LUNG HEALTH
A DEEP BREATH
There’ s no excuse for ignoring tobacco harm reduction, hears DDN
T here’ s tension between tobacco harm reduction( THR) and‘ traditional’ harm reduction, said Tony Duffin, introducing a dialogue hosted by Knowledge Action Change.‘ But harm reduction is about active intervention and not standing about waiting for something to happen.’ So what’ s going on, and what should we be doing?
Firstly, we had to understand the pressing need, said Professor Gerry Stimson. Twenty per cent of the world’ s population now smoked and it killed more than malaria, AIDS, TB and illicit drugs combined. Cigarettes were a convenient but very dirty delivery system; furthermore they were highly reinforcing, providing a big spike in nicotine that quickly made smokers want another.
THR had mainly been about making it difficult to smoke and was also one of the only public health areas to use stigma – the deliberate stigmatisation of smokers. Harm reduction had lagged behind as nicotine replacement therapy was‘ boring’ – there was no hit. Then e-cigarettes came along in the 2000s and were a consumer-led intervention that changed all that, said Prof Stimson. But a lot of misinformation – and silence from key organisations that could have furthered the dialogue – had stalled progress.
The fact remained that most drug users smoked and smokingrelated deaths were the biggest health risk they face, he said. So it made no sense that smoking was still ignored by many services.
‘ Tobacco harm reduction is even more contentious than drug harm reduction,’ said Dr Garrett McGovern of Priority Medical Clinic in Ireland.‘ The field hasn’ t embraced it at all and there’ s a disinterest in getting involved.’ Vaping was revolutionary but was‘ often thrown under the bus’ along with smoking.‘ It’ s hard to believe that tobacco harm reduction is so controversial,’ he said.‘ It should be an easy sell.’
WIDER SMOKING HARMS The risks of smoking were not limited to cigarettes, emphasised Dee Cunniffe, lead of the SWERVE harm reduction hub in London. Safer inhalation and pipe provision could make a significant difference to the health of people using crack – many homemade pipes used steel wool that resulted in people ingesting metal. Yet it was currently illegal to give out pipes and gauze.
‘ People think smoking is safer than injecting, but with new synthetic drugs that’ s not always the case,’ she added.‘ It’ s just as risky as injecting.’ She called for more harm reduction hubs – places like SWERVE, which was unusual as it wasn’ t part of the drug and alcohol service.‘ It works better as people don’ t fear their prescription will be changed,’ she said.
Prof Gerry Stimson is a public health sociologist, with more than 40 years’ experience of public health research and advocacy. He was a key figure in drugs harm reduction in the 1980s and part of research into the harm reduction response to HIV / AIDS. don jon red / Alamy
22 • DRINK AND DRUGS NEWS • MARCH 2026 WWW. DRINKANDDRUGSNEWS. COM