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FPMPAM Position Statement on Tobacco Harm Reduction

10.10.2021

Introduction
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 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 have 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 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.  Exisitng data shows that the consumption of the 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 posiition 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 risk associated with smoking cigarettes, current smokers should be  counseled to switch to less harmful nicotine alternatives rather than having them continue cigarettes.

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

The  strategy of a two-pronged approach usingTHR and smoking cessation is a strategy that may work well in a landscape where there are 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 framework  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 cigarretes..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 policy makers, 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.

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