‘Harm reduction, cessation should be part of tobacco control policies’

Islamabad : The Pakistan Alliance for Nicotine and Tobacco Harm Reduction (PANTHR) has called for making harm reduction and cessation part of the national tobacco control policies to reduce the prevalence of smoking in the country.

“Two research studies have highlighted the effective role tobacco harm reduction and cessation strategies can play in achieving the objectives of FCTC and reducing combustible smoking,” said Arshad Ali Syed, Project Director of PANTHR. Smoking cessation is completely missing from the tobacco control efforts in Pakistan, he added.

The study ‘Overcoming Barriers to Disseminate Effective Smoking Cessation Treatments Globally’ has maintained innovation is urgently needed to fill the gaps in smoking cessation products and services, and for converting global policy into local practice.

According to the study, in low- and middle-income countries (LMICs), health care practitioners’ knowledge, attitudes and practice regarding tobacco use and cessation may hold the key to rapidly scaling up cessation support and delivery to achieve FCTC objectives sooner. Under Article 14 of the FCTC, member states have to take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence.

Arshad said, Pakistan currently does not have a national tobacco cessation strategy lacks cessation clinical guidelines, does not include tobacco in at least one national disease-specific treatment the guideline, and tobacco use status of patients is not routinely recorded on medical grounds. As national toll-free quitline is not included on health warnings or mass media campaigns, training in tobacco cessation is not part of the medical degree or training in Pakistan, he added.

The study said innovation in cessation products and services need to build on learnings in nicotine pharmacokinetics, behavioural insights from consumer research and tap into 21st-century tools such as mobile based apps. “National implementation of FCTC’s Article 14 needs to follow guidelines that encourage integration into existing health programmes and health-care practitioners’ (HCPs) upskilling.”

The study considers health care practitioners’ role important in “offering smoking cessation support in existing national health programmes for TB, cancer screening, and maternal and child health.” It also advocates for using technology for smoking cessation. “Widely prevalent smartphone devices may deliver smoking cessation through telemedicine in LMICs sooner, leapfrogging the hurdles of the existing health-care infrastructure.”

Tobacco smoking is endemic with more than 7 million deaths occurring every year amongst the 1.1 billion smokers worldwide, with 80% of tobacco users in the world’s low and middle-income countries, according to WHO. One of the six primary tactics adopted by the WHO to counter the tobacco epidemic is promoting cessation, the subject of its 2019 annual report.

The other study ‘Tobacco Harm Reduction in the 21st Century’ calls for addressing the barriers to tobacco harm reduction if it is to make the maximum impact on the tobacco endemic.

According to the study, tobacco harm reduction seeks to prevent or reduce the damage caused by the toxins generated by tobacco combustion for smokers unable or unwilling to stop, rather than aiming at complete abstinence from nicotine use.

The study says displacing combustible tobacco products with non-combustion products that deliver nicotine with a lower toxic and risk profile is key to tobacco harm reduction and may promote the cessation of cigarette smoking. “In the 21st century, three classes of products can fulfill this role, namely, snus (oral use tobacco), e-cigarettes (vapor products) and heated tobacco products (heat-not-burn),” it maintains.