Tobacco Harm Reduction in the 21st Century: 3 Key Developments

According to public health experts, tobacco use killed about 100 million people in the 20^th century and could kill as many as 1 billion people this century. That’s a truly staggering estimate, but it was made in 2008 – before novel new nicotine delivery products appeared on the market and changed the face of tobacco harm reduction. Today, the future looks potentially very different; this may ultimately become the century in which traditional combustible tobacco products become entirely irrelevant, eliminating the world’s top preventable cause of death.

Even if you don’t smoke yourself, tobacco harm reduction still affects you because you almost certainly have friends and loved ones who smoke – and if that’s not the case, secondhand smoke – which kills tens of thousands each year – is still a major concern. Reducing tobacco harm, in short, is a cause that benefits virtually every person in the world.

So, how has the 21^st century potentially changed the nature of humanity’s relationship with tobacco and nicotine? We’ll answer that question by examining the three most important developments in tobacco harm reduction over the century’s first two decades.

Vaping: Nicotine Without Tobacco

With at least 40 million users worldwide – a number that continues to grow every year – vaping products from companies like V2 E-Cigs UK are the most important tobacco harm reduction products released to date. Vaping is the act of using an electronic device to vaporize a nicotine-infused liquid called e-liquid. The e-liquid forms a cloud that the user inhales and exhales like smoke. E-liquid contains no tobacco, but it generally contains nicotine. Many experts estimate that vaping could be up to 95 percent less harmful than smoking.

Vaping has been incredibly successful in helping smokers quit because it’s satisfying to the user in ways that traditional nicotine replacement therapies aren’t. Nicotine replacement products like gums and patches deliver the same nicotine as e-liquid; the difference is that they don’t deliver as much nicotine – nor do they deliver it as quickly – as inhaling. Vaping, on the other hand, facilitates quick delivery of nicotine through the lungs, and it features the same satisfying “throat hit” that characterizes cigarette smoking. Vaping also replaces the hand-to-mouth ritual that reinforces the psychological addiction to cigarettes.

Heat-Not-Burn: Tobacco Without Smoke

For the tens of millions of former smokers who have switched successfully, vaping checks all of the right boxes; it feels and looks like smoking, and with the hundreds of different e-liquid flavors on the market, it even tastes better than cigarettes. The only problem with vaping, though, is that no e-liquid in the world tastes like cigarette smoke. It isn’t possible to use aromas alone to recreate that flavor, and some people aren’t interested in a harm reduction product that doesn’t taste anything like a real cigarette. Rather than nicotine-infused liquid, heat-not-burn (HNB) products vaporize real tobacco. Although that may mean HNB products are riskier than e-liquid vaping products, they are still likely to be significantly less risky than combustible tobacco products. Some governments do, in fact, allow the makers of HNB products to claim that their products are safer than cigarettes.

To use a HNB product, the user inserts a plug of tobacco into a device with a heating blade. The heating blade warms the tobacco to the point of pyrolysis but doesn’t ignite it. The heat is sufficient to cause the tobacco to release its nicotine and flavor without generating smoke.

Some public health advocates have spoken out about HNB products, saying that those products represent a step backwards for harm reduction in places where vaping is already legal and accepted by consumers. In some nations, however, nicotine e-liquid isn’t legal – and HNB systems are. HNB products are valuable harm reduction options in those nations, and they are also potentially valuable for smokers who don’t vape because e-liquid doesn’t capture the flavor of real tobacco.

Snus: Tobacco Without Lung Cancer

Invented in Sweden, snus is a moistened smokeless tobacco product that’s usually sold in pre-portioned pouches and is used by placing and holding it in the upper lip. Snus is a niche product outside Sweden – where more than a million people use it daily – but it is a very important harm reduction product in its home country, which has the lowest lung cancer rate in all of Europe.

Snus is similar to dipping tobacco in that both products are held in the mouth, facilitating the absorption of nicotine through the oral mucosa. However, snus differs from dipping tobacco in two important ways.

• Dipping tobacco is held in the bottom lip and causes excessive salivation. Snus users do not need to spit.
• Dipping tobacco is processed by fire curing, and snus is processed by steam pasteurization. The steam pasteurization results in a product with a significantly lower concentration of nitrosamines, which are known carcinogens.

Research into the safety of snus is still ongoing. Some studies associate snus use with increased risk of pancreatic and esophageal cancer, but other studies contradict those. Snus does not increase the risk of developing lung cancer, and it has not been linked conclusively with increased incidence of cardiovascular disease.

What Is Tobacco Harm Reduction?

Tobacco harm reduction is the philosophy that, no matter what, some people are going to smoke even though they know that it causes harm. Although people should still be strongly discouraged from smoking – and encouraged to quit if they smoke already – it’s still a net benefit for public health if the people who will use nicotine either way are encouraged to use products less likely to cause disease and death.

It should be every government’s goal to implement common-sense regulations and ensure that appealing and affordable harm reduction options remain available to adult smokers who can’t quit. It is likewise vital to educate the public and ensure that smokers understand the continuum of risk associated with nicotine use. In a 2004 survey, for example, nearly all respondents incorrectly believed that “light” or “ultra-light” cigarettes were safer than “regular” cigarettes. In a 2014 survey, nearly half of the respondents incorrectly believed that e-cigarettes were no safer than tobacco cigarettes. Dishonest marketing tactics, biased media coverage and a lack of a unified, science-based message from public health authorities have combined to create the false consumer impressions that are among the greatest obstacles impeding the uptake of tobacco harm reduction products.