Category: Harm Reduction

  • James Murphy Makes a Case for Consensus

    James Murphy Makes a Case for Consensus

    Photo: pavelkant

    A global alignment on health policy is necessary to make a smokeless world a reality.

    By James Murphy

    With renewed attention on smoking and vaping regulation around the world, now is the time for action that will realize global smoke-free ambitions and ensure cigarettes become a thing of the past.

    Achieving this vision requires a global consensus on the most effective approach to create sustained and lasting changes to consumer behavior—tobacco harm reduction (THR).

    THR is one the greatest public health opportunities today, representing a pathway for hundreds of millions of smokers who would not otherwise quit to transition from combustible tobacco products to smokeless alternatives.

    Countries that have recognized the opportunity THR presents, and which have adopted supportive policies, have seen striking success in reducing their smoking rates. The U.S., U.K. and Japan are all currently witnessing their lowest smoking rates on record while Sweden is on track to declare themselves smoke-free this year—defined as having less than 5 percent daily smokers in the population—16 years ahead of the 2040 EU target.

    These remarkable transformations have been driven by widespread THR acceptance from policymakers, regulators, health officials and consumers in these markets, enabling and encouraging smokers to migrate from combustible tobacco products such as cigarettes to vapor, oral nicotine pouches, snus and heated-tobacco or herbal products.

    The widespread accessibility of smokeless products is essential for the success of THR. However, at present, this is being hamstrung by many countries limiting access to these alternative tobacco and nicotine products. For example, 60 percent of the world’s population live in just 15 countries. Of these, only about 40 percent permit the sale of smokeless products, leaving millions who would otherwise continue to smoke without the option to switch to such alternatives.

    In order to fully realize the public health potential of THR and significantly reduce the more than 8 million deaths attributed to smoking cigarettes each year, regulators around the world should embrace evidence-based science to drive positive public health outcomes. This means implementing a supportive regulatory framework that encourages adult smokers who would otherwise continue to smoke to switch while also protecting consumers with stringent safety standards and preventing underage use.

    In addition, the global success of THR depends on governments and regulators correcting persistent misperceptions of smokeless products compared to cigarettes.

    A University College London-led study published earlier this year highlighted that most smokers in England wrongly believe vaping is at “least as harmful as smoking,” with 57 percent of respondents saying they thought vaping was “equally” or “more harmful.” This echoes trends reported in the U.S., with research showing that perceptions of e-cigarettes as more harmful than cigarettes doubled year on year between 2018 and 2020. Not only are these misperceptions flawed, but they also have significant implications for public health by actively discouraging smokers who would otherwise continue to smoke from making the switch to smokeless products.

    Greater efforts are needed to counter these misperceptions—something that BAT is trying to tackle. As the world’s largest vapor company and a leader in smokeless products, BAT is committed to producing innovative products backed by world-class science and industry-leading product safety and quality standards. BAT’s THR approach is based on the growing body of research and weight of evidence approach that substantiates its belief of the reduced-risk profile of these products compared to cigarettes, which have been accepted by many international public health bodies. BAT publishes its science research to increase understanding of THR and raise awareness with stakeholders.

    Indeed, the industry developing and producing these products has a critical role to play. But to achieve the conditions required to make a success of THR, an inclusive, open and honest dialogue with all stakeholders is required. That includes policymakers, regulators and the healthcare and medical communities. Unfortunately, this is not yet the case, with the industry all too often excluded.

    We have an opportunity to usher in a new smokeless world, grounded in scientific research and a firm commitment to public health. The solutions are available today. All that is required is for the relevant stakeholders to actively work together to prioritize THR and the well-being of millions of people worldwide.

  • CAPHRA Urges End to Disinformation About Vapes

    CAPHRA Urges End to Disinformation About Vapes

    Vapor Voice archives

    The Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) states that as it celebrates World Vape Day on May 30, 2024, the organization is urging global leaders to recognize the life-saving potential of safer nicotine products and to expose the ongoing disinformation campaign led by the World Health Organization (WHO). 

    “Despite overwhelming scientific evidence supporting the reduced risk of vaping compared to combustible tobacco products, the WHO continues to ignore the facts and mislead the public,” said Nancy Loucas, executive coordinator of CAPHRA. “These products, including e-cigarettes, snus, and heated tobacco products (HTPs), offer a viable alternative for millions of smokers seeking to reduce their health risks.

    “The GSTHR reports have shown that these alternatives are not only effective in reducing harm but also play a significant role in public health by providing accessible and acceptable options for smokers worldwide.”

    CAPHRA has criticized the WHO’s exclusionary tactics, particularly at the 10th Session of the Conference of the Parties (COP10). By excluding consumer groups and harm reduction advocates, the WHO has demonstrated a blatant disregard for the voices of those directly impacted by tobacco use, according to an emailed press release.

    “One of the most egregious aspects of the WHO’s stance is its use of children as pawns to propagate the false narrative that vaping is not a tobacco harm reduction product,” said Loucas. “This disinformation campaign not only undermines the credibility of harm reduction efforts but also jeopardizes the health of millions of adult smokers who could benefit from switching to safer alternatives.”

    CAPHRA is calling on all vaping industry stakeholders, including policymakers, public health officials, and the media, to recognize the truth about tobacco harm reduction. The release states that it is time to challenge the disinformation spread by the WHO and advocate for evidence-based policies that prioritize the health and well-being of smokers worldwide.

    “It’s time for the WHO and FCTC to listen to consumers and integrate harm reduction into their policies. Only then can we tackle both the public health crisis of smoking and the escalating illicit tobacco trade,” said Loucas. “The WHO’s stance not only ignores the evidence supporting these strategies but also undermines the global fight against the tobacco epidemic.”

  • New Briefing Details THR Success for IQOS in Japan

    New Briefing Details THR Success for IQOS in Japan

    Photo: wachiwit

    Knowledge Action Change (KAC) has released a briefing paper on the rapid fall in cigarette sales in Japan following the introduction of heated-tobacco products (HTP).

    Titled “Cigarette Sales Halved: Heated-Tobacco Products and the Japanese Experience,” the paper explores some of the social and cultural factors that have made Japan particularly suited to HTP and provides a case study showcasing the potential of tobacco harm reduction through the adoption of safer nicotine products.

    As well as referencing a number of peer-reviewed science papers, the briefing paper, available in 12 languages, also includes some new Global State of Tobacco Harm Reduction research, which compares up-to-date sales figures that emphasize the changing nature of cigarette and HTP consumption.

    According to KAC, the success of HTP in Japan offers significant hope of their potential to reduce cigarette sales in other similar countries.

    “The speed and scale of the change in Japan shows just how quickly things can improve when those people already consuming nicotine are given access to a safer alternative,” said KAC Director David MacKintosh in a statement.

    “This is not the result of a specific government policy or initiative, yet the benefits to individuals and society are significant. There are lessons to be learnt from Japan by all those who wish to see the use of combustible tobacco consigned to the history books. Harm reduction is about giving people the opportunity to improve their own health and the health of those around them. Given the chance, most people will do just that.”

  • Regulators Urged to Distinguish Combustibles and Smoke-Free

    Regulators Urged to Distinguish Combustibles and Smoke-Free

    Photo: Finn Bjurvoll Hansen

    A study released on May 7 adds further evidence that the harm from nicotine use is determined primarily by the consumption method.

    Titled No Smoke, Less Harm, the report details rates of nicotine usage in Sweden and a number of comparable countries, finding that nicotine use was not a factor in tobacco-related disease.

    Karl Fagerstrom

    While nicotine consumption in Sweden mirrors the European average, the country reports a 41 percent lower incidence of lung cancer and fewer than half the tobacco-related deaths of its European peers. This stark contrast is attributed to the widespread adoption of smoke-free nicotine products such as snus, nicotine pouches and electronic cigarettes.

    “This distinction between smoking and the use of smokeless products is crucial,” says Karl Fagerstrom, a public health expert and contributor to the report.

    “While nicotine is addictive, it does not cause the serious diseases associated with smoking. Our findings support a shift in focus from cessation to substitution with less harmful alternatives for those unable to stop completely.”

    According to the authors, Sweden’s proactive measures in public health education and regulatory frameworks have encouraged a transition to these alternatives, significantly impacting public health outcomes. The report points out that embracing similar harm reduction strategies could be pivotal for other nations striving to reduce the health impacts of tobacco.

    “The Swedish experience demonstrates that understanding and addressing public misperceptions about nicotine can lead to health policies that better protect and inform consumers,” said Fagerstrom.

  • Study Finds Smokers Confused About Relative Risk

    Study Finds Smokers Confused About Relative Risk

    Photo: auremar

    Many smokers fail to understand the comparative risks presented by vapes and traditional cigarettes, according to a new Ipsos survey among 27,000 smokers in 28 countries carried out on behalf of We Are Innovation.

    Currently, 74 percent of smokers worldwide mistakenly believe that vaping is either as harmful or more harmful than smoking combustible cigarettes. This misinformation challenges public health messaging about vaping as a safer alternative to traditional smoking methods.

    The survey identified countries including Brazil, the Netherlands, Slovenia and Kazakhstan as having the highest proportion of smokers (over 80 percent) incorrectly perceiving vaping as equally or more harmful than smoking tobacco. On the other hand, countries such as Italy, the Czech Republic, France and the United Kingdom exhibited a more accurate understanding, although even in these nations, over half of smokers still hold false beliefs regarding the risks of vaping versus smoking.

    “The consequences are grave,” said We Are Innovation CEO Federico N. Fernandez in a statement. “If smokers are under the incorrect assumption that vaping is no better than smoking, they are far less likely to explore potentially lifesaving products as a means to quit harmful combustibles. Misinformation is stifling innovation and obstructing smokers’ ability to escape the clutches of cigarettes.”

  • Critics Claim Registry Bills Harmfully Limit Options

    Critics Claim Registry Bills Harmfully Limit Options

    Photo: Andrey Popov

    Premarket tobacco product application (PMTA) registry bills in the United States are harmfully limiting options for people seeking to quit cigarettes, according to critics.

    The bills, which restrict sales to products that have either been authorized by the Food and Drug Administration under the PMTA pathway or are undergoing that process, have been spreading rapidly around the nation, according to Filter.

    Alabama, Louisiana and Oklahoma already have PMTA registry bills in force while laws in Kentucky, Utah and Wisconsin are set to take effect in 2025.

    To date, the FDA has authorized only a handful of e-cigarettes, all of which are owned by tobacco companies. The remaining vapes on the market are sold unauthorized and often imported from China. Limited FDA enforcement has prompted many states to step in with registry bills.

    Tobacco harm reduction advocates have long condemned the PMTA process as excessively onerous. They point out that it’s easier to bring new cigarettes to market than it is to gain authorization for safer vapes that can replace them.

    Tobacco companies are supporting PMTA registry bills in what critics say is a bid to dominate the market at the expense of people who smoke.

    “Most legislators do not understand that PMTA registries aim to ban the sale of the vast majority of vaping products used by adults in their state,” said Greg Conley, director of legislative and external affairs for the American Vapor Manufacturers trade organization. “They think they are fighting Chinese scofflaws, but really they are making life worse for their own voters.”

  • Royal College of Physicians Releases New E-cig Report

    Royal College of Physicians Releases New E-cig Report

    Photo: Balint Radu

    E-cigarettes represent a valuable aid in smoking cessation, but more can and should be done to reduce their appeal, availability and affordability to nonsmokers, and reduce environmental harms, according to a new report by the Royal College of Physicians (RCP) in the United Kingdom.

    The results are summarized in over 50 recommendations, which explore trends in combustible tobacco use and vaping products, the differences in health effects of vaping in people who smoke, vape or do neither, ethical dilemmas presented by e-cigarette, environmental damage, and the role of the tobacco industry in the rising use of e-cigarettes.

    The RCP report concludes that:

    • since the 2016 RCP report the evidence of the effectiveness of e-cigarettes as an aid to quitting has become much stronger
    • use of e-cigarettes by young people and nonsmokers has increased substantially in recent years
    • prompt remedial measures are needed to curb youth vaping without undermining use by adult smokers as an aid to quitting
    • the government should commission a series of regular evidence updates on the use and effects of nicotine products to guide policy.

    Regarding the effectiveness of e-cigarettes as a cessation tool, researchers emphasize e-cigarettes should be promoted as an effective means of helping smokers to quit smoking tobacco, particularly focusing on those population groups that could benefit the most, such as patients with mental disorders or those who experience socioeconomic disadvantage and people living in social housing.

    Regarding potential health side effects resulting from vaping product use, researchers carried out a review of biomarkers of exposure to and harm from e-cigarettes using data published between 2021 and 2023 comparing people who vape, people who smoke, people who do both (dual use), and people who do neither.

    Although lower levels of harmful substances were found in vapers compared to smokers for many of the biomarkers analyzed, researchers conclude agreement needs to be reached on the methods for vaping health risks research, including which biomarkers are the most relevant to study regarding the relative and absolute risks of vaping, to draw accurate conclusions. Studies with larger samples are needed both on vapers with a history of smoking and on vapers who have never smoked.

    The RCP report insists on finding a balance between preventing these categories from accessing vaping while not demonizing such products in the eyes of those who use them to quit smoking.

    Regarding youth addiction specifically, RCP researchers concluded that standardized plain packaging combined with reduced flavor and brand descriptions together with retail display bans should be introduced to decrease youth interest in trying vaping.

    E-cigarette price and taxation strategies should reduce the affordability of the cheapest products most commonly used by youth vapers (i.e. disposable e-cigarettes), while ensuring that the products most likely to be used by adults who smoke/quitters (i.e. rechargeable and refillable products), which are also less damaging to the environment, remain affordable.

    The report also proposed to increase prices through the introduction of a consumption tax and a minimum unit price, prohibiting multiple purchases but ensuring that they remain a less expensive option for adults who use them to quit smoking, and limiting promotional materials in retail stores and product visibility, and restricting promotion on social media.

    The authors of the report also urge regulators to prevent cigarette manufacturers from playing a role in the development of national policies.

  • Healthcare Providers Urged to Discuss Vape Benefits

    Healthcare Providers Urged to Discuss Vape Benefits

    Tracy Smith and Benjamin Toll have co-authored a commentary suggesting that health care providers providers talk with adult patients who smoke about the relative risks of different tobacco products, including e-cigarettes.
    (Photo: MUSC Hollings Cancer Center)

    Healthcare providers who are working with adult patients struggling to stop smoking should consider discussing e-cigarettes as a potential tool if they’ve already tried FDA-approved medications, say tobacco researchers with MUSC Hollings Cancer Center.

    Benjamin Toll, director of the MUSC Health Tobacco Treatment Program, and Tracy Smith, associate professor in the Addiction Sciences Division of the Department of Psychiatry and Behavioral Sciences, partnered with Brian King, director of the Center for Tobacco Products at the U.S. Food and Drug Administration, to write a commentary in Nature Medicine that lays out the relative risk of e-cigarettes compared with traditional combustible cigarettes. Existing scientific evidence indicates that both products have health risks, but that e-cigarettes generally have lower risks than cigarettes.

    To be clear—neither option is good for your health, Toll and Smith said. And they certainly don’t want any youth, or adults who don’t smoke, to take up e-cigarette use. But among adults who have already tried FDA-approved cessation medicines, if the choice is between continuing to smoke traditional cigarettes or switching completely to e-cigarettes, then a complete switch should be encouraged, they said. They were motivated to work with King to write this commentary because they saw confusion among the general public and doctors about the relative harms of each product.

    “It really bothered me that there are well-intentioned, smart healthcare providers who think that e-cigarettes are worse than smoking cigarettes,” Toll said in a statement. “It’s simply not true.”

    Toll, who is currently serving as president of the Society for Research on Nicotine and Tobacco, wanted to expand the conversation that health care providers can have with patients about ways to stop smoking.

    There are seven FDA-approved smoking cessation aids, including medication and nicotine replacement options like the patch. These smoking cessation products, especially when combined with behavioral counseling, improve a person’s chances of quitting smoking. But because nicotine is so addictive, many people still struggle. That’s where Smith and Toll see a place for e-cigarettes.

    “Doctors and other health care professionals don’t know what to say or how to talk about it,” Smith said. “I always say, ‘If you have somebody who smokes cigarettes, they are standing in a convenience store every single day, buying the most harmful tobacco product they could possibly be buying.’ And it’s a real injustice not to say to them, ‘Hey, there are nicotine products you could buy every day that would be a whole lot less likely to kill you.’”

    However, Toll and Smith are very specific about which types of e-cigarettes they’re referring to. When they say that e-cigarettes have fewer toxicants and cause less harm than cigarettes, they’re referring specifically to the 23 products that have received FDA authorization for marketing.  It’s worth noting that all 23 of these products are tobacco-flavored, not fruity, chocolatey or candy-flavored.

    Smith explained that the FDA created two paths for e-cigarette manufacturers to gain authorization. The first path would allow manufacturers to market their e-cigarettes as smoking cessation devices.

    “Thus far, no company has done that—as far as we know, they have not even applied,” Smith said.

    The second path allows companies to market their products as tobacco products, but makes no claims about smoking cessation. Companies have to show that their products are appropriate for the protection of public health – specifically, that the benefits of the product for helping adults who smoke to transition completely outweighs the known risk of these products to youth and nonusers.

    Besides the likelihood that the product will entice young people, the FDA looks at everything from environmental impact to whether users completely switch to the e-cigarette product from cigarettes. Complete switching, rather than going back and forth between e-cigarettes and cigarettes, is an important factor. If people use both products – something that researchers call “dual use” – then they’re still exposing themselves to the carcinogens and toxicants in cigarettes.

    “So far, the FDA has issued more than a million denials and 23 authorizations,” Smith said.

    Due to the rigorous nature of the reviews, Smith and Toll believe that doctors can reasonably share that list of 23 authorized e-cigarettes with people who are struggling to stop smoking.

    In addition, there’s increasing evidence suggesting that e-cigarettes can help adults who smoke to completely transition away from cigarettes, they said. Recent large-scale studies published in JAMA Internal Medicine and the New England Journal of Medicine showed that e-cigarettes helped people to stop smoking. Further, Smith said, a Cochrane Review conducted earlier this year concluded that there is evidence from enough high-quality studies to say that e-cigarettes are more likely to help people to quit than nicotine replacement therapy, which includes nicotine gum, nicotine lozenges and the patch.

    E-cigarettes remain controversial though.

    “Some believe that we shouldn’t be allowing new tobacco products on the market that could potentially be appealing to youth, no matter what the benefit is to adults who smoke. And I’m just not in that camp because cigarettes are the primary way that tobacco kills people,” Smith said. “For me, because cigarettes are responsible for the vast majority of the deaths and illnesses from tobacco, I think that having less harmful alternatives out there for adults, especially if we can reduce the appeal to youth, is really important.”

  • U.K. Expected to Introduce Generational Ban Today

    U.K. Expected to Introduce Generational Ban Today

    Image: boygostockphoto

    The UK government is set to introduce a bill in parliament aimed at phasing out smoking among young people by prohibiting nicotine sales for future generations.

    The Tobacco and Vapes Bill, if passed unamended, will be one of the world’s toughest anti-tobacco laws and prevent children turning 15 this year or younger from ever being able to be legally sold nicotine products.

    The government said smoking itself would not be criminalized. Therefore, anyone who can legally buy tobacco now will not be prevented from doing so in the future, according to Reuters.

    “If we want to build a better future for our children, we need to tackle the single biggest entirely preventable cause of ill-health, disability, and death: smoking,” Conservative Prime Minister Rishi Sunak said in a statement.

    Critics say the move is “unconservative,” and former prime minister Liz Truss is one of several members of the governing party who have said they will vote against the legislation.

    Despite the opposition, the legislation is expected to pass with the opposition Labour Party suggesting it would support the measure.

    Last month, a similar law introduced by New Zealand banning tobacco sales to those born after Jan. 1, 2009 was repealed by the country’s new coalition government.

  • Scotland Welcomes U.K. Generational Nicotine Ban

    Scotland Welcomes U.K. Generational Nicotine Ban

    simple sign no smoking and vaping, isolated on white
    Credit: 123rf.com

    Scotland Public Health Minister Jenni Minto has welcomed proposed legislation to ban tobacco sales to anyone born after Jan. 1, 2009, and allow for tougher measures on vaping.

    The proposed legislation, which is U.K.-wide, would gradually increase the age of sale, making it illegal to sell tobacco products to anyone born on or after Jan. 1, 2009. The bill also includes powers to regulate displays, contents, flavors and retail packaging of vapes and nicotine products, allowing restrictions to target flavors marketed at children and to move vapes out of sight of children and away from products like sweets, according to the Scottish government.

    The legislation will also remove existing provisions making it illegal for those under the age of 18 to purchase tobacco products.

    The government previously published proposals to ban the sale and supply of single-use vapes, which, if agreed upon by the Parliament, would come into effect April 1, 2025.

    “Scotland has been a world-leader on a range of tobacco control measures, and while there has been a steady reduction in the proportion of people smoking, we know it still damages lives and kills more than 8,000 people a year in Scotland,” said Minto. “Smoking is a huge burden on our NHS [National Health Service] and social care services and contributes significantly to health inequalities, which is why our goal is for a tobacco-free Scotland by 2034.

    “Research suggests that almost one in five young people have tried vaping, and we’re particularly concerned about how flavors are used as an enticement to children and young people.

    “We will now consider how to use these powers, if passed by Westminster, with the consent of the Scottish Parliament, to benefit public health. We will continue our four-nations approach to avoid any unnecessary regulatory divergence and to offer more certainty for business and consistency for consumers. Powers on vapes will be taken forward following further consultation and engagement.

    “In addition, we were the first government to commit to taking action on single-use vapes and have now fulfilled our 2023 Program for Government commitment to consult on measures to tackle the environmental impact of single-use vapes.”

    In accordance with the Sewel Convention, the bill will require the legislative consent of the Scottish Parliament.