When reducing harm is an option

A worker arranges cigarette packets at a shop in Putrajaya September 5, 2018. — Picture by Shafwan Zaidon
A worker arranges cigarette packets at a shop in Putrajaya September 5, 2018. — Picture by Shafwan Zaidon

KUALA LUMPUR, Nov 10 — The term harm reduction was first introduced in Malaysia when the government sought to use several measures in the hopes of bringing down HIV infections.

The methadone replacement therapy and needle syringe exchange programme have since shown to work with injecting drug use contributing only five per cent to new infections last year.

Harm reduction, according to Harm Reduction International, is a term referring to “policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption”.

Subsequently, the term has in recent times been used when it comes to tobacco products.

Proponents seek to use it as an alternative to going cold turkey when it comes to smoking.

Research has shown that while people are addicted to nicotine, it is not the primary cause of smoking-related diseases.

So, what has happened is a burgeoning number of producers who have come up with alternatives such as vaping, heated tobacco products and nicotine replacement therapy (NRT) like gum and patches.

Studies and research, however, are still ongoing in this debate of harm reduction versus complete cessation.

Prof Dr Shamsul Bahri Md Tamrin from Universiti Putra Malaysia’s medicine and health science faculty said quitting without any help was still considered the best method although prescribing NRT could be considered as a method to quit smoking.

He added that another method — using tobacco powder or heating tobacco — was another option to operationally kick the habit.

“In my opinion, less harmful tobacco products should be considered as an alternative to quit smoking although it does not eliminate the overall risk for smokers.

“However, the reduction of risk is a significant step for smokers to quit if they are given an option to switch to such reduced harm alternatives.”

Dr Shamsul Bahri said there needed to be education on factual and accurate information without prejudice regarding reduced risk products.

“The current perception today is that nicotine is the main cause of smoking-related diseases, which is untrue.”

He also recommended that reduced risk products should be considered a tobacco product but complemented with information that they have the probability of presenting less risk of harm compared to continued smoking. 

Ng Yee Guan, also from the faculty, said quitting cold turkey might not be a viable option as the expected effects of withdrawal might affect the judgement of the smoker trying to quit.

 He said there was a need to review the effectiveness of using NRT via patches or gum as it appeared that the statistics of smokers had not decreased significantly and incidences of smoking had been sustained.

Ng also said the key problem from smoking conventional tobaccos was the toxic smoke produced when a cigarette was lit.

“As such, recent development has seen the introduction of several alternative products which enables the use of tobacco without combustion.

“Instead of burning, the technology now controls the temperature such that it heats up the tobacco, delivering the required taste while maintaining the nicotine delivery.”

Various research, he added, into the scientific aspects of these products have revealed the reduction of the hazard and risk levels.

When it came to legislation of reduced risk products, Ng said the legislator could form a committee and carry out their own research to verify the findings presented to them.

Subsequently, after looking at the scientific facts and evidence, the reduced risk products should be allowed to be made available to smokers.

“However, certain counter measures should be instituted to ensure these products do not promote the initiation of tobacco products by non-smokers and access to children.”

Assoc Prof Asrul Akmal Shafie of Universiti Sains Malaysia’s school of pharmaceutical sciences said for reduced risk products to be accepted by detractors and lawmakers, it was necessary to have presentation of good, robust and transparent evidence of the risk and benefit of the product.

There also needed to be a push for legislation to regulate modified tobacco related products.

“This will reduce the ambiguity of appropriate measures to manage such products in the market,” he said, adding that more evidence needed to be generated to measure possible socio-behavioural impact of the product.

“Partner with appropriate independent third party to propagate the tobacco harm reduction solution to the public and government.”

Creating a smoke-free environment

It is ironic for a tobacco company to be part of a smoke-free environment but Philip Morris International (PMI) is moving in that direction after studies showed that cigarette smoke has about 6,000 constituents, many of which are harmful and formed by burning the tobacco, although it is unknown which ones are responsible for smoking-related diseases.

To this end, the company has come up with various products, including its Iqos, available in selected vape outlets in Klang Valley, that heats up a stick containing tobacco in the device instead of burning it.

This means the tobacco is heated below 400°C, there is no sustaining heat, it is an oxygen-free process that has no ash or solid particles.

They have also carried out clinical studies that have been inspired by pharmaceutical practices and in line with the United States Food and Drug Administration and good laboratory practices, good clinical practices and good epidemiological practices.

Clinical studies are also conducted by external research organisations.

The company has invested more than US$4.5 billion (RM18.68 billion) and hired more than 430 research and development experts with one-third of their scientists having backgrounds in life sciences.

They also have more than 2,350 granted patents globally.

PMI external communications manager Joshua Townsend said the company was looking to have products that were significantly less harmful in order to change public health outcomes.

“There has been a drop in smoking much faster than expected,” he said.

Smokers, who switched completely to Iqos in two one-week and two three-month clinical studies, reduced their exposure significantly to 15 toxicants while there is low interest in those who have never smoked or quit smoking to take up the device.

Laboratory studies also show there is lower levels of toxicants in the vapour from Iqos compared to cigarette smoke.

It also does not adversely affect indoor air quality and is not a source of secondhand smoke.

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