Abstract
Purpose This paper aims to overview the need for tobacco harm reduction, the consumer products that facilitate tobacco harm reduction and the barriers to its implementation. The worldwide endemic of tobacco smoking results in the death of over seven million smokers a year. Cigarette quit rates are very low, from 3%–12%, and relapse rates are high, from 75%–80% in the first six months and 30%–40% even after one year of abstinence. In addition, some smokers do not desire to quit. Cigarette substitution in tobacco harm reduction is one strategy that may reduce the burden of morbidity and mortality. Design/methodology/approach This review examines the displacement of smoking through substitution of non-combustible low-risk products such as snus, heated tobacco products and e-cigarettes. Findings Toxicological testing, population studies, clinical trials and randomized controlled trials demonstrate the potential reductions in exposures for smokers. Many barriers impede the implementation of product substitution in tobacco harm reduction. These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines and unsubstantiated fears of youth addiction. These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic. Originality/value This review provides the rationale for tobacco harm reduction, evaluates the current products available and identifies the barriers to implementation.
Highlights
Tobacco smoking is endemic with more than seven million deaths occurring every year amongst the 1.1 billion smokers worldwide, with 80% of tobacco users in the world’s lowand middle-income countries [World Health Organization (WHO), 2019, tobacco facts]
The longitudinal PATH study from 2013 to 2015 assessed 1,082 University of Louisville (US) adults classified as dual users and after j j PAGE 224 DRUGS AND ALCOHOL TODAY VOL. 20 NO. 3 2020 one year 25.5% remained dual users, 59.2% returned to only cigarette use, 4.8% transitioned to exclusive e-cigarette use and 6.7% reported complete abstinence (Miller, Smith and Goniewicz, 2020; data analysed in other studies)
For tobacco harm reduction to be a workable strategy, the public must be persuaded of the evidence for the lower relative risks of e-cigarettes and snus compared to smoking
Summary
Tobacco smoking is endemic with more than seven million deaths occurring every year amongst the 1.1 billion smokers worldwide, with 80% of tobacco users in the world’s lowand middle-income countries [World Health Organization (WHO), 2019, tobacco facts]. A randomized controlled trial by Meier et al (2019) enrolled 150 adult smokers (85 male, 65 female) in an eight-week multi-site study comparing usual cigarette use, partial substitution of snus for cigarette use and complete substitution of snus They conclude that complete substitution reduced exposure to the harmful constituents of acrolein, crotonaldehyde, acrylonitrile and acrylamide, but not others The USFDA announced that “the available scientific evidence, including long-term epidemiological studies, shows that relative to cigarette smoking, exclusive use of these specific smokeless tobacco products poses a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema and chronic bronchitis” (USFDA, 22 October 2019). An amazing finding of a five-year study of 879 Yup’ik people of Alaska (406 male, 468 female) is that users of Iq’mik, a smokeless tobacco produced with tree ash, have a lower risk for negative cardiometabolic health than non-smokers as indicated by multiple biomarker tests (Ryman et al, 2018)
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