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Tobacco Advisory Group of the Royal College of Physicians. Harm Reduction in Nicotine Addiction: Helping People Who Can't Quit. Royal College of Physicians of London. October 2007.
"This RCP report makes the case for harm reduction strategies to protect smokers. The report demonstrates that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved. The report also argues that the regulatory systems that currently govern nicotine products in most countries, including the UK, actively discourage the development, marketing and promotion of significantly safer nicotine products to smokers."
http://www.rcplondon.ac.uk/pubs/contents/e226ee0c-ccef-4dba-b62f-86f046371dfb.pdf
Accortt, N.A., et al. Chronic Disease Mortality in a Cohort of Smokeless Tobacco Users. American Journal of Epidemiology 2002; 156:730-737
"The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products."
http://aje.oxfordjournals.org/cgi/content/short/156/8/730
Heishman, S.J., et al. Meta-analysis of the acute effects of nicotine and smoking on human performance. Psychopharmacology (Berl), 2010 Apr 24.
"RESULTS: There were sufficient effect size data to conduct meta-analyses on nine performance domains, including motor abilities, alerting and orienting attention, and episodic and working memory. We found significant positive effects of nicotine or smoking on six domains: fine motor, alerting attention-accuracy and response time (RT), orienting attention-RT, short-term episodic memory-accuracy, and working memory-RT (effect size range = 0.16 to 0.44). CONCLUSIONS: The significant effects of nicotine on motor abilities, attention, and memory likely represent true performance enhancement because they are not confounded by withdrawal relief. The beneficial cognitive effects of nicotine have implications for initiation of smoking and maintenance of tobacco dependence."
http://www.ncbi.nlm.nih.gov/pubmed/20414766
Xue, Y. & Domino, E.F., Tobacco/nicotine and endogenous brain opioids. Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 32, Issue 5, 1 July 2008, Pages 1131-1138
"Smoking is a major public health problem with devastating health consequences. Although many cigarette smokers are able to quit, equal numbers of others cannot! Standard medications to assist in smoking cessation, such as nicotine replacement therapies and bupropion, are ineffective in many remaining smokers."
http://www.ncbi.nlm.nih.gov
Sweanor, D., et al., Tobacco harm reduction: How rational public policy could transform a pandemic, International Journal of Drug Policy (2007), doi: 10.1016/j.drugpo.2006.11.013
"Nicotine, at the dosage levels smokers seek, is a relatively innocuous drug commonly delivered by a highly harmful device, cigarette smoke. An intensifying pandemic of disease caused or exacerbated by smoking demands more effective policy responses than the current one: demanding that nicotine users abstain. A pragmatic response to the smoking problem is blocked by moralistic campaigns masquerading as public health, by divisions within the community of opponents to present policy, and by the public-health professions antipathy to any tobacco-control endeavours other than smoking cessation. Yet, numerous alternative systems for nicotine delivery exist, many of them far safer than smoking. A pragmatic, public-health approach to tobacco control would recognize a continuum of risk and encourage nicotine users to move themselves down the risk spectrum by choosing safer alternatives to smoking – without demanding abstinence."
http://www.drugpolicy.org/
Sumner, W., Permissive nicotine regulation as a complement to traditional tobacco control. BMC Public Health. 2005; 5: 18. Published online 2005 February 24. doi: 10.1186/1471-2458-5-18.
"Pharmaceutical grade nicotine is the safest known substance that could replace cigarettes, but inherently addictive products are required to compliment traditional tobacco control policies effectively. The FDA could apply restrictions, similar to those on cigarettes, to an increasingly addictive portfolio of nicotine products, requiring honest portrayals of absolute and relative risks, and expect a significant reduction in cigarette smoking and related illness with modest recruitment of new nicotine addicts at each step. A brief and focused research effort could solidify the already substantial justification for such permissive nicotine regulation."
http://www.ncbi.nlm.nih.gov
Sumner, W., Estimating the health consequences of replacing cigarettes with nicotine inhalers. Tobacco Control 2003;12;124-132
"Prevention of tobacco use is historically difficult in spite of clear health hazards. Regulatory responses to the problem are tenuous and subject to reversal or delay as political and economic fortunes change. A lasting reduction in tobacco related illness might result from unleashing clean alternative nicotine delivery systems to compete directly with tobacco products. Even if used very broadly, clean inhaled nicotine might reduce public health problems as much as a very successful tobacco control programme. Additional research should attempt to quantify the health consequences of using pure nicotine. Meanwhile, clinical and marketing trials of clean nicotine inhalers are defensible in populations with a high burden of smoking related illness."
http://www.bvsde.paho.org
Gartner CE, et al., Assessment of Swedish snus for tobacco harm reduction: an epidemiological modeling study. Lancet. 2007 Jun 16;369(9578):2010-4
"Current smokers who switch to using snus rather than continuing to smoke can realise substantial health gains. Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus."
http://www.ncbi.nlm.nih.gov
Heavner, K., et al., Survey of smokers' reasons for not switching to safer sources of nicotine and their willingness to do so in the future. Harm Reduction Journal 2009, 6:14.
"One of the barriers to smoking cessation via product switching is misinformation about Smokeless Tobacco (ST) and pharmaceutical nicotine products. Most (67%) people in a telephone survey in the US and 59.8% of a sample of nurses mistakenly believed that nicotine is the main cause of tobacco-related cancers. Surveys of smokers and college students in North America found that fewer than 15% realize that ST is less harmful than smoking. In addition, a study found that most (75%) male US military recruits believe that switching from smoking to ST does not reduce tobacco users' risk. Many smokers have similar misconceptions about the health risks from using pharmaceutical nicotine products... If efforts to actively convince smokers that there is no opportunity for harm reduction were to end, we would expect to see the change begin. If the resources that are currently devoted to misleading smokers about harm reduction were instead targeted at informing them that they have satisfying choices that are almost as good for their health as quitting entirely, a very large change could happen quite rapidly."
http://www.harmreductionjournal.com/
Ramström, L.M. & Foulds J. Role of snus in initiation and cessation of tobacco smoking in Sweden. Tobacco Control. 2006 June; 15(3): 210–214. doi: 10.1136/tc.2005.014969.
"Among men who used snus as a single aid, 66% succeeded in quitting completely, as compared with 47% of those using nicotine gum (OR 2.2, 95% CI 1.3 to 3.7) or 32% for those using the nicotine patch (OR 4.2, 95% CI 2.1 to 8.6). Women using snus as an aid were also significantly more likely to quit smoking successfully than those using nicotine patches or gum. Conclusion: Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker and an increased likelihood of stopping smoking."
http://www.ncbi.nlm.nih.gov/
Rodu B & Phillips CV, Switching to smokeless tobacco as a smoking cessation method: evidence from the 2000 National Health Interview Survey. Harm Reduct Journal. 2008 May 23;5:18
"RESULTS: An estimated 359,000 men switched to smokeless tobacco in their most recent quit attempt. This method had the highest proportion of successes among those attempting it (73%), representing 261,000 successful quitters (switchers)."
http://www.harmreductionjournal.com
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