The most recent pandemic has simply served as a catalyst for us to restructure how we adapt to new problems and devise new measures to mitigate future shocks. Reduced harm caused by substance addiction is one of the most important components of eliminating vices in the world.
The Economic Times convened a group of prominent specialists to investigate and track the consequences of substance usage overtime for the fourth edition of the Consumer Freedom Conclave. David Sweanor, J.D., chair of the Advisory Board at the University of Ottawa’s Centre for Health Law, Policy, and Ethics, Adjunct Professor Faculty of Law, University of Ottawa, Global Leadership Council, Boston University School of Public Health, provided greater perspectives into the various aspects of harm reduction, challenges faced in the reduction of tobacco abuse, and the importance of evidence-based harm reduction.
- Tobacco harm reduction – how consumers could secure the greatest public health win of the 21st Century?
Rational public health policies require that when we identify risks, we seek to reduce them. This makes tobacco harm reduction an issue with extraordinary potential. The harm is enormous and the ability to reduce it is both straightforward and dramatic.
Currently, tobacco use causes an estimated at 8 million a year globally. India alone accounts for roughly a million of these deaths. This harm is almost entirely due to unnecessarily toxic ways of getting nicotine. Inhalation of smoke and other toxic forms of tobacco use still dominate the market.
Yet we know that nicotine can be delivered in ways that are very acceptable to consumers and at minimal risks to health. A global revolution is already underway as technology allows the replacement of deadly products, and government policies are starting to focus on accelerating this transformation.
- Could you share with us what are some of the leading challenges consumers struggling with addiction face today, in the context of determining whether to quit cold turkey or to find a safer alternative?
Many people have a dependence on nicotine both in an addictive and a self-medication sense. Just as some people find early mornings near-impossible until they get caffeine, other people cope with life with nicotine.
Giving consumer-acceptable alternatives to toxic tobacco products is invariably going to be far less difficult than trying to end any type of use, just as switching from coffee to tea is easier than totally quitting the use of caffeine.
- Do you think the harm reduction approach is evidence-based? Is there adequate application of harm reduction principles in clinical practice in your view?
There is no question that cigarettes are exceptionally lethal. Also, it is clear that nicotine use need not be a significant health risk. Decades of experience with low-risk alternatives in countries such as Sweden proves the point.
We also have many decades of evidence that the substitution of lower-risk products and services for higher risk ones has been a very effective strategy to protect health and wellbeing.
In the case of cigarettes, Japan has seen sales drop by nearly half in just six years as a technology that merely heats rather than burns tobacco was allowed onto the market. Consumers have been switching, just as they have moved to safer water, food, pharmaceuticals and a myriad of other products.
In clinical practice, we regularly see evidence-based interventions to reduce harm; everything from dealing with blood pressure to cancer screening to advice on exercise and diet. But when we use policy measures, we can expand these interventions to a societal level.
Millions of lives can be made longer and healthier simply by the enactment of regulations that allow a market for safer products to replace lethal ones.
- How can we better sensitize both lawmakers and the lay public to the benefits of switching to less harmful alternatives?
The facts are straightforward. We have unnecessarily toxic products causing a global pandemic. The experience with covid has sensitized lawmakers and the public to the role of measures that reduce risks. There is also a very long history of successfully reducing the risks of a great many products, services and behaviours.
Once there is awareness that huge risks can be large, and rapidly, eliminated through risk-proportionate regulation progress can be dramatic. Indeed, we are already seeing this happen on nicotine in many countries.
India has the potential to be a world leader in this revolution and to reap the associated benefits.
- Which countries have set the benchmark, when it comes to creating sustainable and scalable harm reduction frameworks in your view?
Virtually all countries have a history of effectively using harm reduction strategies on a wide range of issues, and the result is far safer foods, medicines, automobiles, aircraft, workplaces, toys, etc.
On nicotine, Sweden has shown that its use need not be a significant health risk. The UK shows us that harm reduction can be incorporated into comprehensive tobacco control policies. Japan shows us that cigarettes can be replaced very rapidly by lower-risk products.
Other countries are making similar moves. But none has the potential of India to fundamentally change the global trajectory of tobacco caused death and disease.
- Why is there a need for robust public health policy to address tobacco in India?
A million preventable deaths a year from the use of unnecessarily toxic tobacco products is a tragedy of almost incomprehensible dimensions.
Where we witness such horrendous harm, and science and technology make solutions viable and self-financing, the opportunity calls out for life-enhancing public health policies. The potential is so great and the ease of implementation so straightforward that this is one of the most attainable health advances available. One with health implications on par with the elimination of smallpox.
- India’s goal is to reduce tobacco usage by 30% by 2030. What role can harm reduction play in addressing India’s tobacco goals?
To achieve health goals, it is the death and disease from that tobacco use needs to be reduced. With current alternative nicotine delivery technologies, a 30% reduction in the total population risks can be achieved extraordinarily rapidly. Likely by 2025.
By 2030, even with already-known products and risk-proportionate regulatory, taxation and educational efforts, the tobacco-caused disease could be well on its way to being a subject for history books rather than medical studies.
