Policy : College Statements

‘Harm Reduction in Nicotine Addiction’ - Frequently Asked Questions

Is the College in favour of lifting the EC ban on snus?

No, definitely not. 

Snus is a form of oral tobacco which is available in some countries, notably Sweden, but is banned by the EU.  The College has no intention of lobbying for that ban to be lifted.  Opening up the EC market to tobacco companies would invite abuse by allowing them to market to children and through smokeless products also promote smoked cigarette brands. 

We want to see research to see how effective it is as a smoking substitute in comparison with medicinal nicotine.  If it is effective, and more effective and/or more acceptable to some smokers than medicinal products, we can see grounds for legalisation within a reformed nicotine regulatory system to capitalise on the potential for harm reduction that smokeless producs can offer smokers.

There are huge potential hazards in legalising such products without careful monitoring and control.  We believe all nicotine products should be regulated by a single authority to encourage all smokers to give up, and for those who can’t, to switch to a safer product.  Suggestions that the College’s call for better and less risky smokeless tobacco products means support for making snus and similar products more available is wrong.

Is nicotine harmful?

Nicotine itself is not very hazardous, but is a powerfully addictive drug.  The overwhelming risk of death and disease comes from the smoke in cigarettes which contains thousands of other chemicals, including many that cause cancer or are toxic.  Nicotine itself accounts for little if any of the death and disability caused by smoking.  Smokeless tobacco also contains toxins and carcinogens, but delivers high doses of nicotine without most of the toxic components in smoke.  So smokeless products, and specifically those that have low levels of nitrosamines (carcinogens) in them, are much less hazardous than smoking but are more hazardous than medicinal nicotine products.

If you make smokeless tobacco products more available won’t non-smokers start using them?

The evidence from Sweden suggests that this is unlikely.  A small percentage of young people will take it up but the hazards to society are far less than through smoking. The person who takes up smokeless could also be the person who takes up smoking: smokeless is the lesser risk.

Why aren’t existing nicotine replacement products adequate?

Current medicinal nicotine products are intended for short-term use to support quitting, not as long-term substitutes for smoking.  They do not generally deliver as much nicotine, or deliver it as quickly, as cigarettes do, and it is probably because of this that most smokers do not find existing therapies to be as satisfying as cigarettes.

It is possible that new, more innovative, nicotine products could provide safer long-term substitutes for cigarette smoking and could benefit people who find it difficult to give up.  However, this would mean encouraging manufacturers to develop safe nicotine sources that would probably also be as addictive as cigarettes, and also making these widely available to smokers.  This would be very difficult within the current regulatory system that applies to drugs.  The regulatory system needs to change to facilitate these developments, and perhaps also to encourage competition to develop better medicinal nicotine products.

Are you saying that it’s OK to be addicted to nicotine?

The Royal College of Physicians takes no position on the morality of smoking or nicotine addiction.  However, since smoking is dangerous to health and hard to give up, the College wants to see a range of effective methods to help smokers quit or reduce their risks if they can’t give up easily.  The long-term goal is still for people to quit.

Is harm reduction an unusual policy?

Harm reduction is a common approach in many areas of health policy.  People take risks every day, they drive too fast, take drugs, practise unsafe sex, and drink to excess.  In many areas of public policy we recognise that people will act this way, and modify advice, products and the law to reduce risk.  Some examples include seatbelts, ABS brakes, helmets, free contraception, methadone and low alcohol drinks.  Smokefree legislation is a harm reduction strategy to reduce the risk of exposure to secondhand smoke by prohibiting smoking in public indoor spaces.

Can’t tobacco companies make safer products?

Safer cigarettes have been designed and marketed, but the advantages are slim compared to non-combustible products.  Tobacco companies also manufacture safer smokeless tobacco products, but these are not marketed as a means of giving up smoking, and there is no advantage to tobacco companies of people using them temporarily – to continue making profits they must keep people addicted to nicotine.

• ‘Harm Reduction in Nicotine Addiction’ - full report
• UK failing heavily addicted smokers, says RCP

 

This page last updated on October 8, 2007