Tobacco harm reduction means trying to lessen the harm caused by tobacco use without completely stopping the use of tobacco or nicotine. It is recognized that the best outcome is for people to stop using tobacco, but alternative methods to reduce harm are accepted. Harm reduction is not more important than preventing tobacco use or helping people quit, but instead works together with these measures.
Harm reduction is considered a human rights issue because it provides a way for smokers to reduce the harm caused by tobacco, regardless of whether they want or are able to quit. It is also seen as a social justice issue because it can help smokers who experience the greatest health disparities. For example, people who are poor or have lower levels of education tend to smoke more and have a harder time quitting. They also have a higher risk of lung cancer compared to those with higher income and education. Smokers with mental illness also have a similar situation. Providing access to harm-reduction products may be one way to reduce these health disparities.
However, the role of tobacco harm reduction in tobacco control is controversial. A long time ago, a Former Surgeon General named C. Everett Koop said that we shouldn’t only focus on stopping young people from using tobacco, but also help people who already smoke. We need to find a way to help smokers quit using harmful tobacco while using less harmful nicotine delivery systems. But we don’t want young people to start using these new products and then start smoking tobacco.
One idea is to make cigarettes and other tobacco products have less nicotine and tar. This would make them less addictive and harmful. The FDA (Food and Drug Administration) wants to create a world where people don’t get addicted to cigarettes and can get nicotine from safer sources. If we do this, we could decrease smoking a lot and save millions of lives.
In 2018, the FDA proposed a rule that would make tobacco products have less nicotine. Many studies have shown that reducing nicotine levels in cigarettes by about 95% could be good for public health. In clinical trials, people who smoked cigarettes with very low levels of nicotine smoked fewer cigarettes, were exposed to fewer harmful chemicals, and were less dependent on nicotine. They also tried to quit smoking more often and were more likely to quit compared to those who smoked regular cigarettes.
However, reducing nicotine levels in cigarettes may have some unintended effects. It did not change people’s moods or how much they drank or used cannabis. But some smokers may gain weight when they try to quit smoking. To reduce nicotine levels in cigarettes, there should be a deadline by which all cigarettes should have a certain low amount of nicotine. But if this happens suddenly, many smokers may start using other products with nicotine, like little cigars or e-cigarettes. This wouldn’t be good for public health, as smoking alternative products with nicotine is still harmful.
To prevent this, if all tobacco products were reduced in nicotine, then smokers would be more likely to use e-cigarettes instead of other harmful products. But it’s important to make sure e-cigarettes are regulated so they are safe and not sold on the black market.
A report from the National Academy of Science, Engineering, and Medicine says that using e-cigarettes instead of smoking cigarettes can reduce exposure to harmful substances found in tobacco smoke. However, the long-term effects of using e-cigarettes are still not clear. The report also says that the amount of nicotine and other harmful substances delivered by e-cigarettes depends on the product and how it’s used. Youth using e-cigarettes is a big concern. To regulate e-cigarettes, the report suggests looking at factors like toxicity, appeal, addictiveness, packaging, and youth access.
The report suggests that more flexible and effective nicotine replacement products should be approved to help people quit smoking. These products should be appealing to smokers and easy to use, including a combination of short and long-acting forms of nicotine replacement and the potential for long-term use for harm reduction.
