Tobacco harm reduction 101: Difference between revisions

Tobacco harm reduction and vaping – why should you care?

More than 34 million adults in the United States (U.S.) currently smoke cigarettes. Accounting for more than 480,000 deaths every year (or about 1 in 5), cigarette smoking is the leading cause of preventable disease and death in the US. In addition, more than 16 million Americans live with a smoking-related disease. For these reasons, it is a public health priority to reduce the number of smokers.

This short Q&A is designed to help answer some of the most common questions about THR and its benefits.

SOURCE: Cdc.gov, 2014 Surgeon General’s Report: The Health Consequences of Smoking-50 Years of Progress.

SOURCE: Creamer MR, Wang TW, Babb S, et al. Tobacco Product Use and Cessation Indicators Among Adults – United States, 2018. Morbidity and Mortality Weekly Report 2019; 68: 1013-1019 (accessed 14 Nov 2019).

Nicotine is the key reason that people become addicted to smoking even though it is not the reason that people die from smoking. Nicotine is a mild stimulant similar to coffee, and while addictive, nicotine is not carcinogenic. It is a fundamental principle of tobacco tpolicy that people “smoke for the nicotine but die from the tar.” Additionally, nicotine is not classified as a carcinogen by the International Agency for Research on Cancer and is relatively safe for human consumption in low concentrations.

SOURCE: Lee PN, Fariss MW. A systematic review of possible serious adverse health effects of nicotine replacement therapy. Archives of toxicology, 2016.

Electronic Nicotine Delivery Systems (ENDS), usually known as vapes or electronic cigarettes (e-cigarettes), were invented in 2003 as a way to simulate the experience of smoking without the associated health effects of inhaling smoke. Since 2012, ENDS have become particularly popular as a method for smokers to quit their deadly habit. In particular, these products benefit users who have tried and failed at other methods of quitting.  

Vaping products mimic the sensation of smoking and provide nicotine to addicted persons without the smoke from burning tobacco. Because ENDS mimic the sensation of smoking, they provide users a method of nicotine delivery similar to their habits. What is absent is the deadly cocktail of chemicals that make cigarettes dangerous to smokers themselves and those around them. As a result, public health bodies around the world have concluded that vaping is significantly safer than traditional products. Using ENDS products allows users to avoid the process of tobacco combustion entirely and thus the harmful health byproducts of smoking.

Vaping products are broadly divided into two main categories. In one product category, nicotine is mixed with water and then heated and vaporized into steam. The aerosol is then inhaled. These liquid-based products are what most people consider e-cigarettes.

A newer technology, known as heat not burn, produces aerosol by the heating or steaming (instead of burning) of a tobacco-based mixture. Similar to other reduced-risk products, this process closely approximates a traditional smoking experience. However, as with e-cigarettes, the deadly chemicals present in traditional cigarettes are almost completely absent in these devices.  

Liquid-based e-cigarettes are divided into two additional categories: open system and closed system. The health benefits of both compared to traditional cigarettes are nearly identical in that neither produces smoke, a byproduct of combustion. However, the design of the e-cigarette is different. Open systems are filled manually by the user with e-liquid generally obtained from a specialty vape store either in person or online. Many users prefer this as a quit-smoking aid as it allows for greater customization of the experience for the smoker’s particular needs. Closed systems use pre-filled tanks that are directly inserted into the device and then disposed of when finished. Closed system users cite the convenience of pre-filled tanks compared to open, manual systems.

Yes. Other harm reduction products include smokeless tobacco products and oral nicotine products. Smokeless tobacco, sometimes known as moist loose tobacco or snus, can be found in a teabag-like pouch and allows users to ingest nicotine without smoking it. This usually involves placing the product between the gum and the cheek. Other oral nicotine products include lozenges and similar products and do not contain any actual tobacco. In addition, nicotine replacement therapies such as patches and gums are also considered harm reduction products and have been available for decades.

Multiple studies have shown that smokers who make the switch to vaping either substantially reduce their cigarette intake or quit completely, and that 69.4 percent of people who use e-cigarettes intended to use e-cigarettes as a complete replacement for regular cigarettes.

SOURCE: CASAA e-cigarette survey results.

According to the most comprehensive peer-reviewed research on the effects of switching coordinated by the George Washington University Medical Center, if a majority of smokers in the United States quit smoking through the use of e-cigarettes over the next ten years, there would be 6.6 million fewer premature deaths with 86.7 million fewer life-years lost.