Tobacco Harm Reduction

Considerable debate has occurred about ‘harm reduction’ as a tobacco control focus. Some think that it detracts from the focus on complete elimination of tobacco use, and others suggest that it could be a pathway to reducing morbidity and mortality until more viable means of helping smokers quit completely can be found. This blog is a discussion of this issue.

Nicotine replacement as tobacco harm reduction

At a recent meeting, I had occasion to engage in a discussion about tobacco harm reduction, and an argument was made that there is insufficient support for a harm reduction approach, and that it could cause smokers to reduce their motivation to quit.  As the debate regarding tobacco harm reduction continues, I think it is important to remind the tobacco control community that harm reduction as a tobacco control strategy has been in place, and has been accepted FDA policy, for many years.  Nicotine replacement gum was approved for smoking cessation in 1984, and since that time several other nicotine replacement products have been approved as well.  Nicotine is not a benign substance.  In high doses, its toxicity can cause significant illness, and even death.  When delivered in specific ways, it can be highly addictive.  Thus, it is far less harmful than tobacco, but certainly not harmless; hence, it is a harm reduction approach to helping smokers quit.   Millions of smokers around the world have used nicotine replacement to quit smoking, and it is recognized by every major regulatory agency in world as a viable means of helping smokers move from combustible tobacco to nicotine.

Given this reality, the notion that tobacco harm reduction is not an acceptable approach per se is simply wrong.   Thus, a key question is how much harm reduction is acceptable as an alternative to combustible tobacco, not whether harm reduction is an approach to pursue.