Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here?

Abstract

[...]6–12-month abstinence rates with no intervention are only around 3%, with an estimated percentage point increase of between 6 and 15% with nicotine replacement therapy (NRT), buproprion or varenicline [3]. [...]smoking prevalence remains disproportionately high in underrepresented (e.g. vulnerable/marginalised) groups (estimates of above 80% in those dependence on illicit substances) [11], and the effectiveness of e-cigarettes and other reduced risk nicotine-containing products have not been extensively researched in these groups. Understanding the conditions under which smokers switch to e-cigarettes or other reduced risk products is clearly a priority area for research but one that may be exclusive to countries where regulation is relaxed, markets are developing and real world user behaviour can contribute to scientific evidence. Tobacco harm reduction, although not risk free, is likely to reap considerable public health benefits but for its potential to be realised, a paradigm shift is required; there is no place for intolerance to nicotine per se when smoking-related death and disease continue unabated across the globe.