Less harmful alternatives to smoking

As long ago as 1976, Michael Russell said that people smoked for the nicotine, but they died from the tar.⁹

Evidence shows that while nicotine is the addictive substance in cigarettes, it is relatively harmless. Almost all of the harm from smoking comes from the thousands of other chemicals in tobacco smoke, many of which are toxic.¹⁰

When considering how to maximise population benefit and minimise population harm, Professor David Abrams and his team concluded that an alternative to smoking cigarettes should provide drastically lower harm while maintaining sufficient appeal and sufficiently satisfying nicotine delivery in order to locate the ‘sweet spot’, which defines the characteristics of products most likely to displace smoking.¹¹

In 2016, the Royal College of Physicians suggested that the ideal harm reduction device should deliver nicotine in a manner as similar as possible to cigarettes, while at the same time maximising palatability and nicotine delivery to approximate the experience of smoking more closely.¹²

A 2022 study found that 63% of e-cigarette users who no longer smoked found vaping more or equally as satisfying as smoking.⁷

A recent report by the Office for Health Improvement and Disparities (OHID) (which replaced Public Health England) found that:⁸

• In the short and medium term, vaping poses a small fraction of the risks of smoking.
• Vaping, compared to smoking, leads to significantly lower exposure to harmful substances, as shown by biomarkers associated with the risk of cancer, respiratory and cardiovascular conditions.
• Biomarkers of potential harm measuring biological changes in the body due to an exposure to smoking or vaping found no major causes of concern associated with vaping when assessing short and medium term risks.