Understanding Harm Reduction

Reducing the Harm Caused by Smoking

Nearly everyone now accepts that tobacco smoking causes lung and heart disease, cancers, and shortens life span. And for decades, the tobacco control community has focused treatment efforts at achieving complete nicotine abstinence. But many people do not realize that nicotine is not the substance that causes smoking-related diseases. [1] The diseases are caused by elements in the smoke itself: tar, carbon monoxide, heavy metals, toxins, and carcinogens.

Nicotine differs from most other drugs that are classified as addictive in that it does not impair judgment or trigger antisocial behavior. Nicotine has beneficial effects on attention, memory, and mood. Additionally, nicotine helps manage pain, and may actually prevent at least two diseases, ulcerative colitis [2] and Parkinson's. [3] 

For some smokers, nicotine withdrawal symptoms are time-limited. They peak within 2-3 days and can last for "up to several weeks." [4] Smokers who have underlying cognitive, mood, or physical problems that are well-controlled by nicotine often suffer severe, persistent problems when they choose to abstain. Researcher Dr. David P. Sachs describes such people as "genetically dependent on nicotine." [5]

Tobacco Harm Reduction is a public health strategy that centers on providing sufficient nicotine to maintain normal functioning while eliminating the harmful effects of inhaling smoke. Currently available alternatives include a variety of modern smokeless tobacco products, vaporized nicotine delivered by "electronic cigarettes" or "electronic cigars", and pharmaceutical nicotine products. These are discussed on our Smoke-Free Alternatives page. It has been estimated that smokers who switch to such alternatives can decrease their risks of smoking-related disease and death by over 95%. [6]

A very important facet of tobacco harm reduction is educating smokers and the general public about the comparative risks of different sources of nicotine. Unfortunately, the tobacco control community has withheld and continues to withhold accurate information about the relative safety of alternatives. [7] Withholding such information "can represent the violation of a human right ??? the right to information." [8]

Unless smoking-cessation rates improve, the World Health Organization estimates that the death toll from tobacco-related diseases will top 500 million world-wide. At least 10 million Canadians and Americans will die prematurely over the next 10 to 20 years. 

"The continued use of alternative nicotine delivery on a long term basis, as an alternative to tobacco products, would massively improve public health. Since the nicotine replacement therapies are short-term, many users are forced to return to tobacco products to satisfy a desire for nicotine. We are effectively condemning those with a continued need for nicotine to a deadly delivery system." [9]


[1] THR: All About Nicotine (and Addiction)

[2] Guslandi (1999) Nicotine Treatment for Ulcerative Colitis 

[3] Quik (2008), Nicotine and Parkinson's disease: Implications for therapy

[4] ACS, Guide to Quitting Smoking

[5] Reinberg (2008) Today's Smokers More Addicted to Nicotine

[6] THR: Harm Reduction: Concepts and Practices 

[7] Phillips (2005), You might as well smoke; the misleading and harmful public message about smokeless tobacco 

[8] Kozlowski (2002) Harm reduction, public health, and human rights: smokers have a right to be informed of significant harm reduction options 

[9] Sweanor (2003) Alternative Nicotine Delivery as a Harm-Reduction Strategy 


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