Rethink Tobacco Harm Reduction Strategies To Curb Smoking

With long-term research, tobacco harm reduction can be a pragmatic approach to reducing the harm from smoking related diseases.

KUALA LUMPUR, May 27 — More than 80 practitioners attended the 11th National Conference on Addiction Medicine (11th NatCAM), which was organised by the Addiction Medicine Association of Malaysia (AMAM) and the Federation of Private Medical Practitioners’ Association Malaysia (FPMPAM) on May 23, 2021.

The 11th NatCAM specifically addressed various issues related to drug addiction and its treatment in the era of the Covid-19 pandemic. 

Experts and practitioners working at ground zero of the addiction disease landscape have raised alarm over the current issue of substance use in adolescents and young adults, which has been neglected during this pandemic.

Among others, the NatCAM addressed the potential health issues related to e-cigarettes and vaping.

AMAM and the FPMPAM will jointly move to support access to smoking cessation service with a programme to train general practitioners to help those wishing to quit smoking.

According to the Ministry of Health’s (MOH) National Health and Morbidity Survey (NHMS) 2019, the prevalence of smokers in Malaysia stood at 21.3%, translating to 4.9 million Malaysians. The report further estimated that more than 27,200 of Malaysians deaths annually are related to smoking.

“We are aware that more than 50 per cent of current smokers in Malaysia are keen to quit, and it is our duty as doctors to help them achieve abstinence,” said Dr Steven Chow, president of AMAM.

The concept of harm reduction is a crucial first step to address this problem.

“By definition, a harm reduction approach to tobacco control encourages those smokers who cannot, or are unwilling to stop smoking, to switch to using nicotine in a less harmful form, and ideally would result in them ultimately quitting nicotine use altogether.”

“People smoke because they are addicted to nicotine and seek a ‘hit’, but it is the other toxins in tobacco smoke that cause most of the harm. Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness, from smoked tobacco at the top end of the harm spectrum, to nicotine replacement therapy products at the bottom end,” Dr Chow added.

There are various nicotine replacement therapy products, but the most widely used and debatable in Malaysia are vape products, and to some extent, smokeless tobacco products such as snus.

The updated Cochrane Review on Electronic Cigarettes for Smoking Cessation, which looked at 50 studies from the USA, UK, Italy, Australia, New Zealand, Greece, Belgium, Canada, Poland, South Korea, South Africa, Switzerland and Turkey found that among the key findings were that smokers were likely to stop smoking for at least six months by switching to vaping with nicotine e-liquid, as compared to nicotine replacement therapy, nicotine-free vape or behavioural support.

The conference called for more intense public and professional engagement to examine the issue of tobacco harm reduction. With long-term research, tobacco harm reduction can be a pragmatic approach to reducing the harm from smoking related diseases.

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