Prohibition Is a Tired, Tested and Failed Tobacco Harm Reduction Intervention-Experts

Around 1920, when new inventions and innovations were gathering momentum, the United States of America launched the Prohibition Law which banned the transportation of intoxicating liquors for beverage purposes in America. Prohibition became effective on January 17, 1920.

This ban however did not stop the illegal trading of alcohol as sneaky Americans devised means to conceal their alcohol from law enforcement. As a result, instead of the prohibition addressing the problems that led to the ban, it only drove the alcohol industry underground and Americans continued to consume alcohol during the 13 years that prohibition was the law of the land.

Even though the heavy-handedness towards alcohol seems to have diminished over decades, the same cannot be said for tobacco products. Between 1890 and 1927, the sale of cigarettes was banned virtually overnight in 15 different U.S. states. Today, the tobacco industry continues to face retributory and unwarranted reactions from governments all over the world.

Novel nicotine products such as e-cigarettes, nicotine pouches and snus face an uncertain future in different parts of the world as governments continue to crack down on the products. At least 33 countries have since banned the sale of Electronic Nicotine Delivery Systems (ENDS). Globally, as many as 121 countries or territories regulate ENDS and 87 countries have implemented regulations such as age restrictions on sales, bans on advertising and prohibition of vaping in public indoor areas.

Tobacco Harm Reduction (THR) advocates, medical doctors and public health experts who attended thejust-ended 7th Summit on Tobacco Harm Reduction (THR) Novel Products, Research and Policy warned against implementing or effecting prohibitions on novel nicotine products.

Speaking during a panel discussion titled “Prohibition or Regulation – Where is the Public Health Frontier?” Dr. Fernando Fernandez Bueno, General Surgeon in the Spanish military said that prohibiting novel and safer nicotine products would just drive users of novel products back to smoking combustible cigarettes.

“The fight against smoking must focus on combating combustible cigarettes which account for 63,000 deaths in Spain every year. Therefore, health authorities are required to offer scientifically based solutions for those smokers who cannot quit with traditional methods or are unwilling to stop using nicotine. The future tobacco control plans must be based on science and empirical data more than personal judgements or preconceived ideas,” said Dr. Bueno.

Spain recently approved a new anti-smoking plan that will expand the number of places where smoking is prohibited, implement a sharp increase in tobacco taxes and place vapers in the same category as conventional smokers as “deterrent” measures. Spain currently has over 9 Million smokers.

Dr. Bueno added that there is vast scientific evidence to demonstrate the potential of THR such as electronic cigarettes, nicotine pouches, snus or heated tobacco.

“Any anti-tobacco debate that excludes science will only result in more than 9 million Spaniards continuing to smoke combustible cigarettes. Prevention and cessation alone are not enough to significantly reduce the high rate of smoking as they do not provide a sufficient solution for those who are unable to quit smoking using the usual tools.”

He also said that in recent years, Spain has lost the leadership in the fight against smoking that the country had earned nearly two decades ago with the approval of the ambitious anti-tobacco law. This is why the new Ministry of Health has the opportunity to once again position Spain as a reference country in the fight against smoking. To achieve this, Dr. Bueno said the Tobacco Control Plan must focus on three key pillars. Science, building on international experience and societal stories, and strengthening prevention and cessation strategies with harm reduction.

Canada’s Minister of Health has since stopped nicotine pouches from being available at corner stores where alcohol is available. This according to Mrs Maria Papaioannoy, spokesperson for Rights4Vapers takes the Tobacco Harm Reduction, takes us 10 steps backwards.

“Our current Tobacco control model is based on the past. They are not looking into the future and they want to stop innovation. Here in Canada, our current health minister has created laws to give him the power to finish his work since he was also in tobacco control a few years ago,” said Mrs Papaioannoy.

She further stressed the need for Canada to learn from New Zealand and Sweden about how to make better regulations and move to the next level. According to data, 48,000 Canadians die every year from tobacco-related illnesses.

Dr. Sudhanshu Patwardhan, a medical doctor, nicotine expert and health tech entrepreneur from India said there is a need to use scientific literature to guide policymaking and regulation.

“Science should be at the core of all policy-making and decision-making. The public health frontier needs to be where the consumers are,” said Dr. Patwardhan.

He added that regulation and policy-making were hard work and needed local regulatory science and enforcement capabilities and that these are often lacking in most of the world.

“That also means that those policymakers and regulators in those countries are very vulnerable to being influenced by policies sent from a handful of ideologically driven countries with no assessment or oversight, and in such a context prohibition is seen as an easy way out due to lack of local expertise and tobacco regulatory science.”

Meanwhile, in Moldova, a very tough medical establishment has been put in place, opposing the ideas of tobacco harm reduction, and supporting the harm reduction ideas only for illegal drugs.

Dr. Eugeniu Cotelea, a Moldovan medical specialist in addiction psychiatry, highlighted the difficulties and the obstacles encountered in advocating for THR in Moldova due to restrictive laws and opposition from the medical community.

“In Moldova, when they hear the word ‘tobacco’ you become a public enemy. We have a lot of prohibitions. Just one week ago the parliament was debating a new law that will be more restrictive than before. This law will prohibit not just consumption but will also prohibit free speech of the patients, the consumer and that of medical doctors,” said Dr Cotelea.

David Sweanor, a Canadian lawyer and Chair of the Advisory Board, Centre for Health Law, Policy and Ethics, said that the bans on free speech are promoted globally and are incredibly protective against the cigarette industry.

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