Rethink tobacco harm reduction strategies to curb smoking

IN 2019, the prevalence of smokers in Malaysia stood at 21.3%, translating to 4.9 million Malaysians, according to the Ministry of Health’s (MOH) National Health and Morbidity Survey (NHMS).

The report further estimated that more than 27,200 of Malaysians deaths annually are related to smoking.

In the World Health Organization’s (WHO) global report on trends in prevalence of tobacco use 2000-2025 (third edition) report in 2019, WHO pointed out that Malaysia is projected to fail the global target for reducing tobacco use prevalence by 30% by the year 2025 relative to 2010.

Experts and practitioners working at ground zero of the addiction disease landscape have been raising alarm over the current issues of substance use in adolescents and young adults which has been neglected during this pandemic.

Addiction Medicine Association of Malaysia (AMAM) and the Federation of Private Medical Practitioners’ Association Malaysia (FPMPAM) will jointly move to support access to smoking cessation service with a programme to train general practitioners to help those wishing to quit smoking.

“We are aware that more than 50% of current smokers in Malaysia are keen to quit, and it is our duty as doctors to help them achieve abstinence,” AMAM’s president Dr Steven Chow said at the 11th National Conference on Addiction Medicine (11thNatCAM).

According to the Health Ministry’s (MOH) National Health and Morbidity Survey (NHMS) 2019, the prevalence of smokers in Malaysia stood at 21.3%, translating to 4.9 million Malaysians. The report further estimated that more than 27,200 of Malaysians deaths annually are related to smoking.

Held on May 23, the conference which was organised by AMAM and PFMPAM was attended by more than 80 practitioners and specifically addressed various issues related to drug addiction and its treatment in the era of pandemic.

Dr Chow who is also FPMPAM president further highlighted that the concept of harm reduction is a crucial first step to address this problem.

“By definition, a harm reduction approach to tobacco control encourages those smokers who cannot, or are unwilling to stop smoking, to switch to using nicotine in a less harmful form, and ideally would result in them ultimately quitting nicotine use altogether,” he explained.

He added that people smoke because they are addicted to nicotine and seek a ‘hit’, but it is the other toxins in tobacco smoke that cause most of the harm.

“Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness, from smoked tobacco at the top end of the harm spectrum, to nicotine replacement therapy products at the bottom end,” he pointed out.

There are various nicotine replacement therapy products, but the most widely used and debatable in Malaysia are vape products and to some extent, smokeless tobacco products such as snus.

Key findings in the updated Cochrane Review on electronic cigarettes for smoking cessation which looked at 50 studies from the US, UK, Italy, Australia, New Zealand, Greece, Belgium, Canada, Poland, South Korea, South Africa, Switzerland and Turkey highlighted that smokers were likely to stop smoking for at least six months by switching to vape with nicotine e-liquid as compared to nicotine replacement therapy, nicotine-free vape or behavioural support.

The conference called for more intense public and professional engagement to examine the issue of tobacco harm reduction. With long-term research, tobacco harm reduction can be a pragmatic approach to reducing the harm of smoking related diseases. – May 27, 2021

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