Scientific Opinion: THR

Carl V. Phillips and Paul L. Bergen. Tobacco Harm Reduction 2010: a yearbook of recent research and analysis. A production of

"THR2010 is an anthology of important writings about tobacco harm reduction, primarily from 2009 and early 2010. The period covered has seen important developments in both the scientific research and politics of THR, particularly the explosion of interest in electronic cigarettes and efforts by tobacco companies to promote low-risk alternatives to smoking. Anyone interested in tobacco use or harm reduction should find something of interest, from general overviews to political analyses. While some chapters report on more technical scientific research or philosophy, even those should be accessible to most interested readers. In spite of the technical subject matter, many of the chapters are genuinely entertaining as well as being educational."

Tobacco Advisory Group of the Royal College of Physicians.  Harm Reduction in Nicotine Addiction:  Helping People Who Can't Quit.  Royal College of Physicians of London. October 2007. 
"This RCP report makes the case for harm reduction strategies to protect smokers. The report demonstrates that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved. The report also argues that the regulatory systems that currently govern nicotine products in most countries, including the UK, actively discourage the development, marketing and promotion of significantly safer nicotine products to smokers."

Sweanor, D., et al., Tobacco harm reduction: How rational public policy could transform a pandemic, International Journal of Drug Policy (2007), doi: 10.1016/j.drugpo.2006.11.013

"Nicotine, at the dosage levels smokers seek, is a relatively innocuous drug commonly delivered by a highly harmful device, cigarette smoke. An intensifying pandemic of disease caused or exacerbated by smoking demands more effective policy responses than the current one: demanding that nicotine users abstain. A pragmatic response to the smoking problem is blocked by moralistic campaigns masquerading as public health, by divisions within the community of opponents to present policy, and by the public-health professions antipathy to any tobacco-control endeavours other than smoking cessation. Yet, numerous alternative systems for nicotine delivery exist, many of them far safer than smoking. A pragmatic, public-health approach to tobacco control would recognize a continuum of risk and encourage nicotine users to move themselves down the risk spectrum by choosing safer alternatives to smoking ??? without demanding abstinence."

Heavner, K., et al., Survey of smokers' reasons for not switching to safer sources of nicotine and their willingness to do so in the future. Harm Reduction Journal 2009, 6:14.

"One of the barriers to smoking cessation via product switching is misinformation about Smokeless Tobacco (ST) and pharmaceutical nicotine products. Most (67%) people in a telephone survey in the US and 59.8% of a sample of nurses mistakenly believed that nicotine is the main cause of tobacco-related cancers. Surveys of smokers and college students in North America found that fewer than 15% realize that ST is less harmful than smoking. In addition, a study found that most (75%) male US military recruits believe that switching from smoking to ST does not reduce tobacco users' risk. Many smokers have similar misconceptions about the health risks from using pharmaceutical nicotine products... If efforts to actively convince smokers that there is no opportunity for harm reduction were to end, we would expect to see the change begin. If the resources that are currently devoted to misleading smokers about harm reduction were instead targeted at informing them that they have satisfying choices that are almost as good for their health as quitting entirely, a very large change could happen quite rapidly."

Gartner CD, Hall WD, Chapman S, Freeman B. Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure? PLoS Med. 2007 July; 4(7): e185.

"Background to the debate: The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of "harm reduction??? point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway??? to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction."

Gartner CE, et al., Assessment of Swedish snus for tobacco harm reduction: an epidemiological modeling study. Lancet. 2007 Jun 16;369(9578):2010-4

"Current smokers who switch to using snus rather than continuing to smoke can realise substantial health gains. Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus."
Tobacco harm reduction: an alternative cessation strategy for inveterate smokers, Brad Rodu and William T Godshall, Harm Reduction Journal 2006

"This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations."

Tobacco harm reduction: an alternative cessation strategy for inveterate smokers 

Debunking the claim that abstinence is usually healthier for smokers: Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

Permissive nicotine regulation as a complement to traditional: The FDA could take a series of small steps that might ultimately replace a large proportion of cigarette smoking with equally addictive nicotine products, without risking serious public health setbacks.

Carl V Phillips, Constance Wang and Brian Guenzel, You might as well smoke; the misleading and harmful public message about smokeless tobacco 
BMC Public Health 2005, 5:31: ST users are told, in effect, that they might as well switch to smoking if they like it a bit more. Smokers and policy makers are told there is no potential for harm reduction. These messages are clearly false and likely harmful, representing violations of ethical standards.

Alternative Nicotine Delivery as a Harm-Reduction Strategy: Position paper by David T. Sweanor, lawyer and prominent figure in the field of tobacco harm reduction