We all know that cigarettes cause thousands of deaths and inflict horrible diseases on many more. Indeed, smoking kills many, many more Canadians every year than AIDS, illicit drugs, alcohol and car accidents combined. What is the right approach to reducing the carnage of smoking?
The worst part of the situation is that smokers, in seeking the nicotine for their addiction, do so via a delivery system that is even more harmful: tobacco smoke. Certainly, nicotine has health risks, but compared to those of the smoke, they are relatively benign.
Harm reduction has a long history as a key tool in the public health arsenal. Consider the mandatory use of seatbelts (people will drive and have accidents so let's reduce the harm); sex education (kids are going to do it anyways so at least let's teach them how to avoid disease and unwanted pregnancy). Is there are harm reduction option for smoking?
One answer is so-called 'smokeless' or oral tobacco. Instead of burning tobacco to extract nicotine, the addict places a pinch or packet of the substance in their cheek or gums and absorbs the nicotine orally. Another example is a product from Sweden called 'snus' that was test marketed in Edmonton in 2008. Snus comes as a small packet rather like a teabag containing tobacco mixed with salt and flavouring.
Certainly any non-burning source of nicotine is preferable to the deadly combination of carcinogens found in tobacco smoke, but is smokeless tobacco the solution? Yes, and no.
When facing any cause of disease or injury, there are four levels of intervention. First is preventing the onset of the behaviour; then encouraging cessation. Third is to protect third parties, and finally, reducing the risks to those who will continue the behaviour irrespective. Smokeless tobacco scores well on the last two stages.
Does that mean we support tobacco use and nicotine addiction? Of course not. Tobacco remains as detrimental to people as it has always been. Consider that all forms of oral tobacco contain carcinogens and that this method of delivery can lead to cancer of the mouth, esophagus, pancreas. It can also lead to gum disease and tooth loss.
The makers of snus claim that it is one of their methods for reducing the harms from tobacco, and even to help smokers to quit altogether. Cynics may say that it's their way of growing their sales in a declining market for tobacco products.
According to the American Cancer Society, the trend has been the reverse for oral tobacco as those users progress to smoking rather than smokers moving to oral forms. Studies also show that while oral tobacco users had lower rates of illness and death than smokers, but were still much more likely than someone who quit entirely. Their conclusion speaks volumes: "There is currently no reliable evidence to support the promotion of alternative tobacco products for smoking cessation."
Dr. Paul Martiquet is the Medical Health Officer for the Sea to Sky.
