Vaping nicotine is tobacco harm reduction

Harm reduction is widely used in public health. Tobacco harm reduction with vaping has the potential to reduce premature death and disease in smokers

1. Vaping is tobacco harm reduction Dr Alex Wodak AM Ambassador, Harm Reduction Australia Westmead Hospital Grand Round 7 August 2024 [email protected] 1

2. Declaration: I have never received funds from tobacco or vaping industries 2

3. Case study : RR KC well known elderly Melbourne barrister  Smoked ~1 packet cigarettes/day for decades  Found nicotine very helpful in his work Tried quit many times, many methods, but unsuccessful  Few years ago small lung cancer nodule found by chance N odule removed, lung cancer  Told by surgeon must stop smoking immediately  Surgeon accepted RR’s decision switch to vaping nicotine  Hasn’t smoked cigarette since  Remains well but struggles to obtain vapes while remaining within law 3

4. Smoking rates Western Sydney: 4

5. Smoking rates Western Sydney: 2 3rd lowest smoking rate in NSW LHDs  Slow decline for many years  But plateaued recent years Smoking related conditions huge impact on Westmead hospital  Low income & other disadvantaged p opulations 5

6. Smoking leading preventable cause of death & disease: True Australia & globally  1.1 billion people smoke globally Down from 1.2 billion smokers 20 years ago relying on conventional tobacco control  8 million people die/year from smoking related conditions 1 billion smoking related deaths by 2100 Problem is combustion of tobacco  6

7. Smoking leading preventable cause: 2 “People smoke for the nicotine but die from the tar”, Professor Michael Russell, 1976 Up to 2:3 long-term smokers die from smoking related condition People dying from a smoking related condition lose 12-13 years of life expectancy  Smokers who quit <40 years old have normal life expectancy  Huge growth Reduced Risk Products 21C provide smoke-free nicotine  110 million people take Reduced Risk Products (RRPs) - captured 10% market share in 20 years 7

8. Tobacco Harm reduction : Harm reduction priority directly reducing consequences of risk behaviour rather than reducing  Harm reduction used very widely in public policy, public health Excellent track record reducing adverse consequences without adverse effects & cost-effective  Road safety eg Car seat belts  Airbags  Motorcycle helmets 8

9. Tobacco Harm reduction : Sexual health eg   Condom promotion  PEP & PrEP HIV HPV vaccination 9

10. Tobacco Harm reduction : Alcohol & drugs eg Thiamine (Vitamin B1) fortification prevents WKS Modifying pub environment  Needle syringe programs slow spread HIV  Methadone/buprenorphine treatment  Medically Supervised Injecting Centres Vaping & other Reduced Risk Products reduce smoking related deaths 10

11. Tobacco Harm reduction : 2 But new drug harm reduction interventions always strongly opposed Crux of argument is conflict between 2 very different approaches: pragmatism ie achieving best that is feasible vs prohibition ie severely reducing/eliminating use 11