MED-TECH | Hostility to harm reduction may cost smokers’ lives

Hostility to harm reduction may cost smokers lives especially now that public perception of nicotine is evolving amid the rise of less harmful alternatives to cigarettes such as vapes, heated tobacco and nicotine pouches, medical professionals and public health experts said in a recent global forum.

“People smoke for the nicotine, but they die from the hostility to harm reduction. And our challenge is to come up with strategies that not just work, but work better than other strategies,” Dr. Alex Wodak, former director of the Alcohol and Drug Service at St. Vincent’s Hospital in Sydney said.

Dr. Wodak said reducing the annual death toll of 8 million smokers should be the main objective of health authorities. “That’s equivalent to the population of Switzerland every year. Reducing that number as fast as possible should be the paramount objective of everyone,” he said.

Dr. Wodak is among the participants in a panel discussion at the recent Global Forum on Nicotine who agreed that nicotine has been increasingly recognized for its broader applications, including potential therapeutic uses, and should not be continuously demonized as the cause of tobacco-related diseases.

Mark Oates, director of consumer groups We Vape and the Snus Users Association, said no society has entirely quit nicotine use. “We’ve only seen countries like Sweden transition to safer versions. And so if people in public health and policymaking recognize that, then they can understand that the only way is safer products,” he said.

Oates pointed to public misconception that nicotine itself causes smoking-related illnesses. “The media are incredibly scared to discuss this issue, which is a huge shame. And science also lacks the ability to research it because funding is hard to come by,” Oates said.

Dr. Garrett McGovern, a general practitioner specializing in addiction medicine, said the rise of e-cigarettes, viewed as safer than cigarettes, has renewed interest in nicotine’s impact.
“I’m pretty sure before electronic cigarettes arrived, we never heard of nicotine and the developing brain,” he said. “It’s time to liberate nicotine and explore its potential benefits.”
Despite the encouraging potential of harm reduction, the stark reality of 1.1 billion smokers globally remains a major concern.

Panel moderator Clive Bates, director of Counterfactual Consulting Limited, said 1.1 billion
people continue to smoke. “Eight million a year are dying from smoking, hundreds of thousands of people are sick, and we can really do something about that,” he said, referring to the readily available harm reduction products.

Dr. Carolyn Beaumont, an Australian general practitioner, said she has been prescribing nicotine to smokers transitioning to vaping. Her research revealed that over half of her patients who switched to vaping were men aged 30 to 50, indicating their preference for safer alternatives before long-term smoking damage occurs.

Dr. Paul Newhouse, director of the Vanderbilt Center for Cognitive Medicine, described nicotine as a complex substance with diverse effects on the brain. He noted the dual nature of nicotine use, citing both its recreational and potential therapeutic purposes.

“I suspect that for many people, they will never want or need to use nicotine. But for some people, it may be useful, and it may turn out to be important for their cognitive performance, for regulating their mood, or managing anxiety. For a certain percent of the population, nicotine will be helpful… We have to acknowledge that for some folks and for some brains, nicotine has beneficial effects,” he said.

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