Nicotine, a food-grade substance that has been shown to have stimulant and sedative effects, plays an important role in helping smokers quit, according to public health experts.
Experts said the introduction of innovative products such as e-cigarettes and heated tobacco products that deliver nicotine without combustion provides smokers an opportunity to drastically reduce the harm caused by cigarettes by switching to these alternatives.
Prof. David Sweanor, chair of the advisory board at Centre for Health Law, Policy & Ethics in University of Ottawa, said that like nicotine replacement therapy (NRT) which is prescribed by doctors, smoke-free products can help smokers quit.
Unlike combustible cigarettes which involve burning or combustion which unleashes thousands of harmful chemicals, these innovative products deliver nicotine at vastly reduced risks, he said.
Prof. Gerry Stimson, a British social scientist and tobacco harm reduction advocate, explained that cigarettes are a harmful delivery mechanism for nicotine, but nicotine itself doesn’t cause tobacco-related diseases.
Nicotine is the main ingredient of various forms of NRT prescribed by doctors to help patients quit smoking.
Stimson said innovation also gave rise to smoke-free alternatives that deliver nicotine at vastly reduced risks, including Swedish snus and e-cigarettes or vapes. The UK’s Royal College of Physicians concluded that vaping is “likely to be at least 95 percent less hazardous than smoking”.
Cigarette smoke contains more than 6,000 chemicals and ultrafine particles, including 80 carcinogens or potential carcinogens.
Dr. David Khayat, a French cancer expert, said nicotine is not among the substances that cause cancer. “Smokers commonly misperceive that nicotine is a major carcinogen,” he said.
He quoted the Cancer Research UK as saying that nicotine does not cause cancer, as people have been using nicotine replacement therapy safely for many years. “NRT is safe enough to be prescribed by doctors,” the research center said, referring to nicotine patches, gums, spray, oral inhalers and tablets.
Sweanor said it is the smoke, and not nicotine, that kills smokers. “Let them know it is the smoke, not nicotine, that will kill them,” he said.
He said this means that nicotine has a significant role to address the smoking epidemic which results in 8 million annual deaths globally. He said NRT has been an integral part of smoking cessation policy, which proves that nicotine is not what causes the diseases linked to smoking.
“We have known at least since the ground-breaking work of Professor Michael Russell in the 1970s that people smoke for the nicotine but die from the smoke. As seen with nicotine pharmaceutical products and through very long-term use of an oral tobacco product called ‘snus’ in Sweden, nicotine can be delivered with minimal risks once the smoke and ancillary toxins are removed,” Sweanor said.
The US Food and Drugs Administration said, “the toxic mix of chemicals—not nicotine—causes the serious health effects among those who use tobacco products, including fatal lung diseases, like chronic obstructive pulmonary disease and cancer”.
The toxic substances such as carbon monoxide, formaldehyde, ammonia, hydrogen cyanide, arsenic and DDT are produced by the burning of dried tobacco leaf and are subsequently inhaled by the smoker.
Prof. Peter Hajek, director of the Tobacco Dependence Research Unit at Wolfson Institute of Public Health, Queen Mary University of London said unfortunately, some anti-nicotine campaigners spread misinformation or exaggerate that nicotine is brain poison as they feel that they are fighting the right cause. He said there is no clear scientific evidence to such claim.
Hajek predicted that “smoking-related cancer, heart disease and lung disease will eventually disappear as smoking is made obsolete by much less risky nicotine products that do not include combustion”.
These smoke-free products are also significantly more effective than NRT in making smokers quit, according to Public Health England, the highest medical authority in the UK.
The use of such smoke-free products such as vapes and HTPs are forms tobacco harm reduction—a public health strategy that aims to provide less harmful alternatives to reduce harms caused by smoking and to provide nicotine to people who cannot or do not want to quit smoking by themselves or with currently approved methods.
A survey commissioned by consumer advocacy group Vapers PH from Aug. 3 to 15, 2021 found that 88 percent or nearly nine of 10 adult Filipino smokers would consider switching to smoke-free alternatives such as e-cigarettes and heated tobacco products. The survey involved 2,000 legal-age smokers (above 18) and vapers (above 21) nationwide.
This is expected to help more than 16 million Filipino adult smokers, most of whom are likely to keep smoking under traditional smoking cessation strategies.
The Global Adult Tobacco Survey (GATS 2015) showed that the Philippines had a measly 4 percent smoking quit rate, which reflects the ineffectiveness of currently approved smoking cessation strategies such as “quitting cold turkey” and NRT.
More than a million Filipino adult smokers have already switched to smoke-free products such as vapes and HTPs, according to consumer groups.
Sweanor said tobacco companies that are aware of the problem should embrace transformation and replace combustible cigarettes with less harmful smoke-free nicotine products.
