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- A critical feature of tobacco use is that morbidity and mortality spring primarily from the combustion process associated with traditional cigarettes. Nicotine, a chemical found in tobacco, is addictive and may not be safe in extreme doses but it, by itself, is not the source of harm from tobacco/smoking. As a result, policymakers must take this into account when considering tax rates for nicotine/tobacco-based products. The harm-reduction approach taken in this Commentary recognizes that cigarettes kill and that if alternative nicotine systems are known with certainty to contain a small fraction of the toxins in cigarettes, this is sufficient to attempt to divert users away from the killer products toward the lower-risk ones, even with uncertainty surrounding the lifecycle health impacts of the latter.
- Several identifiable social groups experience high rates of tobacco use: individuals with poor mental health, First Nations and Indigenous Communities (FNICs), the homeless and individuals who identify as LGBTQ+. For many in these communities, tobacco is both a comfort and a burden: nicotine provides the comfort while the toxins debilitate the body and the mind. The objective of reducing smoking must become more keenly focused upon who is still smoking and why. If nicotine alone provides minimal health damage and at the same time provides satisfaction to users, then the “war on tobacco” needs to separate out combustion-related tobacco toxins from nicotine. These high nicotine-use social groups also have lower average incomes than the population at large and, therefore, should not be denied access to less-expensive nicotine by limiting access to lowerpriced ANDS (Alternative Nicotine Delivery Systems).