Opinion & Columnist

Importance of harm reduction to countries such as Zim

Cathy Allison

Combustible tobacco products are harmful not only to smokers but their smoke has prejudicial effects on non-smokers, says Professor David Nutt, an English scientist specialising in drug research.

Prof Nutt made the observation in his presentation entitled “Estimating the harms of nicotine products in the 21st century” at the recent Global State of Tobacco Harm Reduction (GSTHR)-Burning Issues virtual conference.

The neuropsychopharmacologist – who specialises in the research on drugs that affect the brain and conditions such as addiction, anxiety and sleep – argues that smokers who cannot quit should be encouraged to use other innovative sources of tobacco that reduce harm on people’s health.

From the 14 nicotine products  that were surveyed in 2014, only half – the combustible ones – were found to affect non-smokers.

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Prof Nutt added that smoking scored highly on the mortality rate (at over 8 million deaths a year) through lung cancer.

Overall, he said, if people can use other non-combustible sources of nicotine such as e-cigarettes or heated tobacco products, population harm can be much lower.

E-cigarettes (vaping) could be the answer for the next generation and the World Health Organisation (WHO) should step forward and support this innovation, he said.

Recently, the United States Food and Drug Administration (FDA), after substantial scientific assessment, found that a new smokeless tobacco invention, the ‘IQOS’,  manufactured by Phillip Morris International (PMI), managed to reduce exposure to harmful compounds.

The product delivers nicotine in a non-combustible way.

Research done on the PMI innovation shows that switching completely from conventional cigarettes to the IQOS system significantly reduces the body’s exposure to harmful chemicals that are found in cigarette smoke.

The IQOS system heats up tobacco but does not burn it and, according to the FDA’s recent decision, this significantly reduces the production of harmful and potentially harmful chemicals – consequently the user inhales reduced amount of toxicants.

Prof Nutt is the chaiperson of Drug Science, a non-profit organisation founded in 2010 to promote independent, evidence-based information on drugs.

Until 2009, he was professor at University of Bristol (UK), where he headed its psycho-pharmacologist unit.

Policy

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In her presentation titled “Who should politicians listen to when developing policy?”, Australian MP Fiona Patten said scientists should be listened to on harm reduction options that should discourage people from combustible smoking by using tobacco harm reduction (THR) products.

Covid-19 has shown how fickle politicians can be about evidence, science and medical advice.

“When we are developing policy on tobacco we ask, how can we reduce harm? When we are developing policy on alternative nicotine products we ask, is it safe? “We are failing to change the question to ask how we can reduce harm,” she said.

“There has been some progress made at WHO, but not recognising harm reduction is nothing short of deceptive.”

Speaking at the launch, director of Tobacco Harm Reduction (Malawi), Chimwemwe Ngoma, said low- and middle-income countries (LMICs) are not sufficiently resourced to implement and adopt THR and “the situation  is further complicated in countries where the economy is reliant on income from tobacco cultivation”.

“The challenges affecting THR in LMICs are that government policies and regulations are being unduly influenced by flawed science and anti-harm reduction lobbying,” he said.

“Flawed public health information in many countries is confusing and misleading people who want to switch away from smoking.

“In most low- and middle-income countries, THR products are either banned completely, heavily taxed or there are no specific laws that govern them.”

He added that there not only is there lack of knowledge and limited access to THR in most LMICs (such as Zimbabwe), but these less harmful products are very expensive compared to the easily accessible combustible cigarettes.

“Though some smokers wish to quit, they are unable to do so because they are so addicted to the nicotine and relapse rates are staggeringly high.”

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In her presentation, “The Framework Convention on Tobacco Control (FCTC) – accountability, policy and regulation”, Marina Foltea, founder and managing director  at Trade Pacts – a consultancy based in Geneva advising global companies and governmental institutions on international trade agreements and economic organisations, as well as public policy – said guidelines should not encroach on people’s rights but rather to help them to make right choices on THR.

Martin Cullip, adviser to the Freedom Association’s Freedom to Vape campaign, similarly said there was need to involve the consumer in the whole process of formulating and determining policies.

“There exists a massive imbalance of a small number of well-funded groups that exercise power (WHO, EU, national governments) and 98 million safer nicotine product users around the world that are negatively affected,” he said.

All the speakers at the launch of “Burning Issues: The Global State of Tobacco Harm Reduction (GSTHR) 2020” – the latest in a landmark report series from UK-based public health agency Knowledge Action Change (KAC) – were in favour of tobacco harm reduction.

It is believed there are over a billion smokers in the world and the figure is not likely to drastically drop soon, and the best solution is to offer the innovative scientific THR options.

According to WHO, over 8 million people die from smoking-related diseases such as lung cancer every year and the unfortunate part of this public health crisis is that it also affects non-smokers.

Thus, the encouragement on the use of THR products as campaign for good global health practices.

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