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Do You really know what Tobacco Harm Reduction is?

Jul 21, 2020

In the last decade, the appliance of low risk products in the market to support smoking cessation programs has raised both positive opinions on the effectiveness of these products both strongly contrary reactions.

Media misrepresentations of e-cigarette studies are causing the public to disbelieve the lower relative risks of products for tobacco harm reduction.  The obstructionist public health policy prevent smokers who want to quit to approach new ways that bring benefits in terms of health.

But talking about tobacco harm reduction means embracing a plurality of behaviors, choices and products that can be confusing. But to fully understand the innovation that THR brings to the world we need to consider a basic functional axiom: quitting smoking is not easy.

According to a paper recently published and elaborated by dr. Renée O’Leary and Dr. Riccardo Polosa, Founder fo the COEHAR, Center of Excellence for the Acceleration of Harm Reduction, the heavy taxation, the regulatory bans, the sensational media headlines and the misperceptions about nicotine are the barriers which prevents people to use low risk products.

Just consider that relapse rates are high, from 75%–80% in the first six months and 30%– 40% even after one year of abstinence. Achieving high levels of cessation in the tobacco smoking population is an unrealistic goal because successful quit rates are abysmally low, relapse rates are high and in addition, a number of people wish to smoke.

We have deepened the subject with Dr. Renée O’Leary, author of the paper and COEHAR researcher.

Welcome Renée, can you tell us something about the aim of the paper?

The purpose of this paper was to approach clinicians  and researchers with the arguments of tobacco harm reduction. Why we think it is important, the benefits and the current evidence, alongside with the barriers we face.

Can you explain us what is harm reduction?

Tobacco harm reduction is a way of substituting lower risk products, lower exposure products for smoking. Even with a low level of use, smoking is risky. These products can reduce the risk caused by smoking tobacco. People find very hard to quit and also people who quit relapsed and go back to smoking very frequently, as we said in the paper. It is quite unreasonable to aspect people to quit or to stay quit: it’s something that doesn’t happen in the real world.

There is a way of fighting relapsing?

Unfortunately, as the paper mentioned, a systematic review of behavioral methods to stop relapsing shows that they don’t work. And that’s why we go back to substitution products: The idea is that  you can have a relapse, maybe because of a stressful incidence of your life (divorce, deaths etc) and we like to get you quit again but until then let’s use a products that cause a less toxic exposure for you

Do you think these products and devices will be accepted more by the society in the future?

We really want them to became more accessible and acceptable to people. Lot of people have a misperceptions about harm reduction and low risk products such as electronic cigarettes, But data points to another directions: it is quite a lot less exposure for smokers. So we are constantly fighting misperception.

Let’s talk about the elephant in the room: misperception about nicotine. What is true and what is not? 

As we reported in the paper, nicotine in itself is addictive and we know how addictive it is.There are other components of tobacco use that are addictive. But going back to nicotine, doctors aren’t trained properly on what nicotine risks actually are. Nicotine doesn’t cause cancer. What happened in the last few years is that nicotine has been demonized and part of that is because people are not trained properly on it. Now we know that nicotine affects on baby development or induce low birth rate and there are some question about the development during adolescence. At the same time we know Nicotine does not cause cancer or stroke. The trouble is that people are using cigarettes for other purpose: to calm you down, to be less anxious or because you are bored. I think lot of teenager pick up nicotine because they are bored. There was a study in Canada that showed that the lowest rates of teens smoking were in school with the best after-school programs. 

Let’s talk about vaping and teens: do we have data on why teens turn to vaping? 

No, but there is a theory: the kind of kind who is going to take risk is the kind ok kid that smoke cannabis, or smoke cigarette or goes on a skate with no helmet. Risk taker is a risk taker kids. And there are enough studies who point to this hypothesis. I still think that boredom is a risk factor and studies don’t ask about it. 

What about the media approach ?

In the paper, we quote the 2018 England paper that says that media misrepresentation is huge. There is also a tendency of look to study in isolation: so suddenly there is a study in vitro that shows some pretty nasty results and it becomes the indicator of the situation. People tend to ignore studies that do not fit their position. We don’t want a study that support a single evidence or position. If you choose THR approach you need to know which are the residual risks .

Early you said that the FDA approved IQOs as a low risk products. Do you think this is a step forward for the future of harm reduction or it is a way of chasing the rabbit down to the hole?

It just a limited move forward. The process for the FDA approval is huge and it takes a lot of money to conduct the study, to get the researchers, to produce the reports. This means that the small scale producers of ecig are shout out of the market. It’s a big step forward but at the same time is a small step froward too. We already know what smoking is doing, is killing 7 millions people in the world and we need to act.