Although nicotine itself is not altogether harmless (it is addictive, has cardiovascular effects and can cause minor effects such as throat, nose and skin irritation, depending on the method of administration), it is tobacco that causes the major harm associated with smoking.

Tobacco harm reduction means reducing the illnesses and death caused by smoking tobacco among people who smoke and those around them, but recognising that people may not be able, or want, to stop using nicotine completely.

People who smoke can reduce the harm from tobacco by stopping smoking altogether, cutting down before quitting, smoking less, or abstaining from smoking temporarily. These changes in behaviour might involve completely or partially substituting the nicotine from smoking with nicotine from less hazardous sources that do not contain tobacco.

In 2013, the National Institute for Health and Care Excellence (NICE) published guidance on harm reduction approaches to smoking.

In the guidance, NICE recommends the wider use of licensed nicotine-containing products for smokers who struggle to quit. The guidance also outlines how healthcare professionals should help smokers who find it difficult to give up. The recommendations outlined in the NICE guidance on harm reduction are designed to help people who:

• May not be able (or do not want) to stop smoking in one step
• Want to stop smoking, without necessarily giving up nicotine
• May not be ready to stop smoking, but want to reduce the amount they smoke.