Compared to other tobacco control measures, THR is a good strategy because its main purpose is to accelerate the decline in the number of smokers

by HARIZAH KAMEL

THE tobacco harm reduction (THR) approach is now increasingly popular around the world in encouraging hardcore smokers to give up smoking through the introduction of less harmful alternative products.

However, awareness of the strategy is still at an early stage in Malaysia, as there are still many who hold negative perceptions of THR products such as vape.

In a recent interview with the senior researcher of the University of Patras, Greece, Dr Konstantinos Farsalinos (picture) shed light on the use of THR products among smokers.

Q: There is a lot of speculation on THR globally. What are the findings and facts behind the study?

Dr Farsalinos: I think it is a controversial issue and has always caused confusion to society especially among smokers.

For me, THR is a good strategy compared to other tobacco control measures because its main purpose is to accelerate the decline of smokers.

We are aware that quitting smoking is a very difficult thing to do while taking medication to quit smoking is also less successful with a failure rate of 78% because smokers are unable to quit for the long term. Some smokers are not ready to seek medical help.

Therefore, I feel it is unreasonable to isolate smokers from options like vape which is the first choice for smokers who cannot and do not want to quit smoking with an approved method.

We have strong evidence that vape has lower potential harm compared to tobacco cigarettes.

However, the product should definitely be controlled so that non-smokers do not start to pick up the habit as the THR strategy is targeted towards smokers.

Q: What is the difference between smoking a vape and smoking a traditional cigarette, and how does it help smokers kick the habit?

Dr Farsalinos: THR products do not have tobacco burning, which is the main cause of the danger. Thus, when nicotine is used without burning, most of the toxins found in tobacco cigarettes will be removed.

Naturally, smokers are encouraged to quit smoking with two main options namely stopping on their own without turning to alternatives, or with the help of health professionals and medications.

Yet the reality is, the majority of smokers are now reluctant or unable to quit smoking even with those options. So, because of that, there is a third option, which is through reducing the harm of tobacco with the use of THR products.

Vape is not high risk because it does not contain tobacco, it is just an evaporating liquid.

In Sweden, in addition to vape, there is a smokeless tobacco product called the Scandinavian Snus which is found to have a lower risk than smoking tobacco cigarettes.

Thus, we should explain and convince smokers to quit smoking by switching to less risky products if they are unable to quit on their own or with the help of a health professional.

Q: What are the myths often associated with vape, and how do you clear the air for those who are confused by all the speculations?

Dr Farsalinos: Once a person has been smoking for a long period and at some point, decides to quit, it may not necessarily reduce his or her risk of getting tobacco-related illnesses.

Reducing the risk of getting these diseases after quitting smoking will take a long time — depending on how long a person had been smoking — and his or her health condition will not be the same as that of a person who has never smoked at all.

Vaping does have its own risks, but they are about 95% less than that smoking tobacco cigarettes.

So, I think it is not appropriate to prevent smokers from choosing the third option as a method to quit smoking.

Our job is to guide them to at least try THR products as an additional method of quitting smoking.

For me, we have no choice but to do so before smokers repeat their previous failed attempts and may fail over and over again until eventually, they give up and will continue to smoke.

Q: There are studies that show smokers who switch to vape start a new habit rather than quit completely. What is your opinion about this?

Dr Farsalinos: They will not start a new habit. It is just switching to a less risky option, which is vape.

Although not recommended, they do have the option of using vape that contains nicotine but when compared to smoking a cigarette, it is a much better option. The main problem is tobacco cigarettes and not nicotine.

Q: One of the most common objections to vape is because it may contain nicotine and can induce non-smokers to smoke. What is your opinion?

Dr Farsalinos: The main issue is not nicotine but other chemicals especially tobacco-burning products which are not present in vape. With vape, we are able to eliminate most of the risk by asking smokers to use products that do not involve burning.

Q: Is legislation important, especially in Malaysia, where this industry is growing and turning into a multi-million-ringgit industry?

Dr Farsalinos: Every product that is on the market definitely has its laws. Law is very important and needs to be set for THR products because, in the case of vape, the target is for people who smoke cigarettes. So, it is not appropriate to offer it to people who do not smoke or children under the age of 18.

The law should be implemented in all countries and at the same time, the products should also be disclosed to smokers for less risky product choices.

In addition, the law is also important to ensure the quality of THR products. A common problem is that authorities apply the same tobacco cigarette laws to vape and other THR products.

It is a big mistake because we are supposed to encourage smokers to quit. If THR product laws are as strict as smoking laws, it will prevent them from quitting.

Smokers will lose their purpose and motivation to quit if THR products are just as harmful as smoking tobacco cigarettes.

So, the authorities should apply the principle of proportion to make rules and laws commensurate with the level of risk of a product.

That is the only way to ensure good product quality besides ensuring safer and satisfactory product innovation and development, thus motivating smokers to use less risky products as a substitute for tobacco cigarettes.