The harm in harm reduction

 

I ran into a policymaker yesterday while in the midst of a discussion and was telling him about upcoming tobacco control initiatives.

What was worrying was what he shared with me: “Tobacco control is good. We do need to stop people smoking… but not vape, right? Isn’t vape good? We can recommend people to switch to vaping, right?”

It was this policymaker’s honest misconception that literally acted as a slap in my face. It pointed out to me clearly how much the false idea of ‘vaping is good’ has permeated into the social fabric.

Hence, I am penning these words to attempt to very clearly point out the misconceptions centred around the idea of ‘harm reduction’.

The concept of harm reduction was originally a public health intervention aimed at reducing the risk of intravenous drug users from developing HIV from the sharing of unsafe needles which could transmit the disease.

As such, harm reduction within this context consisted of the provision of clean, sterile needles (through needle exchange programmes) so that these drug users would not then develop HIV, and subsequently, AIDS.

Today, this concept of harm reduction has been ‘hijacked’ into the tobacco control landscape by the industry to shape a narrative that vaping is a wonderful, life-saving device.

Utilising the same analogy, cigarette smokers who are being exposed to the dangers of hundreds of carcinogenic chemicals from cigarettes can now slowly downgrade their nicotine addiction by switching to vaping, a less harmful option that will enable them to slowly then leave their smoking habit altogether.

In fact, the industry has gone to many lengths to present their ‘new’ view that cigarette smoking is bad, and they (industry) too are repenting and moving to slowly stop producing and selling cigarettes altogether (albeit a far distant future that no one can quite foresee thus far).

The alternative put forward is that for these smokers, some alternative which is less harmful must be provided. And this alternative is vaping.

This wonderful narrative about harm reduction seems to be, on the surface, a good public health intervention. Well, it’s not.

In the next couple of paragraphs, allow me to elaborate on the three main harms of the harm-reduction narrative.

HARM 1: Vaping is not harmless as it is being made out to be

The primary reason touted by those in favour of harm reduction is that vaping is less harmful than its conventional counterpart – cigarettes.

Unlike the cigarette that contains tar, soot and many carcinogens, vaping apparently only consists of water vapour (and allegedly little else – this is untrue).

The science, unfortunately, is providing us with a different story in terms of the harmlessness of vape. As with all science, research takes time, and the causation of disease is very connected to exposure over time.

Even with smoking, it takes many years of exposure to cause cancer. Unfortunately, in the case of vape, the case is becoming clearer day by day.

Prolonged use and exposure to vaping is associated with many different diseases, and worse, evidence is pointing out that it is associated with cell mutations which look to lead to development of cancer after an extended period. So, less harmful? Nope.

HARM 2: Vaping is not causing smokers to quit cigarettes. Rather it is getting a lot of newer people who have never smoked before hooked on both

The second reason put forward by harm-reduction proponents is that vaping allows smokers a safer method in which to quit cigarette smoking via them switching to a less-harmful product, namely vape.

According to the narrative, smokers cannot just quit smoking cigarettes because of the addiction to nicotine. They need something to help them transition – and vaping is among these transitory devices that can provide them with the avenue in which they can transition, and from there, quit altogether.

Again, this narrative has gone up in a lot of smoke. The truth is, data from many different countries, including Malaysia, is showing us quite clearly that:

• vaping is not causing smokers to quit cigarettes; rather these smokers are both smoking and vaping;
• many individuals who have never smoked cigarettes in their life have begun to vape; and
• many of these individuals who have never smoked cigarettes and have not started vaping subsequently are going on to start smoking cigarettes.

How ironic. The reality is in stark contrast to the narrative being put forward about harm reduction.

In effect, while existing cigarette smokers are getting hooked on both products; individuals who have never smoked before are now becoming users – worsening the problem in the long run. So, this actually is creating harm, rather than reducing it.

HARM 3: Vaping is a harm-reduction tool, so it needs to be publicly available everywhere for any smoker so that they can switch easily

Harm-reduction proponents have voiced out that since vaping is a harm-reduction tool, it should be publicly available for any smoker at any time.

Using this logic, vape should (and is currently) available in every single possible commercial venue from which it can be sold – from mamak shops to even laundromats.

Unfortunately, this narrative is a poorly-disguised mechanism to legitimise the widespread sale of vapes all over the place – to everyone and anyone who can buy them, including children.

If vape was a genuine harm-reduction tool, it really does not need to come in colourful shapes and sizes to attract children to buy it; nor does it need to come in many different flavours and designs created to attract users.

A true harm-reduction device can merely be a bland delivery device providing nicotine for a smoker who needs to switch from cigarettes.

In fact, since the harm-reduction narrative is contingent on the theory that nicotine is highly addictive, as a physician I argue that addiction needs to be treated by doctors or healthcare professionals and vape prescribed based on the severity of the individual’s addiction.

Currently this is not the case. Whether or not you are a cigarette smoker is irrelevant and unimportant to anyone who sells you vape. As long as you have money, you can make the purchase.

So, stating that vape needs to be widely available for smokers to reduce their harm to manage their nicotine addiction is a thinly-veiled disguise being used to legitimise the widespread sale of vape to all and sundry. Creating less harm? Nope.

The narrative that vaping reduces the harms of cigarette smoking is false and misleading.

By believing in this false narrative, we are opening the door to a whole new generation of Malaysians that will be affected by a whole lot of diseases; all while continuing to falsely believe that this is a ‘good’ thing.

Harm reduction is harmful. That’s the truth. _ FMT

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.