Kenneth E. WarnerUniversity of Michigan

University of IowaNovember 15, 2002

Technology, Policy, and the Future of Nicotine

Addiction

Pillars of Tobacco Control

• Prevention of initiation

• Assistance with cessation

• Protection from environmental tobacco smoke

• Harm reduction?

What is “tobacco harm reduction”?

Why do we care about it?

What are we going to do about it?

Tobacco harm reduction:a definition

  Minimization of the net damage to health associated with use of tobacco products, products including constituents of tobacco, and other substitutes for tobacco products.

Hierarchy of harm reduction techniques, most to least desirable

• Avoidance of initiation (prevention)• Complete cessation

• Substitution of least harmful alternatives (e.g., medicinal nicotine)

• Substitution of moderately harmful alternatives (e.g., smokeless tobacco)

• Substitution of most harmful alternatives (e.g., modified cigarettes; reduced smoking)

Context for the harm reduction debate

• Limited success of prevention/cessation

• New environment– Perception of “hardening of the target”– Tobacco industry’s publicly acknowledging the

dangers of smoking– USST’s desire to promote smokeless as less

harmful

• New products– Marketing of novel tobacco products– Innovations in nicotine replacement products

• Concerns about promotion of harm reduction

Motives for harm reductionPublic health community:

Reducing risk of disease and death for tobacco users incapable of quitting (or unwilling to quit)

Tobacco industry:Selling product on a sustained basis, with goal of profiting from sales to consumers they might otherwise lose

Pharmaceutical industry:Currently, selling product on a short-term basis, with goal of profiting from increased cessation(Future…???)

Product type Examples

Modified conventional cigarettes

Some carcinogens removed; nicotine-free; fire-safe

Pseudo-cigarettes Unorthodox ignition; cigarette-like appearance

Smokeless tobacco, including modified

Nitrosamines greatly reduced

Novel tobacco and nicotine products

Tobacco lozenges; nicotine water

Nicotine pharmaceuticals “Gum”; patch; inhaler; spray; lozenge

About Eclipse and Your Health

May present less risk of cancer associated with smoking..

Produces less inflammation in the respiratory system, which suggests a lower risk of chronic bronchitis, and possibly emphysema..

Reduces secondhand smoke by 80%.

Nicotine WaterThe goal of NICOTINE WATER is to give cigarette users an alternative source of Nicotine that is free of thesevere health risks of tar and smoke.

But what good is an alternative if it does not come in a form or taste that is appealing to the consumer. That is where NICOTINE WATER has no equal. As a result of careful development and attention to detail, with NICOTINE WATER, all you will taste is the water.

Pacific Compounds. Nicotine replacement in a sucker! Accessed 17 May 2002. http://www.pacificcompounds.com/Products/ Stop_Smoking/stop_smoking.asp

Assessing the Science Base for Tobacco Harm Reduction

Institute of Medicine study• Impossible to assess the harm reduction

potential of products, but conceivable that exposure reduction could be assessed.

• Labeled products “PREPS”, potential reduced-exposure products (not “harm reduction products”).

• Called for study of biomarkers and surrogates that might suggest harm reduction potential; surveillance and evaluation of product use; regulation of manufacturer claims.

Potential benefit of PREPs(from public health perspective)

For smokers who cannot or will not quit, PREPs may offer a less risky alternative to continued smoking. Switching to PREPs may reduce their risk of serious diseases.

Potential risks of PREPs

• May substitute for quitting

• May substitute for abstinence (staying quit)

• May supplement (and sustain) ongoing use of conventional tobacco products

• May encourage experimentation by children who would have avoided conventional tobacco products