Doctors discuss tobacco addiction; calls for science-backed policy on harm reduction

India's best-known doctors debate tobacco harm reduction on the third anniversary of the e-cigarette ban.

MUMBAI, India, Oct. 13, 2022 /PRNewswire/ -- Policy Circle, one of the leading multimedia platforms for in-depth discussions on economy, policy and governance hosted a roundtable on 'Tobacco Harm Reduction – Risks and Benefits' to mark three years to India's ban on Electronic Nicotine Delivery Systems (ENDS). The roundtable was in continuation of the earlier discussions where experts such as parliamentarians, lawmakers, eminent doctors, and policymakers deliberated on India's tobacco policy and highlighted the need of harm reduction. Three years after the ban, the market is flooded with illegal products. There is growing concern about the unregulated use electronic nicotine delivery systems, or ENDS, especially among parents about their rampant use among young children.

"The government policies in the last two decades have brought in a big shift in the attitude towards tobacco addiction and cessation. In my opinion, harm reduction is not substitution. We need to prevent tobacco usage," said Dr K Madan Gopal, Senior Consultant, NITI Aayog.

Dr MC Misra, former Director, AIIMS, New Delhi, opined, "People need assistance in quitting, but everyone does not have the will power or sufficient socioeconomic wherewithal to enrol in programmes. There is a need for a team of trained people in all hospitals for cessation programmes"

Discussing the potential of tobacco harm reduction, Dr. Bharat Gopal, Director, National Chest Centre, New Delhi said, "There is a need for appropriate regulation as it cannot be all or none phenomena. While underage children have easy access to such products, the medical community which uses them for smoking cessation programmes cannot use them because of the ban. Neither smoking nor vaping is good for health. There is a need to sit together and understand that there is no choice but to regulate them. India currently follows a 'quit or die' policy that needs to be reviewed." 

"The addiction aspect for tobacco use disorders or tobacco control policies are often neglected, which is not the case with other such disorders such as alcohol addiction. By allowing combustible cigarettes and banning e-cigarettes, India is working towards harm maximisation. We think banned items are not available but, what the ban actually means is that the government has abdicated the responsibility to regulate them. The absence of a harm reduction category in India, has given an impetus to the dangers of combustible cigarettes," said Dr. Atul Ambekar, Professor, National Drug Dependence Treatment Centre, AIIMS.

Dr Sunita Gupta, Professor, Maulana Azad Institute of Dental Sciences, New Delhi, said, "Bans do not work – they will only create underground economies. Making cigarettes expensive has led to people shifting to beedis and chewing tobacco."

Concluding the discourse and summing the larger viewpoints, Prof Dr. Nimesh G Desai, Senior Consultant in Psychiatry, and former Director IHBAS said "There seems to be a consensus on the need for harm reduction as an approach for tobacco cessation. I believe that substitution is the way to tackle the challenge, even NRT (Nicotine Replacement Therapy) is substitution. Eventually, there will be more accommodation for scientific evidence and not being governed by morality or absolute principles."

Several countries employ harm reduction method to reduce the levels of morbidity and mortality from tobacco use is harm reduction. The advocates of harm reduction say that it is difficult to lure smokers away from tobacco. While 70% of the smokers are willing to quit, only 8% of them are able to do it. People use tobacco products because they are addicted to nicotine. Nicotine is a highly addictive substance, but it is not the cause of diseases linked to tobacco use. It is the other toxins contained in tobacco smoke that cause cancer and other deadly diseases.

The supporters of harm reduction support delivery of nicotine through a range of products such as electronic cigarettes and 'heat not burn' products that, they say, are in the lowest end of the spectrum of harm.

Watch the full video recording of the Policy Circle Roundtable here: https://www.youtube.com/watch?v=5Ji0_n05iV4&t=1579s

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