Wednesday, 26 January 2011

Tobacco harm reduction partially explained

Harm reduction means different things to different people. In the context of nicotine, it means using smokeless alternatives to tobacco without resorting to nicotine-based cessation therapies. It's a fairly new area to me, but it's been interesting how e-cigarettes are almost as political an issue as smoking itself.

E-cigarettes are, of course, an obvious example of harm reduction. Whether or not you believe that smoked tobacco is as serious a problem as the authorities wish us to believe, it is unarguable that using an e-cigarette doesn't involve inhaling in the way that smoking involves inhaling, and that it creates water vapour and not smoke.

Many e-cigarette users are far more politicised than smokers, and it is small wonder. Having given up the trouble to give up smoking, perhaps having swallowed anti-smoking propaganda in the process, they that find the product (e-cigarette) that has enabled them to stop smoking is about to be banned in New York, on suspicion that it might present some kind of health risk to the user.

At least that's the official version. In fact they are banning e-cigarettes but not real cigarettes (from which they derive huge levels of tax, but which (officially) carries enormous health risks), or drugs such as Champix, which is the subject of hundreds of lawsuits. New York State wants smokers on either real tobacco or pharmaceutical drugs.

Even ASH Scotland dedicates a section to harm reduction. Its sole item for 2011 so far shows that a few dozen smokers in the US prefer nicotine lozenges to snus. Its briefing on e-cigarettes is full of waffle, but essentially it wants e-cigarettes regulated by the MRHA along with any other smoking cessation treatment.

Unofficially, smokers find an alternative to smoking that's acceptable to them and take to it in their thousands. Officially, the authorities realise that they no longer control the nicotine market (the punters do – shocking!), so they set out to regulate it – although it does look strange when e-cigs are banned before they are known to be hazardous, and other drugs and tobacco itself are not banned, in spite of reported harms, lawsuits and vastly expensive health campaigns by the government.

The ironic result of a ban is that all those in New York State who gave up smoking using e-cigarettes are left without their product of choice. Many will go back to smoking rather than abstain completely or take to pharmaceutical nicotine.

Harm reduction must involve some level of autonomy for the smoker.

All this is bad enough. I now refer you to a post entitled 'If you pretend to be doing honest research, don't punish people for believing you'. Paul Bergen recounts the story of a tobacco cessation delegate who was thrown out of a conference for discussing 'harm reduction' as if it meant anything other than compliance with a medicinal nicotine regime. He then recounts his own similar experience. People like Paul Bergen and the other delegate have learned that people who want to stop others from smoking are not working to an agenda that concerns health.

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