The dangers of smoking are common knowledge. The efforts to create a smoke-free world has been ongoing for more than three decades from the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and other health ministries around the globe.
Yet, there are approximately 1.1 billion people across the world who continue to smoke cigarettes and about 8 million die every year due to smoke-related diseases.
This number does not include 1.2 million premature deaths per year from second-hand smoking, and the 65,000 children who die each year from illnesses attributable to second-hand smoke.
Today, the tobacco industry is developing a wide array of modified cigarettes and electronic nicotine delivery systems (ENDS) and the era of tobacco harm reduction is upon us.
Now, what is Tobacco Harm Reduction? It is a strategy to reduce the harm and health risks to smokers and wider society with an ultimate goal to eliminate smoking and tobacco use.
According to Senior Lecturer from the Faculty of Medicine and Health Sciences in University Putra Malaysia, Dr Ng Yee Guan, the harm reduction strategy echoes entirely with the concept of risk management of Occupational Safety and Health (OSH).
“In OSH, we follow the hierarchy of hazard control. First, we go for elimination, if we can’t eliminate, then we substitute or risk transfer, and then engineering control, administrative control and using personal protective equipment.
“In terms of clinical practice guidelines for tobacco use disorder, we will start with the administrative approach; this means the medical practitioner will ask: ‘Are you a tobacco user? Do you plan to quit?’. If yes, we advise and plan a program to help them quit.
“After this approach and we find that these smokers are highly dependent on tobacco, it means that you are addicted and we will advise to try nicotine replacement therapy- this is a substitution from the tobacco use,” says Dr Ng during the Asia Harm Reduction Forum in Seoul, South Korea, recently.
We also have to understand that these products: e-cigarette, vape, heat-not-burn are relatively new in the society. So the long term health effects has not been evaluated.
Currently, the Ministry of Health (MOH) Malaysia has set up a free programme called ‘MQuit’ to encourage smokers to quit the bad habit by providing customised plans for individuals with comprehensive follow-up sessions by dedicated healthcare professionals.
However this program does not include or recommend the usage of alternative cigarettes products such as e-cigarettes, vapes and heat-not-burn as prescription to help smokers to quit.
“I can understand their (MOH) sentiment because the Clinical Practice Guideline for Tobacco Use Disorder, published by MOH has revealed that there are no clear evidence for the last 15 years that products like e-cigarettes actually reduces the prevalence of smoking.
“We also have to understand that these products: e-cigarette, vape, heat-not-burn are relatively new in the society. So the long term health effects has not been evaluated. However based on scientific evidence, the harmful compounds emitted by these products is 90 percent less than the conventional, combustible tobacco,” says Dr. Ng.
The government of Malaysia is expected to table the regularisation of e-cigarettes and vapes by March next year, which means new laws will be drafted known as the Tobacco Act.
“The regulation of these products can actually help in managing the existing current smokers. We are talking about smokers converting into e-cigarettes users based on the short terms studies that shows it is less hazardous than conventional tobacco smoke.
“The government has a taskforce to look into this issue, and it has to cater to all range of people in the society; the children, the elderly and pregnant women. It cannot be just about the right for the smokers to smoke. So it is important that the e-cigarettes and vape usage be regulated.
“I also hope that the government will not ‘cherry-pick’ information. Some people are actually worried that only certain chosen data are looked at. We must look at the bigger spectrum and look at every information and scientific data to decide objectively.
I also hope that the government will not ‘cherry-pick’ information. We must look at the bigger spectrum and will every information and scientific data to decide objectively.
It is claimed that the usage of e-cigarettes, vapes and heat-not-burn products is safer than the conventional combustible tobacco products, but Dr Ng reiterates: “The vapours from these products are still harmful. It’s not safe, but it’s much safer than tobacco smoke,”
“Let’s face the fact that if we are able to ‘eliminate’ we will definitely do so. But the fact is showing that some smokers are just not willing and they need other motivation.
“The best alternative will still be nicotine replacement therapy because it has the lowest hazardous point. E-cigarettes does not even come close. However, some just like the hand-mouth ritual of smoking. That’s why nicotine-replacement does not work for them.
“The consumers has the right to know and choose a better alternative. If they are currently smoking conventional tobacco, they have a right to know there are better alternatives and it’s up to them to deal with the problem sooner or later,” he says.
When the government imposed a ban on smoking in eateries in Malaysia earlier this year, some have claimed this move as ‘opposing’ the existing Malaysian culture of ‘kedai kopi’ where many gather to chat over a drink.
“All of us need to stop being selfish. We need to be more understanding. If I am a smoker, I need to ask myself if I smoke around another non smoker, will he or she be okay about it?
“If there is a corner designated for smoking or vaping, it is better for you to go there so you won’t expose the harmful chemicals to other people. Prior to the ban, we see many people smoke in restaurants and there are many children, some elderly. This is not ethical.
“There is also the issue; ‘Where do smokers throw their cigarette butts after they finish?’. We can see cigarette butts littering on the grounds everywhere.
“We all need to respect each other’s rights. You want people to respect your right as a smoker firstly, respect the rights of others.
“You can ask the non smokers if it’s okay to smoke. Sometimes it seems like it’s culturally rude to say no, but again, Malaysians are too ‘polite’. It’s okay to enforce your right for your safety and health,” says Dr. Ng.