Category: Harm Reduction

U.K. Health Service to Offer Vaping Devices

Photo: UAV4
As part of a trial being led by the University of East Anglia, the U.K. National Health Service (NHS) will provide vaping devices and e-liquids to smokers coming to the emergency departments of five hospitals across the U.K. to help them quit.
Patients attending emergency departments in five hospitals in Norfolk, London, Leicester and Edinburgh will be offered a device, enough e-liquid supplies for a week and referral to local smoking cessation services alongside medical advice.
This will be followed up at one, three and six month intervals over a 30 month period to monitor success rates for those introduced to vaping compared to those only offered leaflets with details of local smoking-cessation services in the same trial.
“I welcome this trial being launched and the additional research, which will hopefully make it easier for people to quit smoking in the future,” said Norman Lamb, former health minister and former chair of the House of Commons science and technology committee.

I welcome this trial being launched and the additional research, which will hopefully make it easier for people to quit smoking in the future.
Norman Lamb, former health minister
“I am particularly keen to ensure that vaping is made available to people with mental ill health given continuing high smoking rates. It is very positive to have such a prominent trial funded by the National Institute for Health Research (NIHR) including clinical trials. I await the results with interest.”
The U.K. Vaping Industry Association (UKVIA) heralded the NHS’ decision as a landmark moment. “This is a hugely significant moment in the history of vaping and harm reduction,” said John Dunne, director general of the UKVIA.
“For the first time, following years of research and campaigning, we are finally at the point where the NHS looks to be fully embracing vaping and acknowledging its important role as the number one quit method.”
Dunne renewed his call to government to give vaping more opportunity to promote itself as a harm reduction alternative to smoking when it is due to review the Tobacco-Related Products Regulations in May.
“We have put forward the idea of using government-approved expert health claims on vaping products to encourage the remaining six to seven million smokers in the U.K. to switch as well as making sure that there are greater opportunities for the vaping industry to engage with smokers through marketing and advertising means, as current restrictions deter those who may have otherwise made the changeover,” he said.
“It is extremely important that hospital staff have the knowledge to advise smokers about vaping, including which devices to use, nicotine levels and flavors to opt for in order to support a successful quit.”
April 29, 2021
SHEER Opinion on Novel Products Due Friday

Photo: andriano_cz
The European Commission’s Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) is due to present its opinion on novel tobacco products Friday.
The opinion is part of an assessment of the EU Tobacco Products Directive (TPD), which will determine whether e-cigarettes will be treated the same way as traditional cigarettes.
SHEER’s preliminary opinion published in September 2020 drew strong criticism of several stakeholders who accused the EU of being selective in its findings when it comes to their health implications.
“Research in recent years, after the adoption of TPD in 2014, has become increasingly positive about e-cigarettes, always as a substitute for smoking,” Konstantinos Farsalinos of the University of Patras told Eurarchiv. “Compared to 2014, one would expect a more positive attitude. On the contrary, EU policymakers remain scientifically unsubstantiated with the risk of sabotaging the efforts to replace smoking with e-cigarettes,” he said.
Pietro Fiocchi, a member of the European Parliament from the European Conservatives and Reformists Group, expressed concern about increased smoking if the EU Commission decides to equate novel tobacco products with traditional ones.
“My impression is that the Commission is against a differentiation between traditional tobacco and reduced-risk products, and it will plan to apply the same limitations through heavy regulations and fiscal impositions,” he said.
“We all agree that not smoking at all is the best solution, but it would be detrimental if SCHEER will ignore plenty of scientific studies that show much smaller health impact of reduced-risk products versus traditional tobacco,” said Fiocchi.
April 28, 2021
Study: HnB No Less Harmful Than Cigarettes

Photo: Kuznietsov Dmitriy
The impact on lung cells of heat-not-burn (HnB) tobacco products may be no less harmful than that of conventional cigarettes, according to the authors of a small comparative study published by Thorax.
HnB products contain nicotine and tobacco but have been marketed by the tobacco industry as a less harmful alternative to conventional cigarettes on the grounds that they don’t produce specific harmful chemicals that are released when tobacco burns.
Smoking heightens the risk of coronary heart disease, stroke, peripheral artery disease and abdominal aortic aneurysm because it has a role in all stages of artery hardening and blockage. And it causes emphysema and pulmonary hypertension because it contributes to the damage of blood vessels in the lungs.
Specifically, it contributes to endothelial dysfunction—whereby the lining of small and large blood vessels becomes abnormal, causing arteries to constrict instead of dilating or blood vessels to become more inflamed; oxidative stress—an excess of harmful cellular byproducts; platelet activation—creation of “sticky” blood; and plaque development that can block arteries.
The researchers wanted to find out if these effects could also be observed in people who used HnB products.
So they compared endothelial dysfunction, oxidative stress and platelet activation in 20 nonsmokers (average age 28), 20 long-term conventional cigarette smokers (average age 27), and 20 long-term users of HnB products (average age 33).
The conventional smokers had been puffing away for an average of 3.5 years, getting through 13 sticks a day; the HnB users had been getting through around 11 products every day for an average of 5 years.
The findings showed that compared with not smoking, long-term use of HnB products was associated with reduced endothelial function and increased oxidative stress and platelet activation.
And there were no significant differences between conventional cigarette smokers and users of HnB products.
This is an observational study, so it can’t establish cause. And the researchers acknowledge several limitations to their findings.
These include the small numbers of study participants involved, the lack of random allocation to each group and the inability to confirm that a participant wasn’t a dual user of both conventional cigarettes and HnB products.
If confirmed by other large studies, these findings could provide evidence to strongly discourage nonsmokers to start using [HnB products].
Lorenzo Loffredo, et al.
Nevertheless, they conclude, “If confirmed by other large studies, these findings could provide evidence to strongly discourage nonsmokers to start using [HnB products] and to encourage [conventional cigarette] smokers to quit smoking.” In a second linked study, a team of researchers assessed whether the use of HnB products helped Japanese workers to give up tobacco for good.
They offered a smoking cessation program to 158 users of conventional cigarettes (94) alone and/or HnB products (64) between November 2018 and April 2019.
The workplace program included prescription varenicline or nicotine-replacement therapy (NRT), counseling and information about stopping smoking.
The quit rate was logged in August 2019, when 45 (29 percent) of the workers had successfully stopped using all tobacco products.
Those who availed themselves of pharmacological support were more likely to quit than those who didn’t (67 percent vs. 11 percent) as were those who received counseling (69 percent vs. 21 percent).
Analysis of the results showed that people who used varenicline or NRT were three times more likely to stop smoking tobacco than those who didn’t.
But those who either used HnB products alone or in addition to conventional cigarettes (dual users) were 23 percent less likely than exclusive cigarette smokers to give up tobacco altogether, after accounting for age, tobacco dependence, previous quit attempts and use of pharmacological support.
This, too, is an observational study, and the researchers acknowledge that their study was small and restricted to healthy men in just one workplace. Smoking status was also self-reported and assessed at a single time point, and successful quitters weren’t asked how long they had stopped using tobacco.
But they point out that those who used HnB products in their study did so because they thought they were less harmful than conventional cigarettes.
“It is possible that the rhetorical phrases by tobacco industries attract and make consumers misunderstand that changing from cigarettes to [HnB products] can provide a healthier environment for themselves and their surroundings,” they suggest.
“Although [HnB products] are misunderstood to be less harmful, they expose users and bystanders to toxicants, and the evidence does not show that [they] will reduce tobacco-related diseases,” they add.
“Given that [HnB products] undermine cessation among smokers without providing health benefits, [they] should not be recommended for any purpose,” they conclude.
In a linked editorial covering both research papers, Professor Irina Petrache of National Jewish Health, Denver, Colorado, and Esther de Boer of University of Colorado agree.
“[Both] reports provide impetus to conduct larger randomized validating studies and to assess the impact of [HnB products] on additional health parameters. Their work enriches the mounting evidence that [HnB products] are not safer than [conventional cigarettes], suggesting that any tobacco use should be strongly discouraged,” they write.
April 22, 2021
Study Shows Reduced Exposure HnB Products

Photo: Japan Tobacco
Japan Tobacco has announced the results of a clinical study that demonstrates a reduction in exposure to, and uptake of, selected harmful and potentially harmful constituents in healthy Japanese adult smokers who switched to four in-market heated-tobacco products, including Ploom TECH+ and Ploom S 2.0.
The study was conducted in consultation with a medical advisor, Yuji Kumagai, who is a professor at Kitasato Clinical Research Center.

These results strongly underpin the potential of heated-tobacco products, including Ploom TECH+ and Ploom S 2.0, to reduce the health risks associated with smoking.
Ian Jones, vice president and R&D principal scientist, JTI
“With this study, the JT Group contributes another small but meaningful piece to the jigsaw of scientific evidence on heated-tobacco products. Although further research is required, these results strongly underpin the potential of heated-tobacco products, including Ploom TECH+ and Ploom S 2.0, to reduce the health risks associated with smoking,” said Ian Jones, JTI vice president and R&D principal scientist, in a statement.
“We continue to conduct research to provide scientific evidence of the potential benefits of using our reduced-risk products. As we continue our studies, we will communicate our research data on our science website, JT-science.com,” said Jones.
April 22, 2021
‘Asia Blocking Solutions to Tobacco Crisis’

Photo: Paop | Dreamstime.com
Knowledge-Action-Change (KAC), a company dedicated to the promotion of tobacco harm reduction (THR) to improve health, has published Tobacco Harm Reduction: A Burning Issue for Asia.
THR allows people to quit smoking or using oral smokeless tobacco by switching to safer nicotine products. Compared to smoking or smokeless tobacco, vaping devices, heated-tobacco products (HTP) and pasteurized oral products enable people to continue using nicotine at a fraction of the risk, according to KAC. The new briefing shows that Asia has been at the forefront of several key THR successes. The first vaping device was developed by a Chinese scientist. In Japan, cigarette sales have slumped by 32 percent since the introduction of HTP.
Yet many governments in Asia have limited or prohibited people’s access to safer nicotine products while deadly cigarettes and oral smokeless tobacco remain freely on sale. Tobacco Harm Reduction: A Burning Issue for Asia explores the obstacles to THR in the region, including the role of significant state involvement or ownership of tobacco companies, the misinformation campaign against safer nicotine products from apparently credible international agencies and the influence of U.S.-led philanthropic funding on domestic policymaking around tobacco and nicotine.

The report reveals the huge disparity between the number of smokers in Asia at 743 million and the number who have switched to vaping. Research carried out for the report estimates there are 19 million people using vaping products in Asia in 2021—meaning there are 39 smokers for every vaper in the region. They authors argue tobacco harm reduction must be scaled up—and fast.

Tobacco harm reduction is truly a burning issue for Asia. Many of Asia’s millions of smoking-related deaths are preventable—if only consumers had access to safer nicotine products.
Harry Shapiro, author, Tobacco Harm Reduction: A Burning Issue for Asia
“Tobacco harm reduction is truly a burning issue for Asia. Many of Asia’s millions of smoking-related deaths are preventable—if only consumers had access to safer nicotine products. Unfortunately, the failing WHO FCTC and a barrage of misinformation and anti-THR propaganda is getting in the way of public health progress in the region,” said report author Harry Shapiro ahead of the launch.
Tobacco Harm Reduction: A Burning Issue for Asia is part of KAC’s Global State of Tobacco Harm Reduction, a project established to map the development of tobacco harm reduction and the use, availability and regulatory responses to safer nicotine products around the world. The project was produced with the help of a grant from the Foundation for a Smoke-Free World.
April 19, 2021
Cigarette-Level Nicotine May Reduce Exposure

Photo: Auremar | Dreamstime.com
E-cigarettes that deliver a cigarette-like amount of nicotine are associated with reduced smoking and reduced exposure to a major cancer-causing chemical in tobacco, even with concurrent smoking, according to a new study led by researchers at Penn State College of Medicine and Virginia Commonwealth University (VCU).
“We found that e-cigarettes that delivered a similar amount of nicotine as traditional combustible cigarettes helped reduce smoking and exposure to a harmful carcinogen,” said Jonathan Foulds, a researcher at Penn State Cancer Institute and professor of public health sciences and psychiatry and behavioral health. “This study shows that when smokers interested in reduction are provided with an e-cigarette with cigarette-like nicotine delivery, they are more likely to achieve significant decreases in tobacco-related toxicants, such as lower exhaled carbon monoxide levels.”
The researchers conducted a randomized controlled trial of 520 participants who smoked more than nine cigarettes a day, were not currently using an e-cigarette device and were interested in reducing smoking but not quitting.

We found that e-cigarettes that delivered a similar amount of nicotine as traditional combustible cigarettes helped reduce smoking and exposure to a harmful carcinogen.
Jonathan Foulds, professor of public health sciences and psychiatry and behavioral health
According to Foulds, the findings represent an important addition to the scientific literature because they suggest that when e-cigarettes deliver nicotine effectively, smokers have greater success in reducing their smoking and tobacco-related toxicant exposure. Caroline Cobb, associate professor of psychology at VCU and lead author, said the study is important for two reasons.
“First, many e-cigarettes have poor nicotine-delivery profiles, and our results suggest that those products may be less effective in helping smokers change their behavior and associated toxicant exposure,” Cobb said.
“Second, previous randomized controlled trials examining if e-cigarettes help smokers change their smoking behavior and toxicant exposure have used e-cigarettes with low or unknown nicotine delivery profiles,” Cobb said. “Our study highlights the importance of characterizing the e-cigarette nicotine delivery profile before conducting a randomized controlled trial. This work also has other important strengths over previous studies, including the sample size, length of intervention, multiple toxicant exposure measures and control conditions.”
The study contributes to the ongoing question of what role e-cigarettes play in changing smoking behavior, and the findings support limited safety concerns for the use of the specific e-cigarette and liquid combinations over the short term, even in the context of concurrent cigarette smoking. However, Cobb added, very little is known about the effects of e-cigarettes over the course of years as opposed to the study’s 24-week period.
April 14, 2021
Malaysians Quitting Cigarettes with Vaping

Infographic: Green Zebras
Eighty-eight percent of Malaysian vapers successfully quit smoking cigarettes due to their vape products, reports the New Straits Times, citing a survey commissioned by the Malaysian Vape Industry Advocacy (MVIA).
Conducted by the Green Zebras market research firm, the survey also reported that 79 percent who are dual users (users of both vapor products and cigarettes) have reduced the number of cigarettes they smoke since they began vaping.
MVIA President Rizani Zakaria noted that the survey’s results clearly show that vaping can be an effective tool to help smokers quit cigarette smoking and is a much less harmful alternative.
“There is a real need for the Malaysian government to recognize the benefits of vaping, especially the potential that it has to help smokers to quit cigarette smoking by switching to a less harmful product,” he said.
There is a real need for the Malaysian government to recognize the benefits of vaping.
Rizani Zakaria, president, MVIA
“As it stands, the vape products are still unregulated, and we believe it is time for the government to look into introducing regulations on the products and adopt policies that would encourage smokers to switch to vaping that is less harmful.”
April 9, 2021
U.K. Urged to Challenge WHO’s Stance on THR
Mark Pawsey (Photo courtesy of UKVIA)
In a report released March 31, the All-Party Parliamentary Group (APPG) on Vaping calls upon the U.K. government to make the most of Brexit by challenging the World Health Organization’s (WHO) opposition to vaping at the upcoming Framework Convention on Tobacco Control (FCTC) Conference of Parties (COP).
The call follows a four-month Inquiry into the FCTC by the APPG, which investigated the FCTC’s history, governance and approach to evidence-based decision-making. It was prompted by the WHO encouraging and applauding bans on vaping.
At a time when the U.K. government has set an ambitious target to make England smoke-free by 2030 and Public Health England has asserted vaping is at least 95 percent less harmful than smoking, the members of the House of Commons and the House of Lords wanted to ensure the WHO doesn’t turn its back on the lives of the 1 billion people around the world who still smoke, including the 7 million in the U.K.
The parliamentarians—which included Viscount Matt Ridley, a vocal advocate for reduced harm alternatives—have called on the government to consider “dramatically scaling back our funding” if they don’t see a change in the approach from the WHO with the FCTC better reflecting the U.K.’s national interests.
The main recommendations from the report include:
Ensuring the WHO returns to the founding principle of the Treaty, which includes harm reduction.
Restricting any decision to ban vaping and other reduced-risk alternatives to smoking.
Sending experts and consumers to sit alongside the Department of Health & Social Care officials at the multilateral event.
Establishing a Working Group to look at the science and evidence for new and emerging products.
Ensuring openness and transparency instead of secretive decision-making.
If the WHO continue to pursue an agenda-driven approach to ban less harmful alternatives to smoking, then the U.K. should consider dramatically scaling back our funding.
Viscount Matt Ridley
The inquiry heard evidence from Clive Bates, former director of anti-smoking group ASH, as well as professor Lynne Dawkins from the London South Bank University and consumer groups the New Nicotine Alliance and We Vape, among others.
They called for the delegation of departmental health officials, diplomats and activists usually sent to these events to be strengthened with experts who have real world experience and even former smokers who can attest to the benefits of vaping and other reduced-risk products. It was strongly felt that the voice of the consumer has been missing in these debates so far, and by defending the strong story the U.K has to tell at home, the government would be putting the marker down for “Global Britain” abroad.
Now that the U.K. has left the EU, the U.K. delegation is no longer bound to a common European position on tobacco and nicotine policy. The COP9 meeting would be one of the first opportunities for the U.K. to take a stand at a U.N. forum.
We call on the government to defend the U.K. approach, challenge the WHO to stub out their ban on vaping and help return the FCTC to its founding pillar of harm reduction.
Mark Pawsey, chair of the APPG for Vaping

The MPs called for coalitions to be built with like-minded countries that have embraced tobacco harm reduction and have their own good stories to tell. At previous COP meetings, member states have often been afraid to speak up, but the Inquiry encouraged the U.K. government to stand firm in defending its strong domestic position, even if the WHO continues with its prohibitionist approach.
“There is no doubt that the WHO has developed a negative stance in relation to vaping over recent years,” said Mark Pawsey, Member of Parliament for Rugby and chair of the APPG for Vaping. “We wanted to evaluate whether it remained fit for purpose in an evolved landscape where new technology has enabled new harm reduction strategies.
“One of the founding pillars of the treaty the U.K. signed up to nearly 20 years ago was that of harm reduction. If the WHO are opposed to adhering to this and continue to pursue an agenda-driven approach to ban less harmful alternatives to smoking, then the U.K. should consider dramatically scaling back our funding.
“At the FCTC COP9, the U.K. has a unique opportunity to champion its progressive, successful and evidence-based domestic policies on the global stage. We are a world leader in tobacco harm reduction, and we call on the government to defend the U.K. approach, challenge the WHO to stub out their ban on vaping and help return the FCTC to its founding pillar of harm reduction.”
The APPG has written to Jo Churchill, MP, the Public Health Minister at the Department of Health & Social Care, with its findings and has requested a meeting to discuss its recommendations.
This is the first of two Inquiries the APPG for Vaping is undertaking this year. Its second—looking at how the U.K. can diverge from EU rules to further the U.K.’s chances of reaching the smoke-free 2030 goal—is set to launch imminently.
The U.K. Vaping Industry Association (UKVIA) applauded the APPG report.
“It’s about time that the vaping industry stood up against the World Health Organization (WHO), and the APPG on Vaping has done a great job of doing so, challenging the organization to change its approach to harm reduction and calling upon government to consider a reduction in funding if they continue in the same vein by taking a prohibitionist stance,” said John Dunne, director-general of the UKVIA. “It was also good to see that the WHO’s Framework Convention on Tobacco Control treaty was called into question by parliamentarians, who want it to better reflect [the] U.K.’s national interest.”

It’s about time that the vaping industry stood up against the World Health Organization.
John Dunne, director-general, UKVIA
“It is crucial that the vaping sector, and former smokers turned vapers, speak with one voice to put pressure on the WHO to change its ways. As the body, which is meant to promote health, keep the world safe and serve the vulnerable, the WHO has a moral responsibility to do the right thing. We know full well that vaping is a fraction of the harm of smoking and is proven to be the best way to quit smoking. In addition, some 3 million vapers in our country—a significant number who have vaped for a long time now and have experienced positive life changing benefits—is proof that it is highly effective.”
April 1, 2021
Eastern Studies E-cigs as Smoking Alternatives

Photo: Lorendiz Gonzalez from Pixabay
Eastern Co. is studying electronic cigarettes as an alternative to traditional combustible products, reports Egypt Today.
In a statement to the Egyptian Exchange (EGX), Eastern Co. said it is consulting with manufacturers of electronic cigarettes in preparation for putting them on the market after obtaining the necessary licenses.
The move is in line with the company’s strategy to expand and diversify its products.
Earlier in March, Eastern Co. announced that it is studying several new investment projects that will enhance its position in the field of smoking and tobacco alternatives.
Eastern Co. operates within the food, beverage and tobacco sectors. It was established in July 1920 and currently holds a monopoly in the domestic tobacco market.
Egypt has invited tobacco companies to bid for a license to manufacture cigarettes in the country, a move that could reduce Eastern Co.’s dominance of the local market.
March 23, 2021
Korea Urged to Embrace Harm Reduction

Economists have called on South Korea to develop risk-proportionate regulation for nicotine products.
Speaking at the Western Economic Association International (WEAI) virtual conference, Kwon Ill-Oong, a professor at the Seoul National University Graduate School of Public Administration, argued for implementing an inflation-indexed tobacco tax.
Kwon emphasized that tobacco taxes should be inflation-indexed like taxes on alcohol, with a different level of tax applied to products based on their levels of harm and price elasticities. Not only does an inflation-indexed tobacco tax raise consumer predictability; it also eases societal pushbacks from a sudden increase of the tax on tobacco.
Woo-Hyung Hong, professor at the Hansung University Department of Economics, agreed that tobacco taxes should be differentially imposed based on a product’s economic external costs. According to him, the system should consider medical costs, loss of labor capital costs, costs from cigarette-related fires and “avoidance costs,” among others.
Park Young-bum of Hansung University Department of Economics explored the current state and limitations of the current tobacco control policy in Korea and proposed harm reduction measures to encourage smokers to switch to less harmful products.
David Sweanor from the University of Ottawa urged South Korea to follow the example of New Zealand, which passed a bill acknowledging e-cigarettes as a less harmful alternative to combustible products. “It is time for Korea to implement a harm reduction policy like Western countries,” said Sweanor
Created in 1992, the WEAI currently has more than 2,000 members.
March 18, 2021