Leading Change
Now is the time to realize the opportunity of harm reduction for adult tobacco consumers. Adult smokers are interested in alternatives, including those with the potential to reduce risk. Innovative products are available and science exists to support harm reduction.
Tobacco Harm Reduction
The success of tobacco harm reduction in Canada hinges on a regulatory framework that allows manufacturers to communicate accurate health information about potentially reduced-risk products to adult tobacco consumers. This includes the ability to make reduced-harm claims about products that are proven to be lower risk than cigarettes. It is crucial that Canada’s tobacco control strategy evolve to recognize the potential of tobacco harm reduction policies for reducing the death and disease associated with cigarettes.Nicotine Misperceptions
Persistent misperceptions regarding the role of nicotine and the relative risks of different tobacco products prove to be a significant obstacle to adult smokers' switching to potentially reduced-harm products. For example, a study from the Health Information National Trends Survey found "a high prevalence of incorrect beliefs about the relationship between nicotine and cancer."1 Specifically, the study found "Most people (73%) either incorrectly believed that nicotine is the main substance in cigarettes that causes cancer or were unsure about the relationship between nicotine and cancer."2
As the U.S. Food and Drug Administration states on its website: "Nicotine is what keeps people using tobacco products. However, it’s the thousands of chemicals contained in tobacco and tobacco smoke that make smoking so deadly. Some of these chemicals, known to cause lung damage, are also found in some e-cigarette aerosols. This toxic mix of chemicals—not nicotine—cause the serious health effects among those who use tobacco products, including fatal lung diseases, like chronic obstructive pulmonary disease (COPD) and cancer."3
The "Risk Cliff"
Leading public health authorities agree that there is a broad "continuum of risk" among tobacco products, with cigarettes at the highest end of that spectrum and complete cessation at the lowest end.5
While there may be differences in risk profiles between specific smoke-free products, it will take years of epidemiology to quantify those differences. The body of evidence does, however, indicate a profound risk differential between combustible and smoke-free product categories. Data suggests that a two-dimensional "Risk Cliff" model is a useful description of the relative risk between combustible products (such as cigarettes and cigars) and smoke-free products (such as moist smokeless tobacco, heated tobacco, e-vapor and oral nicotine pouches).
The hundreds of thousands of adult smokers in Canada seeking less harmful alternatives to cigarettes deserve to be informed about the role of nicotine and the relative risks of different tobacco products.
1 O'Brien, E. K., Nguyen, A. B., Persoskie, A., & Hoffman, A. C. (2016). U.S. adults' addiction and harm beliefs about nicotine and low nicotine cigarettes. Preventive Medicine, 96, 94-100. doi: 10.1016/j.ypmed.2016.12.048
2 Id.
3 "What Makes Tobacco Use Harmful" in Tobacco Products, Food & Drug Administration View Source
4 Adapted from Nutt, et. al Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach. Eur. Addict Res 2014; 20:218-225.
5 "… we must acknowledge that there’s a continuum of risk for nicotine delivery. That continuum ranges from combustible cigarettes at one end, to medicinal nicotine products at the other.” Remarks by Scott Gottlieb, M.D., Protecting American Families: Comprehensive Approach to Nicotine and Tobacco (June 28, 2017), available at https://www.fda.gov/news-events/speeches-fda-officials/protecting-american-families-comprehensive-approach-nicotine-and-tobacco-06282017.