Are novel nicotine products the game changer towards smoking cessation?

Rumbidzayi Zinyuke

Senior Health Reporter

“Smoking may be hazardous to health” is a notice that we have seen and heard on adverts or on packages of cigarettes for many years. 

Not that we really cared about it. We would see it and forget about it. And really, that warning has never been a deterrent for those who smoke. So why should it bother us non-smokers; we say.

Many of us would testify to having a relative or two who have smoked tobacco cigarettes for the better part of their lives. And some continue to do so because they are yet to see the hazards being spoken about.

But that is not to say these people have not been harmed by their smoking habit. It has been proven that smoking leads to disease and disability, and it harms nearly every organ of the body.

These include cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD). It also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. The list is too long to exhaust.

Tobacco is the leading preventable cause of death in the world.

Data from the World Health Organisation (WHO) shows that at least 8 million smokers die from smoking-related diseases every year while one million non-smokers who are exposed to second-hand smoke also die from passive smoking.

Second hand smoke causes stroke, lung cancer, and coronary heart disease in adults. 

Children who are exposed to second-hand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth.

So everyone can be affected by tobacco smoke.

While the smoking prevalence in Africa remains relatively low at 8,4 percent, there are projections by the WHO that the total number of users on the continent is likely to increase to 62 million, of whom 51 million will be smoking combustible tobacco by the year 2025. 

This surge is being attributed to the exponential growth in population being experienced in Africa, as well as growing stress levels.

So as the world’s smoking rates decline, Africa’s rates are expected to do the opposite. Which should be a cause for concern for African countries.

Among the top users of combustible tobacco on the continent are South Africa, followed by Mauritius, Lesotho, Seychelles, Madagascar, Algeria and Botswana. Zimbabwe comes in at number 16 out of 40 WHO African region countries.

So what should be done?

Even though smoking rates are still low, it is important to try and reduce the harm that tobacco is causing on the population.

And this can be done through the adoption of smoke free and other non-combustible nicotine products.

According to Clive Bates, the Director of Action on Smoking and Health UK, people smoke for the nicotine but they die from the tar.

“When people are smoking, what they really want is the nicotine and the experience of nicotine. Of course there are other things like the float sensation, flavours, it is also a social thing and so on, but at the heart of it, people smoking is a nicotine seeking behaviour,” he said during an Ask Me Informative Session on Tobacco Harm Reduction.

“So whatever way we look at it, people want nicotine so this is where technology comes in because we now have a range of products that can give people the nicotine but without the tar, without the combustion of smoke.”

These include vaping products, heated tobacco products, oral nicotine products and the more traditional smokeless tobacco and snuffs.

Bates says all these are capable of delivering nicotine but without significant exposure to harm and toxins.

He says studies have shown that when people switch to these products, they are exposed to much lower levels of all the toxicants that are harmful and associated with smoking.

“What we have here is the prospect of an alternative to smoking at very much lower risk and that has to be seen as a huge public health opportunity. For people who do not want to quit or can’t quit or like nicotine, or get something from it, switching is going to be a far easier thing to do than asking them to quit completely,” he added.

But can it be done?

Countries such as Sweden, Iceland, and Norway have adopted Sinus and have displaced cigarettes. Sweden now has one the lowest Cancer death rates in the world and is set to be declared Smoke Free according to the criteria WHO. 

New Zealand, the United Kingdom, and the United States of America have adopted E-Cigarettes and are also on their way to displacing combustible cigarettes.

Studies done in the US say the alternative nicotine delivery systems have the potential to disrupt the 120-year dominance of cigarettes.

So it means there could be hope.

But it will take the African countries being proactive on reducing the harm associated with tobacco use.

“If people can get the nicotine they want from a product that does them far less harm, is much cleaner, has much less stigma associated with it and is much cheaper, why wouldn’t they switch? What we have is a market dynamic that is moving people towards these products instead of smoking,” Bates said.

“We have to think, if there is demand for it, how do we provide it in the safest possible way because we are not anytime soon heading for a nicotine free society. Nicotine is harmful if smoked, but is barely harmful if it is taken in a smoke free format. That whole societal attitude to nicotine has to change when it doesn’t come with the harms and parallels of smoking. We need to think of these technologies as a phased transition inside the nicotine delivery system.”

Unfortunately, most nations have yet to come up with robust policies around tobacco control.

But with 44 Sub-Saharan African countries signed up to the World Health Organisation (WHO) Framework Convention for Tobacco Control (FCTC), Zimbabwe included, there should be moves by nations to come up with legislation that help to prevent tobacco uptake in young people and reduce current tobacco consumption in adults. 

This might mean creating room for those non-combustible technologies, particularly for those who want to quit smoking.

Can we?

Founder of the African Harm Reduction Alliance Dr Kgosi Letlape, from South Africa, said the FCTC could not be applied as it is on all nicotine products hence countries needed to find ways to address the problem associated with tobacco harm holistically.

“Now when you look at the FCTC, it was adopted in 2003. At that time, there was really only one alternative to combustible products that was on the market. You had tobacco either by combusting it, by chewing it or grinding it and putting it into your mouth or snuff (smokeless tobacco). And there were associated harms in relation to smokeless tobacco, these included oral cancers.

“Looking at the FCTC, it is inappropriate to be used as a framework to look at alternatives to combustible cigarettes. In the FCTC, there is Article 1 D, which speaks about Harm Reduction in relation to the challenges presented by tobacco products. If you fast-track to now, you cannot apply the FCTC as it is to the risk-reduced products. What any well-meaning nation needs to do is to look at a framework for regulating the RRPs appropriately. Regulation is necessary but must be based on evidence and must be based on science,” he said.

At the end of the day, the aim is to reduce the burden of smoking-related disease and deaths while preventing young people from joining the smoking bandwagon.

Because smoking really is dangerous.

And it can be eliminated. Even if somewhat slowly.