CRUCIAL STEP IN TOBACCO HARM REDUCTION


Dr Arifin Fii is a medical practitioner currently focusing on addiction therapy, with experience in conducting harm reduction programmes. With close to 30 years of practice, Dr Arifin has a multi-disciplinary background which includes general medicine, paediatrics and surgery.

IN Malaysia, it is estimated that more than 27,200 Malaysians’ deaths annually are related to smoking.(1)

Media reports have also reported that the government is expected to spend some RM7.4bil to treat major illnesses caused by smoking – such as lung cancer and coronary heart problems – by 2025.(2)

Although there have been many intervention programmes initiated by the government, not many smokers have successfully quit the habit.

In 2019, it was reported that over a seven-year period, a total of 73,836 smokers participated in smoking cessation programmes in Malaysia, but only 23% quit smoking within six months, representing only 16,930 individuals.(3)

If you tally the numbers, that is 16,930 individuals who quit versus 190,400 deaths in seven years.

While it is the addiction to nicotine that keeps people smoking, it is the combustion producing smoke – which releases thousands of harmful constituents into the body at dangerous levels – that leads to death.(4)

It is also important to remember that it is not only nicotine dependence that makes quitting traditional cigarettes difficult.

For some, smoking offers stress relief and others, psycho-social pleasure. This often makes the physical act of smoking just as difficult to quit as the nicotine that smoking provides.

As healthcare practitioners, we know that smoking is the leading cause of preventable death globally.

Therefore, it is vital that we continually evaluate our strategies for decreasing tobacco-related morbidity and mortality.

One such strategy is the adoption of the tobacco harm reduction (THR) strategy to encourage smokers to switch to less harmful products with the end goal of quitting altogether.

I believe the THR approach presents a public health opportunity to improve the lives of people who use traditional cigarettes and cannot or do not want to stop.

The first step to reap the benefits of the THR approach is the acknowledgement of harm-reduced products such as vape products and their role in helping smokers to quit smoking by switching over.

Multiple studies around the world have already concluded that vape products are far less harmful compared to cigarettes and has the efficacy in getting smokers to quit.(5) This is a fact that cannot be ignored.(6)

The next step is to introduce appropriate and sensible regulations that are differentiated from tobacco products to enable smokers to have access to harm-reduced products to aid their journey to quit smoking.

A critical point that must be considered in developing the regulations is the risk proportionality.

This means that tough measures are applied to the riskiest products such as traditional cigarettes, and a more permissive approach should be taken with vape and other harm-reduced products.

The aim of this is to encourage users to switch from high-risk to low-risk products, and eventually quit completely.

In New Zealand for example, where vape regulations have been introduced, focus is put on ensuring regulations reduce harm, are risk-proportionate, and workable for the people they affect.(7)

At the same time, regulations that ensure protection for children and young people are effectively implemented and enforced.

Further creating an environment that allows for use of harm-reduced products in the name of THR is preferable to an environment where black markets, adulterated products and criminalisation flourish.

Ultimately, my view is that harm reduced products are not without risk although they are only a fraction of the risk posed by tobacco use.

Hence, it must be subject to sensible policy and regulatory measures that maintain the safety of these products without compromising availability and affordability – with the goal of displacing cigarettes altogether.

This can only be done through a multifaceted approach that addresses regulation on product standards that incentivises people to move away from more harmful products.

1. National Health & Morbidity Survey 2019

2. News Article: Govt to bear RM7.4 billion in treatment cost for smoking-related illnesses

3. News Article: Treating smoking-related illnesses costs more than tax collected

4. Report: Vaping and the Gateway Myth

5. Report: Use of e-cigarettes among adults in Great Britain, 2021

6. Report: Vaping in England: evidence update February 2021

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