Tobacco Harm Reduction: How Rational Public Policy Could Transform a Pandemic

Article-Journal 1)

Nicotine, at the dosage levels smokers seek, is a relatively innocuous drug commonly delivered by a highly harmful device, cigarette smoke. An intensifying pandemic of disease caused or exacerbated by smoking demands more effective policy responses than the current one: demanding that nicotine users abstain.

A pragmatic response to the smoking problem is blocked by moralistic campaigns masquerading as public health, by divisions within the community of opponents to present policy, and by the public-health professions antipathy to any tobacco-control endeavours other than smoking cessation. Yet, numerous alternative systems for nicotine delivery exist, many of them far safer than smoking. A pragmatic, public-health approach to tobacco control would recognize a continuum of risk and encourage nicotine users to move themselves down the risk spectrum by choosing safer alternatives to smoking – without demanding abstinence.

MHRA Guidance
Nicotine inhaled from smoking tobacco is highly addictive. But it is primarily the toxins and carcinogens in tobacco smoke – not the nicotine – that cause illness and death. The best way to reduce these illnesses and deaths is to stop smoking – ideally, stopping in one step (sometimes called ‘abrupt quitting’). (See the NICE pathway on smoking)

However, there are other ways of reducing the harm from smoking, even though this may involve continued use of nicotine. This guidance is about helping people, particularly those who are highly dependent on nicotine, who:

  • may not be able (or do not want) to stop smoking in one step
  • may want to stop smoking, without necessarily giving up nicotine
  • may not be ready to stop smoking, but want to reduce the amount they smoke.

It recommends harm-reduction approaches which may or may not include temporary or long-term use of licensed nicotine-containing products.

The guidance is for: commissioners, managers and practitioners with public health as part of their remit, organisations that provide education and training, manufacturers and retailers of licensed nicotine-containing products.

It is especially aimed at those involved in providing advice about stopping smoking, including those working in smoking cessation services.

The recommendations cover awareness-raising, advising on, providing and selling licensed nicotine-containing products; self-help materials; behavioural support; and education and training for practitioners.

This guidance does not cover ‘reduced exposure cigarettes’, ‘smokeless tobacco’ or any other products containing tobacco. In addition, it does not provide advice for women who are pregnant or maternity services.

The guidance was updated in July 2013 to reflect the MHRA decision that all nicotine-containing products should be regulated. This is expected to come into effect in 2016. For further details, see the MHRA website.

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Sweanor, D., P. Alcabes, and E. Drucker (03-2007) 'Tobacco harm reduction: How rational public policy could transform a pandemic', International Journal of Drug Policy, 18: 70–74. doi:10.1016/j.drugpo.2006.11.013,
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