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Applying harm reduction to smoking
  1. John R Hughes
  1. University of Vermont Behavioral Pharmacology Laboratory, Depts of Psychiatry, Psychology, and Family Practice, 38 Fletcher Place, Burlington, VT 05401-1419, USA
  1. Correspondence to: John R Hughes, MD

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Harm reduction as applied to illicit drugs of dependence has included many different strategies (see Reuter and MacCoun, this issue, p. S28), some of which readily apply to smoking and some of which do not (for example, destigmatising use) (table). The idea of applying harm reduction strategies to smoking is not new and previous reviews of this notion have been published.1, 2 Implementing such strategies could produce several benefits: decreased morbidity and mortality, decreased secondhand harm to non-users, decreased health care expenditure, and increased cessation. Implementing such strategies could also produce several problems : decreased cessation, increased initiation, and the diversion of time, money, and effort from research into and treatment for smoking cessation.

This article will focus on the use of safer delivery routes and decreasing drug intake as harm reducing strategies. Other papers in this volume (Orleans, p. S3 and Pinney, p. S10) discuss increasing access to treatment. For brevity, monitoring for associated diseases, protecting non-users, and destigmatising use will not be discussed.

Less hazardous products: low tar, low nicotine cigarettes

Because most low tar cigarettes reduce tar by dilution methods (for example, holes in the filters), most are of these are also low nicotine cigarettes.1, 3 The most recent review of the benefits of low tar, low nicotine cigarettes was the President’s Cancer Panel which concluded :

The smoking of cigarettes with lower machine-measured yields has a small effect on reducing the risk of cancer caused by smoking, no effect on the risk of cardiovascular diseases and an uncertain effect on the risk of pulmonary disease.4

One of the reasons for the failure of the panel to state more resolutely that low tar, low nicotine cigarettes are beneficial was the absence of randomised trials of the effect of low versus high tar cigarettes on disease, or of longitudinal studies of …

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