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Harm reduction approaches can reduce the harm caused by tobacco use for those who cannot or will not stop.

The term Harm Reduction covers a variety of approaches aimed at reducing the harm from tobacco use. Some definitions include smoke-free policies that are aimed at reducing the harm from second-hand smoke. This section will consider harm reduction approaches aimed specifically at reducing the harm to the tobacco user who cannot or will not stop. A number of different approaches have been proposed, ranging from individual approaches such as a smoker using NRT alongside a reduction in cigarette smoking as a first step towards quitting, to population approaches such as making less harmful forms of nicotine more accessible than more harmful forms and the introduction of a comprehensive nicotine regulatory framework so that all nicotine-delivery products are regulated according to their harm (NICE, 2013). Tobacco harm reduction approaches recognize that some people will continue to use tobacco or nicotine.

The rationale for these harm reduction approaches is that dependence on nicotine underpins most tobacco use but it is other constituents of tobacco smoke that cause most of the harm, not nicotine (See Safety section). There is a range of nicotine delivery products across a spectrum of harm. Nicotine replacement therapies are at the least harmful end of the spectrum, with combustible tobacco products at the most harmful end. Cigarettes are one of the most dangerous forms of nicotine delivery, but are currently the most widely used delivery system internationally.

Harm reduction approaches covered by recent guidance offered by the National Institute for Health and Care Excellence (2013) include: stopping smoking (using licensed nicotine containing products for as long as needed), cutting down prior to stopping smoking (with or without out licensed nicotine containing products), smoking reduction (with or without out licensed nicotine containing products), and temporary abstinence from smoking (with or without out licensed nicotine containing products). The guidelines note that at this time “it is not clear whether there are any long-term health benefits from adopting a smoking reduction approach (apart from the fact that someone who reduces may ultimately stop smoking) (page 31) (NICE, 2013). However, there were shorter term benefits highlighted including improved physical and mental wellbeing and reduced exposure to smoke for non-smokers. In addition, for smokers who are ill, stopping or reducing the amount they smoke can mean they have more time to participate in therapeutic activities.

Since its introduction on the market in 2008, electronic cigarettes have sparked a spirited debate about their place in the harm reduction discussion.
For more information, see the Electronic cigarettes section on this website.

Harm reduction approaches are complex and controversial. We suggest that anyone interested in reading further about these issues can access a collection of documents on tobacco harm reduction available at the Harm Reduction International Association website:

National Institute for Health and Care Excellence. Tobacco harm-reduction approaches to smoking PH45. London: National Institute for Health and Care Excellence, 2013. logo
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