Removing bureaucracies to embrace harm reduction key to achieving a smoke-free future

Tobacco harm reduction strategies including vaping and nicotine replacement therapy among others have proven to be effective in reducing harm such as oral and lung cancer, associated with tobacco smoking. 

However, bureaucracies and regulatory barriers in various countries across the globe have hindered accessibility, thereby hampering efforts to create a smoke-free world.

Jarkyn Shadymanova, an associate professor

During the recent Global Nicotine Forum held in Warsaw, Poland, it was discovered that countries such as Sweden have low smoking and oral cancer rates, attributable to the regulation around a safer tobacco product called snus, whose production is regulated and harmful substances are removed during its production.

The story is however different in countries such as Kyrgyzstan, Pakistan and other parts of Central Asia where people have used a locally produced oral tobacco called Nasvai, but inadequate regulation of this substance has posed risks to health as harmful substances are not removed in its production.

This has been the case for several hundred years and it is now part of the cultural practice of the region.

Jarkyn Shadymanova, an associate professor at the American University of Central Asia said, “Nasvai is an oral tobacco, produced locally in Kyrgyzstan and other parts of Central Asia, and in Pakistan. People have used it for several hundred years and it is part of the cultural practice of the region. Because it is part of the culture, its health risks have been largely ignored. But Nasvai contains slaked lime and sometimes animal droppings, particularly chicken or camel droppings. Obviously, this can cause disease.”

She however added that Nasvai, as a smokeless tobacco, is similar to snus in Sweden which is a safer tobacco product except in Sweden, snus production is regulated, and harmful substances are removed.

Removing rigidities to having harm reduction regulations in place is therefore in the best interest of public health, especially for those populations who are addicted to tobacco and just cannot quit.

Consequently, Sweden has low smoking rates and low oral cancer rates. In Kyrgyzstan, it’s the opposite. No one is overseeing production. No one can be sure what’s in the product. We dream of having regulation like Sweden has.”

A Belarus-based psychiatrist specialising in public health, Uladzimir Pikirenia said, “It seems that we punish those who smoke. And I would say that’s a global problem.”

He said for instance that people with schizophrenia live around 15 years less than the overall population and that the main reason for this is diseases brought on by smoking.

He added, “On average, 70 – 90% of people with schizophrenia smoke, similar if slightly lower rates among people with bipolar disorder, and similar again for people with depression.”

But can effective harm reduction regulation really work towards reducing all such outcomes of tobacco use in populations across the world?

In adding his voice, a media professional from Kazakhstan, Gintautas-Yuozas Kentra said it is unfortunate that many health professionals lack both context and understanding of harm reduction. 

He said, “But really, this is an issue of cost. Cancer treatment is much more costly than an outreach campaign providing people with good information. Combating the effects of tobacco smoking or drug use is costly.”

He indicated that the lack of regulation on vaping products in Kazakhstan has created a problem of counterfeit products. “Kazakhstan does not regulate vaping products so instead, the government is simply banning them. This opens the door to counterfeit products. After the ban comes into force, the authorities will clamp down on official sellers – and we will see another surge of poor quality, fake products,” he said.

A similar experience has been recorded in India where a vaping ban which was targeted towards the youth for them not to access the products ended up with a paradigm shift.

The moment the vaping ban came into place, there was a sudden surge in the use of these devices among the youth, which meant that the ban did the exact opposite of what it was supposed to have done.

Cardio-metabolic physician Rohan Sequeira said “There should have been a regulation. There should have been a political discussion on this. There should have been an open-ended forum where things were discussed. But that didn’t happen. It just came in right out of the blue. So, that was surprising for all of us.” 

He says having any kind of prohibition whether on drugs, alcohol or indeed tobacco will just drive the whole thing down to the ground if it comes without engagement and it may just cause a booming black market.

“And then you see this booming black market, you don’t have any regulatory control over that. You don’t get any taxes out of that. You’re getting products that have no quality control. You don’t know what the contents are. You get a whole range of problems that makes the entire matter worse, because now people are falling sick because of inferior quality products, ” he adds.

Cliff Douglas, President and Chief Executive Officer CEO of Global Action to End Smoking said, “We owe it to people to listen, to understand their challenges, to understand how they can reduce their health risks if they can’t or don’t otherwise want to stop smoking.”

“Too many healthcare providers and the consumers they serve believe that their only options for quitting are either going ‘cold turkey’ or using a medicinal nicotine replacement product such as nicotine gum or the patch.” 

He added, “But we know that there are many individuals who either can’t or won’t quit smoking using cessation medicines.” 

He said it is a moral imperative that they not be forced to choose between those limited, and too often ineffective, options or nothing at all and that requiring people who smoke, in effect, to simply quit or die is inhumane and unacceptable.

“We must recognise and build upon the reality that well over a hundred million people across the globe have already decided to use vaping and other non-combustible nicotine products in their dedicated personal efforts to avoid painful and early deaths from smoking,” he emphasised.

The media professional added that it is well-known that harm-reduction products are more appealing, popular and effective for many people who are in urgent need of practical options to save their lives.

According to reviews by Cochrane, a library collection of high-quality, independent evidence to inform healthcare decision-making, e-cigarettes are often effective in helping people stop using combustible tobacco products.

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