Alternative Nicotine Delivery Systems

The upcoming conference on Tobacco and Public Health will bring together top tobacco control experts from countries all over Europe. The conference is sponsored by the Robert Wood Johnson Foundation (RWJF), a philanthropy organization which has granted hundreds of millions of dollars towards tobacco research and is credited as a major contributor to the awareness campaigns that have considerably shifted American social attitudes towards tobacco. Health policy work to reduce the harm of tobacco is fought on two fronts. The cheapest and most politically attractive option is prevention policies, which are policies aimed at stopping young people from using tobacco in the first place.  The second and more complex policy issue is harm reduction, which is aimed at finding the most cost effective way to reduce the health burden of people who are already using and are addicted to tobacco. As action continues to be taken to prevent new people from picking up a cigarette, the health community is still faced with the question of how to decrease the health burden of millions of tobacco users today whose smoking continues to have important social consequences.

The answer to this question seems to be found in a category of pharmaceuticals that have been labeled Alternative Nicotine Delivery Systems (ANDS), which refers to any product that is able to provide nicotine to users without the negative health consequences of smoking. This category of ANDS includes products like nicotine gum, patches, nasal sprays, tablets, and oral inhalers. E-cigarettes, a type of ANDS, are garnering a lot attention because of their rapidly increasing popularity, particularly among young people. In Sweden, smokeless tobacco (called snus) and e-cigarettes have almost replaced cigarette use, and the country is seeing drastic reductions in the health burden caused by traditional cigarettes. ANDS appear to be the best of both worlds, because they allow people to receive however much nicotine they choose, but also drastically decrease the health hazards of smoking on the tobacco user and more importantly on society as a whole.

The reality, however, is that the solution is nowhere near as simple as just replacing all cigarettes with ANDS. There are several considerations health officials and legislators must take into account before advocating for policies that promote the use of ANDS. First, is the question of how best to convince people to substitute cigarettes for ANDS. Studies have suggested that some smokers, even when presented with the health benefits of switching to ANDS, will often still choose to smoke cigarettes. Another question surrounds the method of promoting ANDS by health officials. The makers of most ANDS are the same tobacco companies that the health community has been fighting against ever since research uncovered the link between cancer and smoking. Would policies promoting the use of ANDS now require tobacco companies to work together with the health community? There is also the lingering question of what long-term impact ANDS may have on society. Health experts are hesitant to promote nicotine use, because there is almost no conclusive research regarding the long-term consequences of nicotine use. While many of these questions can only be answered with time, much can be learned through conferences like the Tobacco Conference taking place here on September 24-25,  which offers the invaluable opportunity to share and compare international experiences and perspectives.

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