Konstantinos Farsalinos, a renowned Tobacco Harm Reduction (THR) advocate, moderated a session where three distinguished experts explored the intersection of public health and THR. Jeannie Cameron, founder of JCIC International, a UK-based strategic advocacy consultancy focusing on tobacco harm reduction, presented the therapeutic potential of nicotine for neurological conditions and highlighted its benefits in reducing the risk and slowing the onset of diseases like Parkinson’s and mild cognitive impairment. Muazu Elazeh, an award-winning journalist from Nigeria, addressed the media’s negative portrayal of harm reduction and the unrealistic pursuit of zero risk, which obstructs the promotion of effective strategies. Finally, Jeffrey Zamora, an activist in tobacco harm reduction from Costa Rica and President of ARDT Iberoamerica, provided an insightful and informative overview of the current state of harm reduction alternatives to smoking in Iberoamerica, highlighting the opportunities and challenges to promoting public health in the region.
Nicotine’s Therapeutic Potential
The first speaker, Jeannie Cameron, did an excellent presentation about the therapeutic effects of nicotine. “There are 69 identified carcinogens in tobacco smoke, but nicotine is not among them,” Mrs. Cameron stressed. In human studies, acute administration of nicotine can have positive effects on cognitive processes, such as improving attention, fine motor coordination, concentration, memory, and speed of information processing. And although nicotine can address some of the big societal issues our world faces (obesity, depression, anxiety, etc.), many in the health profession fail to acknowledge the evidence which suggests that nicotine may have potential therapeutic value.
Parkinson’s Disease is the fastest growing neurological condition in the world. Many studies have suggested that smokers have up to a 70% reduced risk of developing Parkinson’s disease because of the nicotine, Mrs Cameron said. These large-scale studies show that the longer someone has smoked the lower their risk, and that stopping smoking reduces the protective effect against Parkinson’s. The researchers believe it is the nicotine in cigarettes that is protecting the dopamine producing cells in the brain.
Mild cognitive impairment (MCI) afflicts nearly one in seven adults over the age of 65, putting them at an increased risk of developing Alzheimer’s disease and other dementias. In an early study, adults diagnosed with MCI who were prescribed nicotine patches for six months had improvement in attention and memory, without any serious side effects or signs of withdrawal; however, more studies are needed, the speaker pointed out. In patients with dementia of the Alzheimer type (DAT), nicotine produced a significant and marked improvement in some cognitive tests; these results suggest that nicotine may be acting on cortical mechanisms involved in visual perception and attention. Nicotine may therefore be of some value in treating deficits in attention and information processing in DAT patients.
Nicotine has been shown to suppress appetite and to attenuate obesity in many studies. Individuals who quit smoking generally gain approximately 4-5 kg in the first year after quitting, primarily because of the removal of nicotine’s effect on the central nervous system, which results in a slowing of the metabolism and an increase in hunger. Moreover, Mrs Cameron added, postmenopausal women who quit smoking can gain as much as 20% of their pre-cessation weight. Nicotine patches have been found to be useful in delaying—though not necessarily preventing—weight gain in post-menopausal women.
High rates of smoking are observed among individuals with psychiatric disorders, including schizophrenia, bipolar disorder, major depression, attention deficit hyperactivity disorder (ADHD), and comorbid substance use disorders. Nicotine administration to people with schizophrenia shows more normalized hyperconnectivity in brain cognition function. Scientific results suggest that the high prevalence of nicotine use in schizophrenia may be an attempt to correct a network deficit known to interfere with cognition. Studies also show that nicotine can be significantly effective for people suffering from post-traumatic stress disorder, obsessive-compulsive disorder, and late life depression. Moreover, smokeless nicotine is already being used for ADHD and it may become more mainstream in the future.
Beneficial effects of nicotine have also been observed in Tourette’s syndrome, ulcerative colitis, aphthous ulcers, auditory processing deficits, multiple sclerosis, insomnia, epilepsy and many other conditions.
Mrs. Cameron predicts that in the next 10-15 years nicotine will become mainstream and almost as ubiquitous as coffee. With so many benefits, it’s hard to see why it would not be. However, more research is needed into specific benefits of nicotine use unlinked to smoking cigarettes. It’s not just about switching smokers, but about looking more broadly at the benefits for the wider population of non-smokers —this is where the benefits of synthetic nicotine may emerge as there is no link at all to tobacco. As Mrs Cameron said, we also need good regulatory pathways, and indeed the direction of travel with cannabinoids for medicinal and therapeutic use is showing us what is possible.
Mr. Farsalinos commented that although nicotine is a very old compound that was discovered in 1828, it has not been studied enough, due to its association with smoking. Nicotine receptors are found not only in the brain, but throughout the body; so, it has enormous possibilities for many conditions, and it represents an exciting field for further research.
Media’s role in endorsing harm reduction
The next speaker, Muazu Elazeh, stressed the tremendous roles that mass media play in shaping people’s attitudes. The mass media provide essential information on different issues, including health, and ultimately shape public judgments and opinions. Through coverage, journalists and media organizations determine how people perceive events. Various studies show that the press provides alternative sources that people rely on for information, allows readers to act, and sets the topic for public discourse. This very important role of the media underscores not only how the media shape public opinion, but also how the media have the ability to highlight and bring forth certain issues into the public agenda. The media’s influence extends beyond informing; it directs societal perceptions and sets agendas for what people think about.
Media in health reporting can be best situated to create awareness and provide information on reducing harm, Mr Elazeh said. They are expected to effectively communicate the threats posed by diseases and the actions needed to curtail them, so that people can make informed decisions. Media can help contain the spread of fake news, rumors, misinformation, conspiracy theories, and information epidemics (infodemics). The role of the media in health emergencies can never be over-emphasized, he underscored; through risk communication, they help to save lives, by preventing or reducing the spread of disease, guiding those affected towards health services and educating the people on important health emergency measures. The media can help connect the audience with health specialists who use the media as an essential and trustworthy source of health information, which the public relies on for education and enlightenment messages. Useful health information and research is disseminated to widely dispersed audiences through mass media, even in hard-to-reach areas. They are also effective allies in persuading target audiences to adopt new behaviors, or in reminding them of critical information, as well as in keeping the public updated about immunization campaigns.
According to Mr Elazeh, the media can also play a decisive role in mitigating tobacco’s negative impact on both people and the environment; this means that the world must put emphasis on harm reduction, if quitting smoking fails to work. This presupposes the need for advocacy for a smoke-free world through the production of alternative products. As far as harm reduction is concerned, the media are expected to inform about alternative products readily available to people, especially those who still smoke. The media, the speaker said, must lead in providing accurate, science-based information about alternative products, like oral smokeless, heated tobacco, e-vapor and nicotine pouches, among others.
Mr. Farsalinos agreed with Mr. Elazeh that the media have not endorsed harm reduction in any meaningful way; they advocate for zero risk, zero harm, which is something extremely unrealistic, because in real life there is nothing which is risk-free. He commented that the media are exploiting the fact that the human brain is programmed with a basic instinct of avoiding harm. When people hear a negative story, they pay a lot more attention to the negative, because the brain instinctively wants to protect them from any possible hazard. So, it is more appealing to the audience to discuss negatively about issues and to expose harms, risks, and so on. That’s why the media are also more prone to discuss negative aspects of everything instead of positive aspects. Harm reduction is not risk-free, but it is a positive strategy in order to reduce risk; unfortunately, that’s not really very appealing to the media.
Current situation of Harm Reduction & Alternatives to Smoking in Iberoamerica
Finally, Jeffrey Zamora depicted the situation in the countries of ARDT Iberoamerica regarding smoking prevalence and the accessibility of harm reduction products. ARDT Iberoamerica is an alliance of consumer organizations from Latin America, Spain, and Portugal; its members are united by their languages and by a genuine desire to improve public health strategies that guarantee access to scientifically proven harm reduction alternatives for adults who are unable or unwilling to quit smoking.
The situation regarding the regulation of harm reduction products varies widely among the members of ARDT Iberoamerica, Mr Zamora said. In countries like Peru and Colombia there is no regulation at all for tobacco harm reduction products – although a new bill came recently for discussion at the Congress of Peru. On the other hand, commercialization of nicotine-vaping products is illegal in Argentina, Mexico, Brazil, and Uruguay; however, heated tobacco products are legally available in Uruguay and Brazil.
Nevertheless, it is estimated that 6 million people use nicotine-vaping devices in Brazil, 1.8 million in Mexico, and around 1 million in Argentina. All users of these products are accessing them through illicit sources, which proves that prohibition is not working: it is not eradicating the demand for safer alternatives to smoking. What it does is to prohibit a safer supply of the products, through a properly regulated way of manufacturing and distribution.
In other countries of the region, nicotine-vaping and heated tobacco products are regulated, such as in the case of Costa Rica, Paraguay, Ecuador and recently Chile.
Even in countries where a regulation exists, the speaker commented, it is far from being impeccable as it cannot guarantee that harm reduction products are accessible and affordable for adults. Ecuador currently has a 150% tax on everything related to nicotine-vaping devices; as a result, these products are not easily accessed by the people who need them the most, and people keep turning to the illicit market to save money or simply be able to afford them.
Meanwhile, Mr Zamora said, the decrease in smoking prevalence has flattened during the past ten years, creating a need to look for different approaches to inform adults about the health benefits of alternative ways of consuming nicotine. Many studies prove that nicotine-vaping is effective in helping adults quit smoking; the same has been proved for snus and nicotine pouches in Sweden and for heated tobacco products in Japan. However, just in Latin America, almost 49 million people who smoke are being denied access to proven, effective harm reduction products legally, and close to 9 million people who currently use nicotine-vaping devices are forced to do so through illicit sources.
“Tobacco harm reduction is a critical and pressing issue for our countries, as many of our nations continue to grapple with high rates of smoking prevalence and related health burdens,” Mr. Zamora said emphatically. Implementing harm reduction strategies is crucial for addressing the public health challenges associated with smoking. Furthermore, tobacco harm reduction is important for reducing the stigma associated with smoking, which often leads to social exclusion and barriers to seeking support for smoking cessation. By understanding the nature of substance use and dependence and by offering practical solutions, harm reduction strategies help bring tangible advantages for individuals, families and communities. Embracing harm reduction is a fundamental aspect of health policy and has the potential to foster healthier and more supportive societies for everyone, Mr. Zamora concluded.
Mr. Farsalinos expressed his frustration for the “total mess,” as he said, prevailing in Latin America, and mentioned that recently Brazil tried to criminalize even the possession of electronic cigarettes —an evolution that was fortunately reversed. Mr. Farsalinos congratulated all activists for their efforts to promote tobacco harm reduction strategies.