Letters

Tobacco: Calculated risks can save many lives

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A person smokes an electronic cigarette. PHOTO | AFP

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Summary

  • Tobacco harm reduction is all about helping smokers who can’t or won’t quit to move away from cigarettes to alternative nicotine products that pose significantly less risk.
  • One of the biggest challenges is convincing policymakers that tobacco control needs to be more evidence-based than the traditional quit-or-die approach.

New research by the University of Nairobi shows Kenyans are using a variety of oral stimulants and each carries its own varying degree of risk.

The study titled, “Review of the Risks and Toxicants of Smokeless Tobacco, Areca Nut And Khat Products Available in Kenya” shows users are more likely to consume the riskier products such as chewing tobacco, areca and khat.

And it leads us to a simple conclusion: we should be making much greater effort to encourage these people towards available tobacco-free products that carry a lesser risk, such as nicotine replacement therapies (NRT) and nicotine pouches or, as they are formally known, modern oral products (MOP)

Tobacco harm reduction is all about helping smokers who can’t or won’t quit to move away from cigarettes to alternative nicotine products that pose significantly less risk.

One of the biggest challenges is convincing policymakers that tobacco control needs to be more evidence-based than the traditional quit-or-die approach.

For many people — including some who should know better — tobacco and nicotine are inextricably linked. But, although people smoke cigarettes for the nicotine, it’s the burning of tobacco that causes the vast majority of the disease from smoking.

With alternative nicotine products, such as oral pouches and e-cigarettes, there is no burning. According to the World Health Organisation, nicotine does not cause cancer, and thereby any risk is significantly diminished.

Sweden, for example, has the highest consumption of pouches and the lowest smoking rates in Europe. Tellingly, the Swedish rate of tobacco-related lung cancer for men is less than half the EU average.

Lozenges, gums

Compared with many of the oral products used in Africa, Sweden’s smokeless tobacco pouches — or snus — have low levels of carcinogens and other toxicants. As the report points out, tobacco-free MOPs have the potential to be even less harmful than Swedish snus.

The fact that they do not require combustion and do not contain tobacco means that these products have a risk profile close to that of licensed NRTs.

Internationally, they are also helping more adult smokers to quit successfully than NRT products such as lozenges, gums and patches, which are on the WHO’s list of essential medicines.

A study in Kenya earlier this year suggests they could be just as successful in cutting our stubbornly high smoking rates

Market research company Ipsos interviewed scores of Kenyan smokers who had tried to quit using oral nicotine pouches before the products were suspended from sale by the government.

The users said they viewed pouches as a safer and healthier alternative to cigarettes and most said they used them as part of their “quitting journey”.

However, after the pouches were taken off the shelves, these people had gone back to tobacco — despite the dangers they know it poses. Four out of five users said they now smoke fewer cigarettes than before the pouches went on sale in Kenya two years ago.

One in three Kenyan smokers wants to quit but only seven percent of those who make a quit attempt succeed

Meanwhile, the lives of 8,000 Kenyans are lost every year to smoking-related disease.

We need to help these people.

To do so, the relative risk of nicotine products needs to be properly understood, acknowledged and, most importantly, communicated to adult smokers.

We need more research comparing the ingredients in products used in Kenya and investigation of the risks they carry.

Harmful products should be regulated in the appropriate manner, and measures taken to prevent their sale on the black market.

Unregulated or illicit products can be laced with drugs or have unknown quantities of other dangerous chemicals.

On taxation

They can cause mental, physical and social issues for users and their families, and pose a high risk of oral cancer.

If we hope to discourage people from putting themselves in such danger, products carrying less risk should be made more accessible and affordable through regular consumer channels.

They should be subject to taxes that reflect their positive potential for public health and their relative risks should be communicated properly.

Joseph Magero, Tobacco Harm Reduction (THR Kenya)