When I first heard the words “tobacco harm reduction,” as recently as 2022, I was a little surprised. What is that? I wasn’t turned off. I just had no idea what it consisted of. Was it collecting cigarette butts from places, or passing out those old-fashioned filter tips?
No one in the prisons where I’ve spent the past three decades of my life ever says that chewing is safer than smoking, or that vaping is safer than either. So I was uninformed.
I had never really thought there would be a need for tobacco harm reduction (THR). Like everyone else, I thought the only reduction of harm that could be done here is quitting, and “Quit if you want to live” is not really harm reduction.
That’s the mainstream message: Tobacco kills! Don’t do it! End of story. And at least where I live, there isn’t another story.
I tested HIV positive in 1992. I had not heard the words “harm reduction” then, but I started to pass out clean needles and bleach kits in my circle of peers, and talk about how to not transmit the virus. When I was sent to prison in 1995, everyone already knew me from that work, and I have continued HIV harm reduction ever since.
Why on earth, I wondered, are we talking about “tobacco harm reduction” when we haven’t remotely accomplished regular harm reduction?
But in that light, I admit that some of my first feelings about the concept of THR were less than welcoming. A lot has been done to reduce HIV transmissions and HIV/AIDS-related deaths. Yet, in marginalized populations and many parts of the world, transmission rates stay high and people keep dying.
Why on earth, I wondered, are we talking about “tobacco harm reduction” when we haven’t remotely accomplished regular harm reduction?
This knee-jerk reaction is common. Some North American harm reductionists, working to stem a devastating overdose crisis, might feel similarly. And when I more recently told a few friends that I was going to be a tobacco harm reduction fellow for Filter, some of their responses reflected that. Not disrespectful, but almost dismissive.
But that reaction, which I initially shared, becomes a problem when you consider, as I began to do, the sheer scale of harms THR works to reduce. Close to a half million smoking-related deaths each year in the United States. About 8 million around the world.
Just like deaths from HIV/AIDS or overdose, these deaths are preventable. Quitting nicotine is an option, but for many people, particularly those experiencing high stress and anxiety, it’s undesirable or impossible. That’s where far safer ways of using nicotine come in—and if you’re not in prison, as I’ve come to learn, there are now more of these available than ever before.
I believe that intersectionality can be used to address common misgivings about THR, and to achieve greater success in both THR and harm reduction generally.
As harm reductionists, we have to be able to direct our compassion and our efforts to multiple issues, without feeling that one focus detracts from another—especially when these issues so obviously intersect. People who use banned drugs, for instance, smoke at very high rates. And their deaths are more likely to be related to combustible tobacco than to any other drug use.
I believe that intersectionality can be used to address those common misgivings about THR, and to achieve greater success in both THR and harm reduction generally. There are real, tangible reasons that harm reductionists of all stripes should consider THR a purposeful element of the work they do.
The need to fight misinformation is another example of common interests. How many times have we been told that you can overdose from touching fentanyl? Or that naloxone “enables” drug use? Or that naltrexone should be the priority medication for prisoners with opioid use disorder?
Similarly, misinformation about THR is rampant. It powerfully influences policy, and costs human lives.
Most people don’t know that vapes, and oral or heated tobacco products, are much safer than smoking. I didn’t, either. The common rhetoric is that switching from cigarettes to vapes is the same thing as switching from brand name A to brand name B. These are fundamentally different things and have completely different levels of risk. But everyone keeps parroting the false information that has been provided. They’re denied lifesaving knowledge.
The real human impacts of misinformation are particularly apparent to prisoners. My experience of nearly 30 years in prison shows how both government and prison officials fail to protect us because of misinformation. They enact policies for moral and ideological reasons, not because any data show those policies will work.
In many cases these policies have created more harm. Making vapes and snus available on commissary would improve our safety; tobacco-related harms in prison mean not only lung cancer and other diseases, but the debt and violence fostered by tobacco bans.
Deliberate reframing of data or history to meet a specific narrative is reprehensible. It diminishes the value of the efforts of the people who did the work, and dismisses the facts in favor of a preconceived idea. This is what certain actors are feeding the masses.
Perhaps most of all, the answers I’m seeking concern how we can collectively move toward a more integrated and complete harm reduction approach.
Misinformation is generated, facilitated and fed by stigma. And just like people who use banned drugs, people who smoke have been stigmatized and subjected to decades of “Just say no” campaigns.
There have to be ways of overcoming these phenomena, which impede all areas of harm reduction. It seems to me that seeking to write accurate articles about THR is one of them.
I’m still near the beginning of my journey in tobacco harm reduction, and I don’t have too many answers. But I do have a lot of questions. These concern the science behind THR, and how to communicate it effectively. They concern the roles of Big Tobacco, Big Philanthropy, lawmakers and regulators in creating a situation where—60 years after a landmark surgeon general’s report highlighted the risks of smoking, and decades after THR alternatives emerged—smoking is still our biggest cause of preventable death.
Perhaps most of all, the answers I’m seeking concern how we can collectively move toward a more integrated and complete harm reduction approach. If some of my questions over the course of my fellowship were to inspire new work in this direction, I would consider that the biggest success of all.
Photograph by anokarina via Flickr/Creative Commons 2.0
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