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Harm reduction in tobacco control: where do we draw the line?

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Abstract

With substance abuse, harm reduction refers to reducing or replacing use of a harmful product with a less risky agent. But many advertised “non-pharmaceutical” harm reduction alternatives for tobacco smoking are problematic. Studies have revealed inconclusive results using agents including chewing tobacco and e-cigarettes to quit smoking and have demonstrated continued use of these agents. Many smoking harm reduction agents pose other health risks not found in traditional tobacco smoking. Given these limitations, efforts should focus on promoting nicotine replacement therapy, and other pharmacologic agents with a better chance of producing sustained smoking cessation. To address the harmful nature of many tobacco replacement products, public health should focus on regulating these alternatives with the same stringency as tobacco, and social marketing efforts should target evidence-based and safer pharmaceutical grade or behavioural alternatives.

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References

  1. Single E. Defining harm reduction. Drug Alcohol Rev. 1995;14(3):287–90. https://doi.org/10.1080/09595239500185371.

    Article  Google Scholar 

  2. Centre for Addiction and Mental Health. Methadone. Toronto: Centre for Addiction and Mental Health; n.d. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/methadone

  3. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2003. https://doi.org/10.1002/14651858.CD002209.pub2.

    Article  Google Scholar 

  4. Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ. 2017. https://doi.org/10.1136/bmj.j1550.

    Article  Google Scholar 

  5. Harvard Health Publishing. Treating opiate addiction, part I. detoxification and maintenance. Cambridge, MA: Harvard Medical School; 2005. [updated 2019 June 27]. https://www.health.harvard.edu/mind-and-mood/treating-opiate-addiction-part-i-detoxification-and-maintenance

  6. Zhu S, Wang JB, Hartman A, Zhuang Y, Gamst A, Gibson JT, et al. Quitting cigarettes completely or switching to smokeless tobacco: do US data replicate the Swedish results? Tob Control. 2019;18(2):82–7. https://doi.org/10.1136/tc.2008.028209.

    Article  Google Scholar 

  7. Fould J, Ramstrom L, Burke M, Fagerström K. Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tob Control. 2003;12(4):349–59. https://doi.org/10.1136/tc/12/4/349.

    Article  Google Scholar 

  8. Nordgren P, Ramström L. Moist snuff in Sweden—tradition and evolution. Br J Addict. 1990;85(9):1007–12. https://doi.org/10.1111/j.1360-0443.1990.tb03435.x.

    Article  Google Scholar 

  9. Al-Hamdani M, Manly E. Smoking cessation or initiation: the paradox of va**. Prev Med Rep. 2021;22:101363. https://doi.org/10.1016/j.pmedr.2021.101363.

    Article  Google Scholar 

  10. Berry KM, Fetterman JL, Benjamin EJ. Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths. JAMA Netw Open. 2019;2(2):e187794. https://doi.org/10.1001/ja0.manetworkopen.20198.7794.

    Article  Google Scholar 

  11. Owotomo O, Stritzel H, Mccabe SE, et al. Smoking intention and progression from e-cigarette use to cigarette smoking. Pediatrics. 2021;146(6):e202002881. https://doi.org/10.1542/peds2020-002881.

    Article  Google Scholar 

  12. Sohlberg T, Wennberg P. Snus cessation patterns - a long-term follow-up of snus users in Sweden. Harm Reduct J. 2020;17(1):62. https://doi.org/10.1186/s12954-020-00405-z.

    Article  Google Scholar 

  13. Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, Li J, Parrott S, Sasieni P, Dawkins L, Ross L, Goniewicz M, Wu Q, McRobbie HJ. A randomized trial of E-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019;380(7):629–37. https://doi.org/10.1056/NEJMoa1808779.

    Article  Google Scholar 

  14. Wang JB, Olgin JE, Nah G, Vittinghoff E, Cataldo JK, Pletcher MJ, Marcus GM. Cigarette and e-cigarette dual use and risk of cardiopulmonary symptoms in the Health eHeart Study. PLoS ONE. 2018;13(7):e0198681. https://doi.org/10.1371/journal.pone.0198681.

    Article  Google Scholar 

  15. Zhu SH, Gamst A, Lee M, Cummins S, Yin L, Zoref L. The use and perception of electronic cigarettes and snus among the U.S. population. PLoS ONE. 2013;8(10):e79332. https://doi.org/10.1371/journal.pone.0079332.

    Article  Google Scholar 

  16. Norwegian Institute of Public Health. Health risks of Scandinavian snus consumption (English summary). Norway; 2016. https://www.fhi.no/en/publ/2014/helserisiko-ved-bruk-av-snus/

  17. Arefalk G, Hergens MP, Ingelsson E, Arnlöv J, Michaëlsson K, Lind L, Ye W, Nyrén O, Lambe M, Sundström J. Smokeless tobacco (snus) and risk of heart failure: results from two Swedish cohorts. Eur J Prev Cardiol. 2012;19(5):1120–7. https://doi.org/10.1177/1741826711420003.

    Article  Google Scholar 

  18. Akhtar S, Sheikh AA, Qureshi HU. Chewing areca nut, betel quid, oral snuff, cigarette smoking and the risk of oesophageal squamous-cell carcinoma in South Asians: a multicentre case-control study. Eur J Cancer. 2012;48(5):655–61. https://doi.org/10.1016/j.ejca.2011.06.008.

    Article  Google Scholar 

  19. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. France: World Health Organization International Agency for Research on Cancer; 2007. https://www.ncbi.nlm.nih.gov/books/NBK326497/pdf/Bookshelf_NBK326497.pdf. Accessed 2021 April 29

  20. Nowak D, Jörres RA, Rüther T. E-cigarettes–prevention, pulmonary health, and addiction. Dtsch Arztebl Int. 2014;111(20):349–55. https://doi.org/10.3238/arztebl.2014.0349.

    Article  Google Scholar 

  21. Alzahrani T, Pena I, Temesgen N, Glantz SA. Association Between Electronic Cigarette Use and Myocardial Infarction. Am J Prev Med. 2018;55(4):455–461. https://doi.org/10.1016/j.amepre.2018.05.004. Erratum in: Am J Prev Med. 2019;57(4):579–584.

  22. Landman ST, Dhaliwal I, Mackenzie CA, Martinu T, Steele A, Bosma KJ. Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth. CMAJ. 2019;191(48):E1321–31. https://doi.org/10.1503/cmaj.191402.

    Article  Google Scholar 

  23. Moore D, Aveyard P, Connock M, Wang D, Fry-Smith A, Barton P. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ. 2009;338(7699):867–71. https://doi.org/10.1136/bmj.b1024.

    Article  Google Scholar 

  24. Ebbert JO, Hughes JR, West RJ, Rennard SI, Russ C, McRae TD, Treadow J, Yu CR, Dutro MP, Park PW. Effect of varenicline on smoking cessation through smoking reduction: a randomized clinical trial. JAMA. 2015;313(7):687–94. https://doi.org/10.1001/jama.2015.280.

    Article  Google Scholar 

  25. Mottillo S, Filion KB, Bélisle P, Joseph L, Gervais A, O’Loughlin J, Paradis G, Pihl R, Pilote L, Rinfret S, Tremblay M, Eisenberg MJ. Behavioural interventions for smoking cessation: a meta-analysis of randomized controlled trials. Eur Heart J. 2009;30(6):718–30. https://doi.org/10.1093/eurheartj/ehn552.

    Article  Google Scholar 

  26. Chang PH, Chiang CH, Ho WC, Wu PZ, Tsai JS, Guo FR. Combination therapy of varenicline with nicotine replacement therapy is better than varenicline alone: a systematic review and meta-analysis of randomized controlled trials. BMC Public Health. 2015;15:689. https://doi.org/10.1186/s12889-015-2055-0.

    Article  Google Scholar 

  27. Koegelenberg CF, Noor F, Bateman ED, van Zyl-Smit RN, Bruning A, O’Brien JA, Smith C, Abdool-Gaffar MS, Emanuel S, Esterhuizen TM, Irusen EM. Efficacy of varenicline combined with nicotine replacement therapy vs varenicline alone for smoking cessation: a randomized clinical trial. JAMA. 2014;312(2):155–61. https://doi.org/10.1001/jama.2014.7195.

    Article  Google Scholar 

  28. Mills EJ, Wu P, Lockhart I, Thorlund K, Puhan M, Ebbert JO. Comparisons of high-dose and combination nicotine replacement therapy, varenicline, and bupropion for smoking cessation: a systematic review and multiple treatment meta-analysis. Ann Med. 2012;44(6):588–97. https://doi.org/10.3109/07853890.2012.705016.

    Article  Google Scholar 

  29. Wang C, Cho B, **ao D, Wajsbrot D, Park PW. Effectiveness and safety of varenicline as an aid to smoking cessation: results of an inter-Asian observational study in real-world clinical practice. Int J Clin Pract. 2013;67(5):469–76. https://doi.org/10.1111/ijcp.12121.

    Article  Google Scholar 

  30. Boudrez H, Gratziou C, Messig M, Metcalfe M. Effectiveness of varenicline as an aid to smoking cessation: results of an inter-European observational study. Curr Med Res Opin. 2011;27(4):769–75. https://doi.org/10.1185/03007995.2011.557718.

    Article  Google Scholar 

  31. Wilkes S. The use of bupropion SR in cigarette smoking cessation. Int J Chron Obstruct Pulmon Dis. 2008;3(1):45–53. https://doi.org/10.2147/copd.s1121.

    Article  Google Scholar 

  32. Hatsukami DK, Lemmonds C, Tomar SL. Smokeless tobacco use: harm reduction or induction approach? Prev Med. 2004;38(3):309–17. https://doi.org/10.1016/j.ypmed.2003.10.006.

    Article  Google Scholar 

  33. Farzal Z, Perry MF, Yarbrough WG, Kimple AJ. The adolescent va** epidemic in the United States-how it happened and where we go from here. JAMA Otolaryngol Head Neck Surg. 2019;145(10):885–6. https://doi.org/10.1001/jamaoto.2019.2410.

    Article  Google Scholar 

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Correspondence to Mohammed Al-Hamdani.

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Al-Hamdani, M., Manly, E. Harm reduction in tobacco control: where do we draw the line?. J Public Health Pol 43, 149–154 (2022). https://doi.org/10.1057/s41271-021-00327-5

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