This report aims to provide a fresh update on the use of harm reduction in tobacco smoking, in relation to all non-tobacco nicotine products but particularly e-cigarettes. It concludes that, for all the potential risks involved, harm reduction has huge potential to prevent death and disability from tobacco use, and to hasten our progress to a tobacco-free society.
Smoking is the biggest avoidable cause of death and disability, and social inequality in health, in the UK.
Most of the harm to society and to individuals caused by smoking in the near-term future will occur in people who are smoking today.
Vigorous pursuit of conventional tobacco control policies encourages more smokers to quit smoking.
Quitting smoking is very difficult and most adults who smoke today will continue to smoke for many years.
People smoke because they are addicted to nicotine, but are harmed by other constituents of tobacco smoke.
Provision of the nicotine that smokers are addicted to without the harmful components of tobacco smoke can prevent most of the harm from smoking.
Until recently, nicotine products have been marketed as medicines to help people to quit.
NRT is most effective in helping people to stop smoking when used together with health professional input and support, but much less so when used on its own.
E-cigarettes are marketed as consumer products and are proving much more popular than NRT as a substitute and competitor for tobacco cigarettes.
E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking.
E-cigarettes are not currently made to medicines standards and are probably more hazardous than NRT.
However, the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.
Technological developments and improved production standards could reduce the long-term hazard of e-cigarettes.
There are concerns that e-cigarettes will increase tobacco smoking by renormalising the act of smoking, acting as a gateway to smoking in young people, and being used for temporary, not permanent, abstinence from smoking.
To date, there is no evidence that any of these processes is occurring to any significant degree in the UK.
Rather, the available evidence to date indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely.
There is a need for regulation to reduce direct and indirect adverse effects of e-cigarette use, but this regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers.
A regulatory strategy should, therefore, take a balanced approach in seeking to ensure product safety, enable and encourage smokers to use the product instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy.
The tobacco industry has become involved in the e-cigarette market and can be expected to try to exploit these products to market tobacco cigarettes, and to undermine wider tobacco control work.
However, in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK.