FPMPAM Position Statement on Tobacco Harm Reduction

Based on statistics from the Malaysian Ministry of Health, there are approximately 5 million smokers in Malaysia.

The question today is, “Can  Tobacco Harm Reduction (THR) approach  really  help reduce the number of smokers  to help achieve the target of Malaysia Smoke-free 2045”

Global studies have shown that THR strategies can indeed play a vital role in reducing smoking prevalence. In the United Kingdom, where THR strategies are used, smoking prevalence has continued to fall.

THR Strategy

The primary value of THR is to reduce the negative consequences associated with smoking cigarettes. By definition, THR  offers an option for smokers who cannot or are unwilling to stop smoking, to switch to using other less harmful nicotine products.

It must be remembered that nicotine is the addictive substance in tobacco but it is the tar and other toxins in the smoke produced from the burning of tobacco that is the main cause of harm.

Nicotine is considered to be a safer alternative to tobacco. Nicotine is a substance found predominantly in tobacco, and in significantly lower quantities in tomato, potato, and eggplant. It has been approved for use in nicotine replacement therapies, such as the nicotine patch or nicotine gum.  Existing data show that the consumption of nicotine is increasing following its introduction in nicotine replacement therapy.

However, there are also risks linked to nicotine especially to children and youth. FPMPAM stands firm against the use of any tobacco, vape or other nicotine products for children and teenagers.

Caveats

Uncontrolled use of nicotine is linked to known health hazards like an increased risk of cardiovascular, respiratory, gastrointestinal disorders, lowered immune response, carcinogenesis and also adverse effects on reproductive health. 

For a start, no one should be encouraged to start using any nicotine products.

FPMPAM is of the position that the use of nicotine in THR requires strict regulations and should be under the supervision of trained medical experts. It is not a decision that should be taken lightly.

As an option in reducing health risks associated with smoking cigarettes, current smokers should be counselled to switch to less harmful nicotine alternatives rather than having them continue cigarettes.

THR strategy and goals

With these caveats in place, a medically centred THR approach would have a role in Malaysian national tobacco control policy and be incorporated into the national health agenda to help reduce cigarette smoking prevalence and smoking-associated diseases.

The strategy of a two-pronged approach using THR and smoking cessation is a strategy that may work well in a landscape where there is a significant number of people contemplating quitting.

The  goals to benchmark in THR practice are as follows:

• The first objective is to eliminate smoking tobacco products
• The  intermediate goal  is  to reduce or eliminate the harms from smoking for  individuals who are unable or unwilling to quit to adopt the THR approach as an interim measure.
• The final goal must be  total abstainence from all forms of nicotine  or tobacoo-related products.

Economic  Considerations

Realistic and risk-proportionate regulatory frameworks are needed to differentiate various tobacco products based on their harm potential. Evidence on risks must be studied and this data can be used to determine the level of restrictions that need to be implemented.

Likewise, the taxation levels that have been introduced for THR products in Malaysia must remain risk-proportionate benchmarked against high-risk products such as cigarettes..Inappropriate taxation will lead to increased prices, which will deter smokers from switching to less harmful alternatives.

Annually,  Malaysia spends billions of Ringgit in treating smoking-related illnesses. By implementing THR strategies, the country will be able to reduce cigarette smoking-related illnesses, which will save money used for treating these diseases. Whether this will be replaced with an increased cost to treat nicotine-related morbidity needs to be examined closely.

Conclusion

THR is not the sole answer to the public health devastation caused by smoking.

Rather, it holds the potential to complement evidence-based prevention and cessation interventions.

We urge all policymakers, regulators, healthcare practitioners and relevant NGOs to examine all dimensions of this issue, consider all the pros and cons, risks and benefits, and to encourage healthy debate before any policy on THR is cast in stone.