The Importance of Accessible Alternatives in Harm Reduction   

Tobacco harm reduction is about minimising the negative health impacts of smoking while recognising that some people can’t or don’t want to give up using nicotine. One way to do that is by helping consumers to find something that works for them, but isn’t a cigarette. This can only happen if: 
 

• Consumers have access to products that they want to use instead of a cigarette and,
• They are confident that these products are actually a reduced risk compared to smoking 

Smokers need products that works for them and that means products that they like and want to use.  An important aspect of these alternative products, and something that really differentiates them from smoking, is the availability of a wide range of flavors. 

Some regulators have taken the view, however, that because flavors are banned in cigarettes, they should be banned in alternative products too. The assumption is that removing flavors will reduce smoking and vaping. But real-world experience shows that this is not to be the case. 

A study of seven US states that introduced vape flavor bans for example found that, sales of flavored e-liquids were reduced (because they were banned), but there was a trade-off - for every 0.7mL e-liquid not sold, an additional 12 cigarettes were sold. So, in essence, the effect of the flavor ban was to drive vapers back to smoking. See also an editorial in the Washington Times that discusses some of the impacts of ill thought out policies on smoking rates in the US. 

Sweden is about to become the first country to become smoke-free, in large part because has easy access to a smokeless, reduced-harm product – Snus.  
There is a lot of research as to the benefits of switching to snus, but there has until recently been questions as to the potential effect of snus on blood vessels and the cardiovascular system.  

A study published in the journal Nicotine & Tobacco Research showed, however, that the risk of cardiovascular disease among users of smokeless tobacco products (ST) such as Swedish snus, snuff or chewing tobacco, is the same as that of those who have never smoked. The study, which involved 4347 adults revealed that was the case even though ST users were exposed to more nicotine than smokers. These findings support the concept that increases in the risk of cardiovascular disease among cigarette smokers is primarily caused by chemicals found in tobacco smoke and not nicotine. 

Studies like these are important and consumers need to aware of scientific data relevant to their product of choice. This is important because even if consumers find a product they want to use, they need to be confident that is safer than a cigarette.  

Unfortunately, misinformation and misunderstanding are commonplace. Surveys have repeatedly shown for example that despite ample evidence to the contrary, many people still believe that vaping is just as harmful or more harmful than smoking.  This has, in turn, proved to be serious barrier to switching – there are still significantly more smokers than there are vapers. 

Vaping products don’t burn tobacco so there is no smoke – vapers are not therefore inhaling the many toxic chemicals in smoke that are known to be responsible for smoking-related disease.

We have also found that there is a low of misunderstanding about nicotine pouches. Our e-commerce brand Nicokicks commissioned a YouGov survey on consumers awareness of the various health risks of nicotine pouches and found that 8 out of 10 smokers are either not familiar with the health risks of nicotine pouches or believe that they are equally or more harmful than cigarettes. The percentage is roughly the same for e-cigarettes. 

Like vapes, nicotine pouches don’t contain tobacco and don’t burn and don’t expose consumers of smoke toxicants.

The belief that alternative products like vapes or nicotine pouches are equally or more harmful than smoking creates less incentive for smokers to switch to them. All tobacco and nicotine products are not equally harmful, and it is important that consumers are aware of that. 

But consumers are not the only ones who are confused. Health care providers are often just as badly informed. As the evidence base grows for vapes and other products (in terms of both safety and efficacy for harm reduction), physicians’ understanding in the context of harm reduction must keep pace with the emerging scientific evidence. 

Ensuring that consumers and those advising them have the right information will help them make an informed decision as to what’s best for them and their health.