Tobacco harm reduction

Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of drugs. Tobacco smoking is widely acknowledged as a leading cause of illness and death,^[1] and reducing smoking is vital to public health.^{[2][3][4][5][6]}

Tobacco use if not stopped can be the cause of death in 50% of its users according to WHO report. ^[7] The benefits of tobacco cessation starts within minutes as heart rate and blood pressure starts falling.

The consumption of tobacco products and its harmful effects affect both smokers and non-smokers,^[8] and is a major risk factor for six of the eight leading causes of deaths in the world, including respiratory diseases, cardiovascular diseases, cerebrovascular diseases, periodontal diseases, teeth decay and loss, over 20 different types or subtypes of cancers, strokes, several debilitating health conditions, and malignant diseases.^{[2][3][4][5][6][9][10]} In high income countries, smoking rates have been reduced mostly by reducing the uptake of smoking among younger people rather than improving the rates of quitting among established smokers. It is, however, mostly current smokers who will face disease and death from smoking.^[11][12]

Nicotine itself, however, is addictive but not otherwise very harmful, as shown by the long history of people safely using nicotine replacement therapy products (e.g., nicotine gum, nicotine patch).^[13] Nicotine increases heart rate and blood pressure and has a range of local irritant effects but does not cause cancer.^[14] None of the three main causes of death from smoking—lung cancer, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), and cardiovascular diseases—is caused primarily by nicotine; the main reason smoking is deadly is the toxic mix of chemicals in smoke from combustion (burning) of tobacco. Products that can effectively and acceptably deliver nicotine without smoke have the potential to be less harmful than smoked tobacco. THR measures have been focused on reducing or eliminating the use of combustible tobacco by switching to other nicotine products, including:

1. Cutting down (either long-term or before quitting smoking)
2. Temporary abstinence
3. Switching to non-tobacco nicotine containing products, such as pharmaceutical nicotine replacement therapies or currently (generally) unlicensed products such as electronic cigarettes
4. Switching to smokeless tobacco products such as Swedish snus
5. Switching to non-combustible tobacco products

Quitting all tobacco products definitively reduces risk the most. However, quitting is difficult, and even approved smoking cessation methods have a low success rate.^[1] In addition, some smokers may be unable or unwilling to achieve abstinence.^[15] Harm reduction is likely of substantial benefit to these smokers and public health.^[1][13] Providing reduced-harm alternatives to smokers is likely to result in lower total population risk than pursuing abstinence-only policies.^[16]

The strategy is controversial: supporters of tobacco harm reduction assert that lessening the health risk for the individual user is worthwhile and manifests over the population in fewer tobacco-related illnesses and deaths.^[15][17] Opponents have argued that some aspects of harm reduction interfere with cessation and abstinence and might increase initiation.^[18][19] However, surveys carried from 2013 to 2015 in the UK^[20] and France ^[21] suggest that on the contrary, the availability of safer alternatives to smoking is associated with decreased smoking prevalence and increased smoking cessation. In Japan the sales of cigarettes have decreased by 32% since the introduction of heated tobacco products.^[22]