The Global State of Tobacco Harm Reduction 2018

Bottom Line: Countries should embrace tobacco harm reduction as a legitimate approach to help tackle the global smoking epidemic. Apart from being founded on the well-established principles of the right to health for the world’s citizens, it is also grounded in evidence-based pragmatism. The tobacco cigarette is the most dangerous nicotine delivery device. Over-proscriptive regulation and control cannot be allowed to deny access to products that have the potential to be one of the most dramatic public health coups of modern times.

There is simply no robust evidence to support concerns of ‘gateway’ effects or ‘re-normalizing’ smoking, despite e-cigarettes being on the market for more than a decade. Fears of nicotine ‘addiction,’ a word freighted with the worst images of serious and chaotic drug and alcohol use, are overblown.

Appropriate regulation should ensure consumer safety and confidence, encourage product innovation, and favor use of SNP over cigarettes. Smokers should not be denied access to harm reduction products that will help them avoid disease and early death from smoking. 

Existing forms of tobacco control are proving insufficient. While many people give up smoking, on their own or with medicinal products, many fail. There is substantial international, independent evidence that these SNP products are demonstrably safer than cigarettes. These potential lifesaving products could lead to a global revolution in public health.

The rapid rise in the use of safer nicotine products (SNP) has been driven by consumer demand often in the face of public health or government opposition. Flawed science, misleading public information and sensational media reporting are all sowing seeds of doubt about SNP among consumers, politicians and the general public. Banning these products, or subjecting them to onerous regulation or high taxation effectively deny access to potentially lifesaving products. SNP could not only affect a global revolution in public health but could also do so at no cost to governments.

Use of heat-not-burn products in Japan has seen cigarette sales fall by 27% in two years, an unprecedented national decrease in smoking. In Sweden, snus has been instrumental in reducing smoking-related mortality to the lowest in the EU. If the EU ban on snus is lifted, then around 320,000 premature deaths a year could be prevented in the EU. As Norwegian smokers switch to snus, the smoking rate among young Norwegian women has dropped to a world record of 1%. Over 50% of the UK’s 3 million e-cigarette users are ex-smokers.

Switching to vaping can help people quit smoking. There are currently no known long-term adverse health effects of vaping or snus. While young people will experiment with e-cigarettes, there is no evidence that this leads to regular cigarette smoking. Smoking rates among young people are falling. There is no evidence for adverse effects from passive vaping – hence no risk to bystanders. There are no known short or long term adverse effects from using nicotine, meaning that being ‘dependent’ on nicotine of itself is not a health risk.

Read the full report here.