EDITORIAL

Harm reduction strategies for tobacco smoking: report from an ERS Research Seminar

Y. Martinet1 Against the background of the profound and The main messages from the K. Fagerström2 well-known health risks associated with tobacco smoking, the European Respiratory Seminar A. McNeill3 Society (ERS) organised a Research Seminar in Nicotine exhibits all the principal properties of a 4 F. Godfrey Ferney-Voltaire (France) on October 3–4, 2005, drug of dependence, but appears to contribute in order to explore the feasibility of harm reduc- little to overall disease caused by tobacco use. tion (HR) approaches. Improved health outcomes were observed when 1Service de Pneumologie, CHU, At the meeting, a number of presentations non-combustible nicotine delivery devices were Nancy, France. were given, ranging from the basic mechanisms used compared with smoking. 2Smokers Information Centre, of nicotine dependence, the toxicity of smoked Conditionary reinforcers and pharmacologic- Helsingborg, Sweden. and non-smoked tobacco and pure nicotine-con- ally active substances in tobacco other than nico- 3Dept of Epidemiology & taining products, to the policy aspects of various tine may play a role in the addiction to tobacco Public Health, University HR approaches. smoking. In Sweden, for example, where more College London, London, UK. The participants comprised civil servants males now use snuff rather than smoke, it has 4EU Policy Adviser, ERS Office, from health branches of some governments, ERS been suggested that it may be easier for smokers Brussels, Belgium. officials and ERS members with a special interest to transfer their dependence to another form of in the field. tobacco than to pure nicotine.

302 Breathe | June 2006 | Volume 2 | No 4 EDITORIAL

Tobacco control is not recognised as a medic- cigarettes is growing in Europe, as well as in ERS Research Seminars gather al and academic discipline, and it may therefore reducing the yields of certain toxins from cig- together a limited number of be important for tobacco HR to learn from other arette smoke. However, without a firm goal to well-established investigators drug addictions, in particular patterns of heroin end smoking, reduced toxicity cigarettes could with a view to address scien- use and the introduction of needle-sharing pro- be seen as cementing the continuance of smok- tific topics in depth and break grammes and methadone substitution. ing, instead of as a precautionary protective new ground, through examin- Although agreeing on the basic premises measure for smokers until such time as cigarettes ing newly published work and research in progress. The that certain products are much less toxic than are no longer sold. Also, it was recognised that Seminars last for 2 days and others, there was ambivalence in moving for- little is known about how interested smokers are are located in easily accessi- ward because of the possible role of the tobacco in HR and which types of products they would ble European cities. For more industry as a purveyor of the products. In gener- consider using. information, visit al, the industry has a blemished record and some In conclusion, it was proposed that an ERS www.ersnet.org delegates would be reluctant to help it survive in Task Force should be set up to focus specifically a new marketplace even with less harmful prod- on HR in Europe. ucts. However, to a large degree, this can be Material from the presentations given at the taken care of by a European Union (EU) or local Harm Reduction Strategies Seminar is available Regulatory Agency that should regulate all nico- at www.ersnet.org/elearning tine-containing products. Thus, it was felt that an appropriate regulatory framework and regulato- The main recommendations ry authority were urgently needed. Following discussions, a draft consensus state- With the current mix of tobacco-control ment of the meeting was revised as follows. strategies and assuming continued declines in • HR is desirable as part of a compre- smoking prevalence, it will take several decades hensive tobacco-control programme. to eliminate smoking completely, and much • Nicotine is not the main cause of longer in certain populations and countries. health problems. Some participants felt that alternative less harm- • Combustible products cause the most ful products would be necessary in order to harm. achieve a near-zero smoking prevalence. By • The status quo should not continue. doing nothing, the status quo would remain, • Snuff is a lot less harmful than cigarettes will dominate and the tobacco-control cigarettes. movement will be out of line with the science. • Snuff also has potential as a smoking- In addition, the Seminar participants dis- cessation aid. cussed the priorities for tobacco-product regula- • Lifting the EU ban on snuff within a tion, i.e. whether this should be regulating proper regulatory framework needs to conventional cigarettes, potentially reduced be considered. exposure products, smokeless tobacco or nico- • The playing field for "clean nicotine" tine replacement therapy. It was also questioned should be levelled via deregulation whether a goal should be set for removing com- and taxation and pricing measures. bustible tobacco products from the market. • Toxic ingredients should be removed Political interest in reduced ignition propensity from conventional cigarettes.

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