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Harm reduction in nicotine addiction: Helping people who can't quit

October 1, 2007
By Tobacco Advisory Group of the Royal College of Physicians

A report by the Tobacco Advisory Group of the Royal College of Physicians, October 2007

Cigarette smoking is powerfully addictive, and caused 100 million deaths in the 20th century. In the 21st century, if smoking trends persist as expected, one billion people will die from smoking tobacco. All of these deaths are preventable.

Current national and international tobacco control policies focus, quite rightly, on measures that help to prevent people from starting smoking, and help existing smokers to quit. However, once established, smoking is a very difficult addiction to break, and millions of people smoking today will never succeed. At present rates of progress it will take over two decades for the prevalence of smoking in the UK to halve from current levels, such that by 2025 there will probably still be over five million smokers in the UK. Preventing harm to the
health of these smokers is a vital priority in this country, and in all countries where the smoking epidemic is established.

The Royal College of Physicians first called for radical policies to reduce the prevalence of smoking in 1962. Several of the policies we recommended then have since become established international practice. However, those measures, then and now, do not address the problem of smokers who cannot quit. The majority of the 150 million deaths from smoking expected worldwide in the next 20 years will occur in people who are smoking today. These people need help.

In this report we make the case for harm reduction strategies to protect smokers. We demonstrate that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved. We also argue that the regulatory systems that currently govern nicotine products in most countries, including the UK, actively discourage the development, marketing and promotion of significantly safer nicotine products
to smokers.

Harm reduction is a fundamental component of many aspects of medicine and, indeed, everyday life, yet for some reason effective harm reduction principles have not been applied to tobacco smoking. This report makes the case for radical reform of the way that nicotine products are regulated and used in society. The ideas we present are controversial, and challenge many current and entrenched views in medicine and public health. They also have the potential to save millions of lives. They deserve serious consideration.