ERS statement

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ERS Position Paper on Tobacco Harm Reduction

Author(s): Stylianos Loukides, e-Learning Director on hehalf of the ERS Tobacco Control Committee

Airway diseases
General respiratory patient care
Public health

Digest Author(s): Paraskevi Katsaounou MD / 2 June, 2019

Harm reduction is a tactic (policy, program, practice) that aim primarily to reduce the adverse health, social and economic consequences of the use of psychoactive drugs without necessarily reducing drug consumption. Harm reduction in smoking was suggested as a tactic to curb the tobacco epidemic of diseases caused by smoking (smoking will kill around one billion people in the 21st century) instead of using only Tobacco Control measures (FCTC). The tobacco harm reduction strategy is based on incorrect claims (smokers cannot or will not quit smoking), undocumented assumptions (alternative nicotine delivery products are highly effective as a smoking cessation aid and are generally harmless; smokers will replace conventional cigarettes with alternative nicotine delivery products). Alternative nicotine delivery products can have a negative impact on public health even if “stick-by-stick” they turn out to be less harmful than conventional cigarettes, since in real life smokers see alternative nicotine delivery products as a viable alternative to the use of evidence based smoking cessation services and smoking cessation pharmacotherapy. Alternative nicotine delivery products are the tobacco industry’s adaptation to declining tobacco consumption and acceptability of smoking, and increased regulation of cigarettes. There are tobacco industry documents that show that the tobacco companies have attempted to deter smokers from quitting by developing products that appeared to be less harmful, less addictive or more socially acceptable. The tobacco industry is just attempting to rehabilitate its reputation, to appear as responsible members of society and as a part of the solution, so that they can more effectively influence decision makers and have no intention to stop manufacturing conventional cigarettes, as they claim (using vast resources against efforts to reduce conventional smoking to expand the sale of conventional cigarettes in low income countries). We urge smokers to seek safe and effective smoking cessation programs with professional assistance in smoking cessation services and advice them not to be tem tempted by alternative nicotine containing products that have not been proven safe and exposed themselves long-term re to toxic and carcinogenic substances (although reduced).


Harm reduction evidence on the safety and the effectiveness of alternative nicotine delivery products as a smoking cessation tool is still lacking, while use of nicotine containing products is spreading to non-smokers, which is very alarming. Although we acknowledge the good intentions of many HCP and policy makers that hope curbing the tobacco epidemic using harm reduction, we advise that before a large-scale implementation we need strong evidence and we remind them the low tar cigarettes experiment. Harm reduction in tobacco control should be reserved for a minority of high-risk smokers; it is not a population-based strategy. With the occasion of World No Tobacco Day ( we remind that full implementation of Frameworld Convention on Tobacco Control ( be totally and widely implemented. Make everyday World No Tobacco Day.