Tobacco Harm Reduction and the right to health

6 Nicotine, the drug for which people to continue to smoke, is not a carcinogen. Nor is it harmless – no substances are. But the clinical evidence suggests that at “commonly used dose levels, short-term nicotine use does not result in clinically significant harm.” 8 Studies of nicotine replacement therapy (NRT) products, such as patches, gum, inhalators, tablets/lozenges or nasal/oral sprays containing nicotine, have demonstrated this. Long-term, it is more difficult to know, as studies to date have mainly relied on nicotine obtained through smoking tobacco. But, according to the UK Royal College of Physicians, “it is widely accepted that any long-term hazards of nicotine are likely to be of minimal consequence in relation to those associated with continued tobacco use.” 9 The risks nicotine poses to human health are minute compared to those posed by its most commonly used delivery system, the tobacco cigarette. The majority of smokers want to quit smoking and many thousands do so successfully every year. Some manage to quit by themselves. In countries where they are accessible and affordable, some people use NRT products, or medications such as varenicline or bupropion. Many smokers have very many unsuccessful quit attempts before finally managing to quit indefinitely. For many, using NRT or medicines does not work. The reasons for this will be as individual as the person who wants to quit, but may include the failure of these products to replicate the ritual aspect of smoking and the lack of a sufficient nicotine experience. Tobacco control The primary piece of international legislation concerned with tobacco control is the Framework Convention on Tobacco Control administered by the WHO, which encourages FCTC delegate countries to adopt the following strategy: M onitor tobacco use and prevention policies P rotect people from tobacco smoke O ffer help to quit tobacco use W arn about the dangers of tobacco E nforce bans on tobacco advertising, promotion and sponsorship R aise taxes on tobacco In higher income countries, the so-called MPOWER model has been in place for years. Most recently, these have included increasing numbers of public smoking bans. These measures have helped to bring down adult daily smoking rates. But rates among people who are vulnerable or marginalised due to poverty, sexuality, ethnic minority or indigenous background, mental health diagnosis, involvement with the criminal justice system or use of illicit drugs or alcohol remain consistently high. Raising cigarette prices has helped to reduce smoking rates. However, the strategy has a regressive effect, namely, increasing economic inequality, given that both smoking rates and the number of cigarettes smoked each day are higher among people from lower socioeconomic groups. Moreover, public anti-smoking campaigns have embedded feelings of guilt and shame in people who, for whatever reason, continue to smoke. Research has shown that the stigma attached to smoking can prevent people from seeking help if they 8 Royal College of Physicians (RCP) (2016). Nicotine without smoke; tobacco harm reduction. A report by the Tobacco Advisory Group of the Royal College of Physicians . https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction 9 Royal College of Physicians (RCP) (2016). Nicotine without smoke; tobacco harm reduction. A report by the Tobacco Advisory Group of the Royal College of Physicians. https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction Image: Google