Smoke-free option is one Oklahoma should consider to reduce tobacco harm

Published September 30, 2012

A quit-smoking strategy with “the potential to save millions of lives” will be the subject of an Oklahoma legislative hearing Wednesday. At issue will be tobacco harm reduction, which aims to reduce Oklahoma’s 5,800 deaths per year due to smoking. The strategy is based on science: smokers who have been unwilling or unable to quit can achieve nearly all the health benefits of abstinence by switching to smoke-free cigarette substitutes, including snus, dissolvables and electronic cigarettes. By eliminating smoke, these products minimize health risks. They satisfy smokers’ nicotine cravings, making them effective cigarette substitutes. Nicotine, like caffeine, is addictive, but it doesn’t cause smoking-related diseases. Decades of medical research prove that smokeless tobacco use is at least 98 percent safer than smoking. Claims about smokeless risks are often wildly exaggerated. In truth, all health risks from smokeless tobacco, including that for oral cancer, are so low as to be barely measurable. Statistically, smokeless tobacco consumers have about the same risk of dying from its use as automobile users have of dying in a car accident. Tobacco harm reduction is saving lives in Sweden, where men smoked less and used more smokeless tobacco — Swedish snus — over the past century than in any other Western country. The result: Swedish men have the lowest rates of lung cancer — indeed, of all tobacco-related deaths — in the developed world. The Swedish snus experience is not only about men; increasing numbers of Swedish female smokers are switching to spit-free, socially acceptable snus products. In the United States, tobacco prohibitionists demand total abstinence. They argue that giving adult smokers access to smoke-free products threatens children’s health. But Oklahoma is eliminating youth access to tobacco. This year, based on some 1,100 retail inspections statewide, the FDA reported 97.6 percent compliance. The 8 million Americans, including 116,000 Oklahomans, who will die from smoking over the next two decades aren’t children today; they are adults age 35 and older. Prohibitionists extol the use of behavior therapy and expensive FDA-approved nicotine replacement products that, in reality, provide an insufficient dose of nicotine. Research documents that they fail 93 percent of the time. Some complain that arguing for a switch from cigarettes to smoke-free tobacco is an industry ploy. Nothing could be further from the truth. Tobacco harm reduction is backed by legions of peer-reviewed articles published in the world’s leading scientific journals. It is endorsed by the British Royal College of Physicians, the American Association of Public Health Physicians and others. The Royal College concluded that smokers smoke “predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.” Quit tobacco or die, the simplistic position of prohibitionists, contributes to the horrible death toll among longtime smokers. The Oklahoma Legislature deserves praise for its efforts to expose the truth about the life-saving potential of tobacco harm reduction through the substitution of smoke-free products. Rodu is professor of medicine and an endowed chair in tobacco harm reduction research at the University of Louisville.