Smokers should be treated like drug addicts

Smokers should be treated like drug addicts, say doctors -By Jeremy Laurance, Health Editor
Published: 05 October 2007
Smokers should be treated the same as heroin addicts and offered tobacco substitutes that deliver the same hit of nicotine without the harm, doctors say today.
The number of people smoking is declining by only 0.4 per cent a year and a new approach is needed to protect those who continue to smoke from the lethal effects of their habit.
Half of all smokers will die prematurely if they do not give up, 150 million of them worldwide in the next 20 years. One hundred million died last century and one billion are projected to die in the 21st. Yet the only response is to warn people not to start smoking or to tell them to stop.
The Royal College of Physicians today calls for a middle way in the approach to smoking, based on "harm reduction," which it says holds real potential for saving lives. By getting smokers to switch to safer forms of nicotine, they would avoid the damaging effects of the burning tobacco that delivers the drug.
Professor John Britton, a lung specialist at the University of Nottingham and chair of the RCPs Tobacco Advisory Group, said: "Smokers smoke because they are addicted to nicotine but it isn't nicotine in cigarette smoke that kills – it's the hundreds of other toxic chemicals that come with it. There are millions of smokers who can't quit and those people need nicotine products that can satisfy their addiction without killing them."
Existing products, such as nicotine chewing gum and patches, were unsatisfactory because they were designed as aids to stopping smoking rather than as substitutes for it. They delivered a steady, low level of the drug, rather than the hit of nicotine that smokers craved.
Tobacco companies had tried for decades to develop a safer cigarette but their efforts had been "pretty pathetic," Professor Britton said. The medicinal market for nicotine gums and patches was so tightly regulated that it prevented innovation.
"We need to liberalise the medicinal market and introduce a decent cigarette substitute. We may end up with millions of people addicted to nicotine inhalers, but so what? Millions are addicted to caffeine," he said.
A national Nicotine Regulatory Authority should be set up to monitor the developments and control the market in order to prevent exploitation by the tobacco companies, he said.
Harm reduction is an established principle in the treatment of drug addiction, where addicts who cannot give up their habit are encouraged to switch to a safer drug. In Sweden, an oral tobacco product called snus that is chewed instead of smoked has been available for decades, and the country has the lowest smoking rates in the world among men at 13 per cent, half the rate in the UK.
Snus is banned in the European Union but Professor Britton said it was an example of the kind of product that needed to be developed. "It would be premature to lift the ban but we need to research a whole range of other products. If there is something in there of benefit to public health then let's have it."
Critics attacked the proposal yesterday, warning it could increase smoking. Professor Martin McKee of the London School of Hygiene said in The Lancet there was a danger tobacco companies would promote cigarette substitutes as an extension of smoking – in public places where tobacco is banned, for example – rather than as a substitute for it.
Ash, the anti-smoking pressure group, however, has backed the Royal College of Physicians report and called for a review "to allow safer nicotine products to be made available while ever stricter measures are applied to tobacco products to deter their use."

Nicotine substitutes

• Snuff – ground tobacco that delivers nicotine via the lining of the nose.
  
• Snus – popular in Sweden. Ground tobacco in muslin that is sucked.
  
• Eclipse and Accord – safer cigarettes launched in the 1990s designed to deliver nicotine with less tobacco. Not popular.
  
• Nicotine inhaler – delivers the drug direct to the mouth and reproduces the feeling of smoking.
  
• Nicotine nasal spray – delivers nicotine to the nose
  
• Nicotine gum – chewable nicotine
  
• Nicotine patch – stuck on the skin, delivers a steady low dose of nicotine over several hours