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Discussion subject: Tobacco harm reduction – Heated tobacco as a smoking alternative
Globally, 1.3 billion People are estimated to use tobacco, with 1.1 billion of those being smokers. 4,5 Smoking kills more than 8 million People annually. 4
In the UK, despite the proportion of smokers declining steadily, the Latest data indicate that 13.3% of adults – around 6.6 million People – still smoke.
Around 15.1% of men and 11.5% of women smoke. Younger adults are the heaviest smokers; those aged 25 to 34 years have the highest proportion of current smokers (15.8%), compared to the 65+ years age group who have the lowest (8.0%). 6
Harm reduction
There is a growing consensus that for adult smokers, completely switching to tobacco- or nicotine-containing products that do not burn tobacco has the potential to present less risk of harm than continued Smoking.
Epidemiology shows that Smoking increases the risk of developing a Smoking-related disease and increases the risk of early death. Epidemiology has also demonstrated that if a smoker quits, the risk of developing a Smoking-related disease decreases. 7,8
The best way for adult smokers to reduce their risks associated with Smoking is to quit tobacco and nicotine altogether. However, evidence has shown that many smokers don’t quit. 9
Smoke and combustion-free alternatives
For adult smokers who would otherwise continue to smoke cigarettes, switching to a smoke-free alternative could reduce their risk of Smoking-related harm, such as lung cancer , chronic obstructive pulmonary disease ( COPD ) and cardiovascular diseases, compared to continued Smoking.
In recent years, an increasing number of smokers have switched from cigarettes to smoke-free alternatives such as e-cigarettes , heated tobacco or oral tobacco products to reduce the risk of harm to their Health compared to continued Smoking.
These products could, indeed, complement existing tobacco control efforts and be part of an overall harm reduction strategy to benefit public Health. Evidence from Stop smoking services and the Cochrane review on electronic cigarettes for Smoking cessation shows that vaping is effective for stopping Smoking. 10
UK governmental analysis has stated that “vaping poses only a small fraction of the risk of Smoking and is at least 95% less harmful than Smoking (that is, Smoking is at least 20 times more harmful to users than vaping)”, at least over the short to medium term. 10
Tobacco smoke
The primary cause of Smoking-related disease is the high levels of harmful and potentially harmful constituents (HPHCs) in smoke formed during the combustion of tobacco. The red glow of a cigarette is tobacco combusting at 800°C11 resulting in the smoke containing high levels of HPHCs.
However, IT is possible to heat tobacco to release nicotine without the combustion products of HPHCs and ash particulates. 1
Several different types of inhalable nicotine products have been developed that avoid burning tobacco or producing smoke. They are designed to deliver a nicotine-containing aerosol with a reduced level of harmful and potentially harmful toxicants compared to cigarette smoke.
vaping products are designed to vaporise a nicotine-containing liquid as a heated aerosol. Other technologies include blade and induction heating, which can heat a plug of real tobacco to release nicotine-containing vapour without combustion.
This article is funded by an educational grant from Philip Morris Limited.
“Heated tobacco products do not combust tobacco and therefore produce an aerosol that is not smoke”
Tobacco heating systems
Heated tobacco products do not combust tobacco so avoid the high temperatures where tobacco is burnt and therefore produce an aerosol that is not smoke.
Studies indicate that the aerosol of these tobacco heating systems (THS) does not contain solid particles that are produced when tobacco is burned.2
Moreover, as combustion requires oxygen, testing a THS device in an oxygen-free atmosphere shows the nicotine aerosol is released, meaning that combustion does not occur when heating tobacco with a THS device.2
Indeed, by eliminating combustion, the levels of harmful chemicals are reduced on average by 95% in the THS aerosol compared to cigarette smoke.12
| Heated tobacco product types | |
| Tobacco heating system (THS) | THS uses an electronic heat-control technology to heat tobacco within a specific temperature range |
| Pin-based heating system (PHS) | PHS electrically heats the tobacco using either inductive or resistive heating |
How do e-cigarettes compare to heated tobacco products?
Extensive laboratory and clinical data is available supporting the potential of THS devices for risk reduction compared with continued cigarette smoking. The totality of evidence gathered so far demonstrates that a THS device is a better choice for adult smokers who would otherwise continue smoking, and that switching completely to THS presents less risk of harm than continued smoking.
In addition, THS products compare favourably with e-cigarettes. A new study using a randomised controlled trial evaluating heated tobacco products and e-cigarettes showed that THS products are as effective as e-cigarettes for promoting abstinence from cigarettes among people not intending to quit.3
Customer scenario
Customer: I’m a smoker who’s worrying about the harm cigarettes are doing to me, but I can’t stick with nicotine replacement therapy. Have you any advice?
Pharmacist: You’re not alone. Many smokers find it difficult to stick with NRT.9 But there is good evidence that electronic cigarette devices increase quit rates compared to NRT.13
There are several different types of products that can provide nicotine in a vapour. E-cigarettes vaporise a nicotine-containing liquid, but there are also devices that work by heating tobacco but not burning it.
Customer: I’m familiar with vaping, but I’ve not heard anything about heating tobacco. Can you tell me more?
Pharmacist: Tobacco heating systems, or THS products, are electronic devices that heat up a tobacco wad so that it releases a nicotine vapour. However, the temperature means it is not burning the tobacco, so the vapour lacks the harmful compounds found in cigarette smoke.1
THS devices have actually been around for a decade in other parts of the world. Japan introduced them in 2014 and they have become popular for many reasons – for example, they don’t burn so there is
no ash or smoke, and there is less smell than with cigarettes.
More importantly, the data show that THS products decrease smoking as they help ease smokers away from cigarettes.
Customer: What about potential harms?
Pharmacist: Research found that there is a huge reduction in the level of harmful chemicals inhaled with a THS device compared to cigarettes,12 but you’re right to be cautious. Neither heated tobacco products nor e-cigarettes are risk-free. Both product types, like cigarettes, generally contain nicotine. Nicotine is addictive and not
risk-free, but it is not the primary cause of smoking-related diseases.
Customer: Are heated tobacco devices as useful as vaping in helping me avoid cigarettes?
Pharmacist: It would seem so. New research shows that THS are as effective as e-cigarettes for helping smokers to not use cigarettes if they are not intending to quit smoking.3
Customer: Thank you – that’s given me something to think about.
Pharmacist: Good luck, but remember that the best choice any smoker can make is to quit cigarettes and nicotine altogether.
This article is funded by Philip Morris Limited.
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