The Royal College of Physicians said today that the UK was failing to help heavily addicted smokers who find it the most difficult to give up. Speaking at the launch of a new College report 'Harm reduction in Nicotine Addiction: Helping people who can't quit', Professor John Britton, Chair of the RCP Tobacco Advisory Group, called for a new approach in favour of harm reduction and said that there was far more that could be done to save lives:

"Smokers smoke because they are addicted to nicotine, but it isn't nicotine in cigarette smoke that kills: it's the hundreds of other toxic chemicals that come with it. At the moment, most of our efforts on smoking are aimed at preventing people from starting to smoke and helping smokers to quit completely. The best thing that a smoker can do for his or her health is to quit all smoking and nicotine use completely. However, there are millions of smokers who can't quit, or else who are unlikely to quit, and those people need nicotine products that can satisfy their addiction without killing them."

Pure nicotine is not especially harmful, but is powerfully addictive. That addiction is extremely difficult to overcome and as a result, although most smokers want to give up, many find it difficult or impossible to achieve. So, if we could provide the nicotine 'hit' that smokers seek in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved by encouraging smokers to switch to lower risk nicotine products - ideally as a step towards complete quitting or else as a long-term less risky alternative to smoking.

Unfortunately, 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. In contrast, and despite their lethal nature, cigarettes are relatively unregulated - giving them an unfair advantage in the marketplace. The RCP wants to see the entire nicotine market reformed by a new regulatory framework that favours harm reduction, which would include:

- Providing smokers with safer sources of nicotine that are acceptable and effective cigarette substitutes
- Encourage the development of innovative, more effective and user-friendly medicinal nicotine substitutes for cigarettes
- Change nicotine product regulation to make it easier to produce and market medicinal nicotine products
- Create a nicotine regulatory authority to take control of all aspects of regulation of all nicotine products and reverse the advantage cigarettes have in the marketplace

Making safer nicotine products more widely available would also help reduce health inequalities, as people in disadvantaged groups are more likely to smoke, to smoke heavily, and be more addicted to smoking. However, they are less likely to be successful in giving up smoking, so have most to gain from harm reduction strategies and safer alternatives to smoking.
RCP President Professor Ian Gilmore said:

"The Royal College of Physicians has been at the forefront of policy development in the field of smoking ever since our first report drew attention to the health risks of smoking 45 years ago. This radical and stimulating report demands Government faces up to the issue of nicotine addiction by implementing far-reaching reforms to save the lives of millions of smokers."

Royal College of Physicians

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