Cigarette smoking is responsible for more than 480,000 deaths a year in the US and affects an estimated 1.2 billion people globally. Yet with all the marketing, statistics, and politics related to smoking, and the negative impact that smoking has, some people continue to smoke. The mentality for some might be related to not having enough willpower, or having tried to quit using methods such as nicotine gums, patches, and lozenges, with little success. Smoking is a very difficult addiction to break, and studies have shown that over 80% of smokers who attempted to quit on their own relapsed within the first month. It’s important to note that typically nicotine abstinence or nicotine replacement therapies fail, as many people believe that the nicotine is bad for you, when, in fact, it’s the tar, carbon monoxide, and countless toxins in the smoke that are causing more damage to the body. Alternatively, many smokers will keep smoking if presented with only 2 options: quitting outright or continuing to smoke. One method that has been gaining more attention is tobacco harm reduction (THR). Harm reduction is essentially choosing alternatives that carry fewer health risks; in the case of smoking, this involves choosing an alternative that provides the same nicotine “hit” but with less exposure to tobacco-specific nitrosamines.

Is Tobacco Bad?

There are numerous and unidentifiable chemicals contained within a traditional cigarette; there are also different methods for the preparation of tobacco, otherwise known as curing. Curing is used to create a flavor profile for the tobacco and, depending on the process or method used, determines which end product is created. The most traditional and widely used methods of curing in the US are fire and flue. As a side effect of these curing methods, levels of tobacco-specific nitrosamines are raised substantially higher, and when combined with the chemicals contained within, this makes for a dangerous concoction. Fire-cured tobacco is used in products such as cigars, dipping tobacco, and chewing tobacco, whereas flue-processed tobacco is used in traditional cigarettes. Generally speaking, avoiding the use of tobacco or other nicotine products is always the preferred and safest method of quitting, but the alternatives, while bad, are deemed less harmful and can slowly assist someone with quitting. When considering the alternatives, it’s important to separate the risks of inhaling cigarette smoke vs nicotine. The chemicals within the cigarette are far more harmful than the nicotine contained within. Studies have shown that nicotine presents little if any risk by itself, and data suggest that it may even be beneficial in treating certain diseases! A study, “Transdermal nicotine and haloperidol in Tourette’s disorder: a double-blind placebo-controlled study,” shows its potential use in the treatment of Tourette’s syndrome.

How Can I Use Harm Reduction to Quit


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Smoking, without question, is the worst method for using tobacco. For those who want to quit smoking, but enjoy the kick from nicotine, there are alternatives. THR was first studied by Michael A.H. Russel in a 1974 article in The Lancet. THR can be categorized into 2 broad groups: non-tobacco or alternative tobacco reduction. Non-tobacco alternatives are products such as nicotine gum, nicotine patches, e-cigarettes, and lozenges. Alternative tobacco products are dip, snuff, snus, and chewing tobacco. THR provides smokers with the potential to gain control over their nicotine addiction, although scientists and professionals agree that cessation is always the best option. Many opponents of THR state that this method prohibits smokers from experiencing a truly healthier lifestyle and sidetracks them, but wouldn’t it better to provide a different option? By not pigeon-holing smokers into 2 groups, but 3, you can raise the chance of success and dissuade smokers from reverting back to the most harmful method of obtaining their nicotine: inhaling smoke.

Smoking natural-cut tobacco without chemical additives may seem healthier than standard cigarettes, but both have similar lung cancer rates. Similarly, cigars and pipe smoking are considered a safer alternative, as the individual is not directly inhaling the smoke, but is still exposed to the smoke and rather high tobacco-specific nitrosamine (TSNA) values. Dip and chewing tobacco, which are smokeless tobacco alternatives, are associated with lower incidences of lung cancer, but have a higher propensity for oral cancer. These products involve placing a portion of cut tobacco between the teeth and gums, allowing for the absorption of nicotine through the gums for a longer and more gradual nicotine high. The commonality between these forms of tobacco and smoking tobacco is that they are still fire or flue cured. A person is essentially trading one form of cancer for another.

Two of the most prominent forms of THR have only in recent years made their way to the US: nasal snuff and Swedish snus, originating from Sweden, as the name suggests. Nasal snuff delivers the nicotine through inhalation. Swedish snus is a form of smokeless tobacco, similar to American dip, but similarities end there. In Sweden, snus has been manufactured since the 1800s and is treated like a food, and as such is heavily regulated by the Swedish FDA. Numerous studies have shown that there is no increased risk for lung, oral, and gastric cancers and cardiovascular disease, and no increase in all-cause mortality. Snus undergoes a form of steam pasteurization, essentially reducing TSNA levels and limiting carcinogens to the same trace amounts as a cup of a coffee. There have been no incidences of oral cancer reported from the use of snus, and it has progressively replaced cigarette smoking in Sweden over the past 20 years. This is also due to strict tobacco regulations deterring smoking. Tobacco-related mortality in Sweden is the lowest when compared to many other Western countries. Though Swedish snus appears to be entirely risk free, there may be an increased risk for pancreatic cancer.

The Lesser of Two Evils

What was once a prominent habit among the populace has after countless studies and time become taboo. For some, quitting is a realization of all the dangers that have repeatedly been presented to us. Others may want to quit, but are unable to break the chains that bind them to their addiction. The best method for quitting depends on the individual; cold turkey is always the best, but having additional options that ultimately provide people with higher chances for success are critical. The end goal is the same, but the journey to get there will be different for all of us.

Reference

  1. Harm reduction: concepts and practices. Tobacco Harm Reduction website. http://www.tobaccoharmreduction.org/faq/harmreduction.htm
  2. Kozlowski LT, O’Connor RJ, Edwards B, Quinio. Some practical points on harm reduction: what to tell your lawmaker and what to tell your brother about Swedish snus. Tob Control. 2003;12:372-373. http://tobaccocontrol.bmj.com/content/12/4/372.full.
  3. Nicotine. Gwern website. http://www.gwern.net/Nicotine.
  4. Peto R, Lopez AD, Boreham J, Thun M: Mortality From Smoking in Developed Countries 1950-2000: Sweden. 2nd edition. 2006. http://www.ctsu.ox.ac.uk/deathsfromsmoking/download%20files/Original%20research/Mortality%20from%20smoking%20in%20developed%20countries%201950-2000%20(2nd%20ed.).pdf
  5. Poloso R, Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal. 2013;10:19. http://www.harmreductionjournal.com/content/pdf/1477-7517-10-19.pdf.
  6. Rodu B, Cole R. The burden of mortality from smoking: comparing Sweden with other countries in the European Union. Eur J Epidemiol. 2004;19:129-131. http://www.ihra.net/files/2011/07/13/Rodu_-_Burden_of_Mortality.pdf
  7. Roth D, Roth AB, Liu X. Health risks of smoking compared with Swedish snus. Inhal Toxicol. 2005;17:741-748.
  8. Silver AA, Shytle D, Philipp MK, Wilkinson BJ, McConveille B, Sanberg PR. Transdermal nicotine and haloperidol in Tourette’s disorder: a double-blind placebo-controlled study. J Clin Psychiatry 2001;62(9):707-714.
  9. Tobacco: harm-reduction approaches to smoking. National Institute for Health and Care Excellence website. June 2013. http://www.nice.org.uk/guidance/PH45