Health & Fitness

Use of alternative nicotine is one way of harm reduction


Proposed new taxes on e-cigarettes and other alternative nicotine products have attracted significant attention since their announcement in the national Budget speech.

Treasury Cabinet Secretary Ukur Yatani’s commitment to protect the health of citizens is to be commended. But there is concern among many in the public health community that his proposals to make tobacco harm reduction products less affordable will negatively affect efforts to cut Kenya’s stubbornly high smoking rates.

Harm reduction is a concept that is widely accepted in the treatment of drug addiction, yet seems to receive less support in our country when applied to the treatment of smokers.

The provision of methadone to drug addicts is one of the most common examples of harm reduction. It is recognised by the World Health Organisation (WHO) as essential medicine and forms part of evidence-based strategies to wean users away from more harmful heroin or narcotic painkillers.

Just last month, Kenyans celebrated the opening of a public rehabilitation centre for drug addicts in Mombasa, which is using methadone to treat 270 patients.

Harm reduction also plays a key role in our everyday lives. Bike riders wear helmets to minimise the risk of head injury, for example. Mask-wearing has recently been mandatory to reduce the threat of Covid infection as we go about our daily routines.

Unfortunately, when it comes to applying harm reduction principles to lessen the impacts of smoking, Kenyan policymakers seem to adopt a negative approach that stands in the way of saving thousands of lives.

Tobacco harm reduction is about encouraging adult smokers, who have been unable to quit, to switch to alternative sources of nicotine with lower health risks.

It is founded on a simple, scientifically established principle: people smoke cigarettes for the nicotine, but it is the burning of tobacco that causes the vast majority of the disease from smoking.

With alternative nicotine products, such as e-cigarettes and oral pouches, there is no burning.

The common belief that nicotine products pose similar risks to cigarettes is simply not supported by science.

As stated by the US Food & Drug Administration (FDA), it is the mix of chemicals in tobacco smoke - not nicotine - that causes serious disease and death in tobacco users. According to the World Health Organisation (WHO), nicotine does not cause cancer.

Nicotine itself is not totally risk-free but it has been widely sold in medicinal form for many years as Nicotine Replacement Therapy (NRT), endorsed by the WHO as an essential medicine.

An increasing number of bodies in the international public health community are now endorsing new nicotine products to help the one billion people worldwide who continue to smoke.

Last October, the FDA authorised the marketing of e-cigarettes as a means of quitting smoking. This follows their 2019 decision to allow approved nicotine pouch products to state that they are less harmful than cigarettes.

An independent evidence review by Public Health England, an executive body of the UK Department of Health, has concluded the “expert estimate is that using e-cigarettes is around 95 percent safer than smoking”. Regulators there recently paved the way for e-cigarettes to be prescribed by doctors to help smokers to quit.

Dr. Kariuki is a medical doctor and public health specialist.

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