Barek Kaiser : Smoking is one of the leading causes of illness and death in the world. More than eight million people die each year due to smoking with almost 99% of tobacco related deaths caused by smoking- not from other forms of nicotine consumption. Bangladesh, like many nations, has also been fiercely battling against the tobacco epidemic for decades. It is home to an estimated 6.2 million adult smokers. The government’s vision of achieving a tobacco-free Bangladesh is laudable, and it’s time to reassess our approach to harm reduction. For too long, the war on tobacco has mistakenly targeted nicotine as the primary antagonist, while overlooking crucial distinctions. 

Nicotine is a natural ingredient found in several vegetables & plants, mainly tobacco. Contrary to popular belief, nicotine itself while addictive, does not cause diseases. The primary health risks associated with smokingstem from the combustion of tobacco. There are more than 7,000 chemicals in cigarette smoke. Of these, at least 250 are known to be harmful to health, such as hydrogen cyanide, carbon monoxide & ammonia. Some are natural components of the tobacco plant itself, but most harmful substances are only formed when cigarettes are burned.

A recent paperauthored by Michael Landl, Director of the World Vapers’ Alliance & Maria Chaplia, Research Manager, Consumer Choice Center, titled ‘Six Reasons to Stop the War on Nicotine’ outlines 6 reasons why nicotine is not the enemy& it’s time to end the war on it.

1. People consume nicotine, but they die from smoking

Nicotine is not the primary culprit in smoking-related harm; it’s the thousands of toxic chemicals in tobacco smoke that cause health issues. To improve public health, smokers need to be given all possible options to quit. A war on nicotine will not improve public health but discourage many from switching to less harmful alternatives. Yorkshire Cancer Research states nicotine is not the cause of death from smoking; there is no evidence that sustained use of nicotine alone increases the risk of cancer. Of the three main causes of death from smoking (lung cancer, Chronic Obstructive Pulmonary Disease and cardiovascular disease), none are caused by nicotine.

2. Nicotine in patches & gums is not a problem- it is neither when vaped nor in a pouch

Nicotine is not considered a problem in conventional nicotine replacement therapy, therefore it cannot be a bigger problem in vaping or snus. Royal College of Physicians summarized the role of vaping as a nicotine delivery method the following way: “E-Cigarettes meet many of the criteria for an ideal tobacco harm-reduction product. Although nicotine delivery from e-cigarettes depends on a number of factors, they can in principle deliver a high dose of nicotine, in the absence of the vast majority of the harmful constituents of tobacco smoke. Vaping has been proven to be 95% less harmful than smoking & has been endorsed by multiple international health bodies as a safer alternative. If governments followed the lead of these countries, 200 million lives could be saved around the world.

3. Addiction is complex and not solved by a war on nicotine

There is no doubt that nicotine triggers the release of dopamine&thus contributes to addiction to smoking, but it can’t be the only reason why so many people fail to quit smoking. If nicotine were the sole reason for smoking addiction, every smoker using a nicotine patch should be able to quit smoking right away. Clearly, this is not the case. The smokers’ addiction is based on a combination of nicotine and other ingredients of tobacco smoke together with conditioned behaviour [the socalled ‘smoking ritual’] like the coffee break or the inhalation process. A study compared the dependence levels between NRTs, vaping and smoking and showed that in the absence of tobacco smoke, the potential for addiction to nicotine is very low, so that most vapers feel much less addictive pressure than smokers. When it comes to addiction, public health should not single out a single substance. Addiction is more complex and is not solved with a war on nicotine.

4. Therapeutic potential of nicotine

For decades nicotine has been synonymous with smoking. This made a majority of people believe that nicotine per se is the main reason for the negative health effects caused by smoking. While it is clear that most people should not start consuming nicotine if they don’t already do, it is time to assess nicotine fully &completely without leaving out the evidence that doesn’t fit into the anti-nicotine agenda. Nicotine can have positive health effects in some settings& for the sake of scientific honesty, the discourse on smoking shouldn’t turn a blind eye to those.It has therapeutic benefits, such as cognitive enhancement, potential treatment for Parkinson’s disease & appetite suppression. It can also improve exercise endurance.

5. Misconceptions about nicotine are hindering progress

Less smokers who are unable to quit are trying less harmful alternatives such as vaping. If smokers believe that nicotine is the main factor of negative health effects, they don’t have a reason to switch from smoking cigarettes to safer alternatives. This should concern public health advocates, because if they truly want to improve public health, every smoker should be encouraged to at least switch to less harmful ways of consuming nicotine. This can only be achieved, if smokers, but also to experts and the general public are educated on the actual dangers of smoking.

6. Prohibition never works

History has shown that restricting or even banning nicotine for adults has led to black market activitiesAccording to Clive Bates, “black marketeers are a gateway to other black-market products and have no scruples about age restrictions or what is sold to whom.”

It is time for a science and evidence-based approach when it comes to nicotine. The primary goal should be to reduce harm as much as possible. Therefore, policy makers should follow practical solutions instead of idealized goals like ending nicotine consumption at all. Such a practical solution is to encourage those smokers who cannot or don’t want to quit to switch to less harmful alternatives. A war on nicotine itself is not possible to win, because “any harm reduction approach should include harms created by the policies introduced to attain the goal – for example, arising from black markets, regressive taxation, stigma or negative welfare arising from coercion or punitive measures. These harms place limits on how a government can push conventional tobacco control policies”, according to Bates.

Putting practical solutions first: to reduce smoking rates, public health needs to make use of all available possibilities. People who cannot quit smoking should be encouraged to switch to less harmful alternatives. Nicotine is not the main problem when it comes to smoking, the toxins are. Reducing the number of smokers and allowing them to rapidly &efficiently switch to a less harmful alternative is a pragmatic step towards moving closer to tobacco-free Bangladesh and ultimately improving the public health.

Writer:

Doctoral Student

Peoples’ Friendship University of Russia