people who are not already experimenting with smoking tobacco are using these products. A study conduced in the UK unequivocally showed that there is no concrete evidence that nicotine replacement devices renormalise smoking. Conducted over a 2 year period, the study surveyed over 60,000 11-16 year-olds and found that only between 0.1% to 0.5% of participants who had never smoked a cigarette regularly used e-cigarettes. [30] Thus ‘most e-cigarette experimentation does not turn into regular use, and levels of regular use in young people who have never smoked remain very low.’ [31]

New Zealand is on the cusp of regulating lower risk nicotine delivery products with the New Zealand Ministry of Health stating that ‘there is no international evidence that vaping products are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it.’[32]. This was also echoed by the University of Victoria in Canada who also stated that there is ‘no evidence of any gateway effect whereby youth who experiment with vapour devices are, as a result, more likely to take up tobacco use’[33]. There is concrete evidence that nicotine replacement devices are not a gateway to youth cigarette smoking and should not be a deterrent for appropriate and robust regulations to be implemented by the government to aid those struggling with addiction.

References

REFERENCES:

[1] Australian Bureau of Statistics. National Health Survey: First Results, 2017-18. Catalogue no 4364 0.55.001. 2018.Available at: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release#smoking (accessed January 19 2020).

[2] Australian Institute of Health and Welfare, Alcohol Tobacco and other Drugs in Australia, People with Mental Health Conditions viewed 16 January 2020, <https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/people-with-mental-health-conditions> (accessed 20 January 2020)

[3] Australian Bureau of Statistics, Smoking, https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release#smoking (accessed 19 January 2020)

[4] Australian Institute of Health and Welfare, Alcohol Tobacco and other Drugs in Australia, People with Mental Health Conditions viewed 16 January 2020, <https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/people-with-mental-health-conditions> (accessed 18 January 2020)

[5] Australian Bureau of Statistics. National Health Survey: First Results, 2017-18. Catalogue no 4364 0.55.001. 2018.Available at: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release#smoking (accessed January 19 2020).

[6] Australian Bureau of Statistics, Smoking, https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release#smoking (accessed 19 January 2020)

[7]  Centers for Disease Control and Prevention. Burden of tobacco use in the US. 2017. Available from:  https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html (accessed 19 January 2020)

[8] Statistics Canada. Smoking, 2016. 2017. Available from:  https://www.statcan.gc.ca/pub/82-625-x/2017001/article/54864-eng.htm (accessed 19 January 2020)

[9] Ministry of Health. Annual update of key results 2016/17: New Zealand Health Survey. 2017. Available from:  https://www.health.govt.nz/publication/annual-update-key-results-2016-17-new-zealand-health-survey (accessed 19 January 2020)

[10]  NHS Digital. Statistics on smoking, England – 2017. 2017. Available from:  http://digital.nhs.uk/catalogue/PUB24228 (accessed 19 January 2020)

[11]  Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.1 Socio-economic position and disparities in tobacco exposure and use. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2019. Available from: http://www.tobaccoinaustralia.org.au/chapter-9-disadvantage/9-1-socioeconomic-position-and-disparities-in-toba (accessed 19 January 2020)

[12] ABS 2019b. National Aboriginal and Torres Strait Islander Health Survey, 2018-19. ABS cat. no. 4715.0. Canberra: ABS. (accessed 19 January 2020)

[13] Australian Institute of Health and Welfare, Alcohol Tobacco and other Drugs in Australia, People with Mental Health Conditions viewed 16 January 2020, <https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/people-with-mental-health-conditions> (accessed 18 January 2020)

[14] Johnson J, Malchy L, Ratner P, Hossain S, Procyshyn R, et al. Community mental healthcare providers’ attitudes and practices related to smoking cessation interventions for people living with severe mental illness. Patient Education and Counseling, 2009; 77(2):289–95. Available from:  www.ncbi.nlm.nih.gov/pubmed/19398293 (accessed 19 January 2020)

[15] Guydish J, Passalacqua E, Tajima B, and Manser S. Staff smoking and other barriers to nicotine dependence intervention in addiction treatment settings: A review. Journal of Psychoactive Drugs, 2007; 39(4):23–33. Available from:  www.ncbi.nlm.nih.gov/pubmed/18303699 (accessed 19 January 2020)

[16] Whetton S, Tait R, Scollo M, Banks E, Chapman J, Dey T, Abdul Halim S, Makate M, McEntee A, Muhktar A, Norman R, Pidd K 2019. Identifying the Social Costs of Tobacco Use to Australia in 2015/16. National Drug Research Institute, Curtin University, Perth, Western Australia.

[17] Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report 2013. Drug statistics series no. 28. Cat. no. PHE 183. Canberra: AIHW., 2014. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848. (accessed 19 January 2020)

[18] Wodak, A. Mendelsohn, C. Legalising Vaping in Australia, McKell Institute. https://mckellinstitute.org.au/app/uploads/McKell-Institute-Vaping-in-Australia-1.pdf (accessed 19 January 2020)

[19] The Department of Health, Tobacco Control Timeline, https://www1.health.gov.au/internet/publications/publishing.nsf/Content/tobacco-control-toc~timeline (accessed 19 January 2020)

[20] Marmot M, Goldblatt P, Allen JG. Fair Society Healthy Lives. 2010.Available at: http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review (accessed 19 January 2019)

[21] Wodak, A. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia Submission 317. https://www.aph.gov.au/DocumentStore.ashx?id=132666e8-be27-49a6-972a-da706153dbdd&subId=512681 (accessed 19 January 2020)

[22] Farsalions KE, Poulas K, Voudris V, Le Houezec J. Electronic cigarette use in the European Union: analysis of representative sample of 27 460 Europeans from 28 countries, 2016.

[23] Bullen C, Howe C, Laugesen M, McRobbie H, Parat V, William J, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013;382

[24] Action on Smoking and Health UK. Use of electronic cigarettes (vaporisers) among adults in Great Britain. May 2016. http//ash.org.uk/information/facts-and-stats/fact-sheets (accessed January 19 2020)

[25] ‘Nicotine without smoke tobacco harm reduction’, The Royal College of Physicians https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0)(accessed 20 January 2020)

[26] ‘New Report One of the Most Comprehensive Studies on Health Effects of E-Cigarettes; Finds That Using E-Cigarettes May Lead Youth to Start Smoking, Adults to Stop Smoking’, The National Academies of Science, Engineering and Medicine (http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24952) (accessed 20 January 2020)

[27] Wodak, A. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia Submission 317. https://www.aph.gov.au/DocumentStore.ashx?id=132666e8-be27-49a6-972a-da706153dbdd&subId=512681 (accessed 19 January 2020)

[28] Wodak, A. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia Submission 317. https://www.aph.gov.au/DocumentStore.ashx?id=132666e8-be27-49a6-972a-da706153dbdd&subId=512681 (accessed 19 January 2020)

[29] Wodak, A. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia. Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia Submission 317. https://www.aph.gov.au/DocumentStore.ashx?id=132666e8-be27-49a6-972a-da706153dbdd&subId=512681 (accessed 19 January 2020)

[30] Bauld, L et al: Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015-2017, Int J Environ Res Public Health, 2017

[31] Bauld, L et al: Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015-2017, Int J Environ Res Public Health, 2017