Tobacco Harm Reduction and the right to health

10 Tobacco harm reduction: the potential No longer just ‘quit or die’, but ‘quit and try’ From the 1980s onwards, the main tobacco harm reduction product was nicotine replacement therapy (NRT) – products including patches, gum and inhalators. NRT is now the medically approved way to consume nicotine without tobacco and is on the WHO’s List of Essential Medicines. Given this, it is easy to refute any claims that the harmful chemical in a cigarette is the nicotine. Though still banned or tightly regulated in some countries, in others NRT is widely available, and in many places, it can be obtained without prescription, including by young people. Since the mid-2000s, however, an entirely new harm reduction front for tobacco has opened up. There has been widespread uptake of nicotine vaping products among consumers in many countries, together with the realisation of significant public health gains from the switch from combustible tobacco to smokeless tobacco (snus) in Sweden, and a proliferation in the range of newer products, such as heated tobacco products and oral nicotine pouches (containing no tobacco). 14 In comparison to conventional tobacco control initiatives, uptake of safer nicotine products has largely occurred without any overall public health input – without encouragement or investment from governments, tobacco control experts or tobacco control NGOs. However, following consumer uptake, the UK and New Zealand gave strong policy support to this development. A few other governments are beginning to be supportive, but again, this has come after initial consumer interest. Safer nicotine products There is substantial international, independent evidence that the new products are demonstrably and significantly safer than traditional cigarettes. There is no more dangerous way to consume nicotine than by smoking a tobacco cigarette. Nicotine vaping products (also known as e-cigarettes) These products allow the user to inhale nicotine in a vapour which contains no tar or carbon monoxide. All vaping products have three basic elements: the battery, which heats up the coil or atomiser, which turns the flavoured liquid into a vapour to be inhaled. Most e-liquids contain four ingredients: vegetable glycerine (VG) which provides the vapour, propylene glycol (PG) which carries the flavour (although PG-free liquids are available as some people are allergic to this ingredient), nicotine, and flavouring. “With vaping, you get […] the action of smoking, you get the inhalation, the exhalation, you can choose what nicotine level you want, you can choose what flavours you want.” Catherine 15 14 Foulds J. et al. (2003). Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tobacco Control , 12:349-359 15 Catherine is a UK vaper interviewed for The Switch, a video made by the New Nicotine Alliance (NNA) and the National Centre for Smoking Cessation Training (NCSCT). All videos accessible at the NNA website: https://nnalliance. org/nnaresources/switch-videos Image: Wikimedia Commons