Tackling Tobacco: Experts push for harm reduction strategies for smokers battling addiction

According to the World Health Organisation (WHO), approximately eight million people die each year as a result of tobacco use, with an additional 1.2 million deaths attributed to exposure to second-hand smoke.

Despite these alarming statistics, many smokers continue to find it challenging to quit, as experts highlight the powerful grip nicotine has on addiction.

To address this challenge and support smokers in quitting, various stakeholders from Africa and globally convened in Nairobi this week for the 4th Harm Reduction Exchange.

The event focused on exploring potential solutions to help individuals struggling with tobacco addiction. Central to the discussions was the concept of harm reduction, which aims to minimise the negative health impacts of tobacco use while providing practical alternatives for those seeking to quit smoking.

Prof. Issa Wone, a representative from Senegal, address participants on the future of Africa in harm reduction during the Harm Reduction Exchange 2024 Forum held in Nairobi on November 27, 2024. (Justine Ondieki)

The traditional approach to addressing substance abuse and addiction has often been inflexible and judgemental, with some assuming that those who relapse did not try hard enough.

In many countries, law enforcement adopts a reactive stance by criminalising individuals struggling with addiction. This approach frequently leads to widespread stigma, with many being marginalised not only by society at large but also by their families and loved ones. Instead of offering support or understanding, these individuals are often treated with disdain and exclusion.

However, experts are now advocating for a shift towards the concept of harm reduction in addressing public health issues related to substance use, particularly tobacco use.

Harm reduction approach

Harm reduction involves strategies, policies, and programmes that focus on minimising the harmful health, social, and legal consequences associated with substance use, drug policies, and the enforcement of drug laws. Instead of punishing individuals, harm reduction supports safer practices and provides resources to reduce the risks and negative effects of substance use.

Dr Vivian Manyeki, a public health specialist from Kenyatta National Hospital in Nairobi, emphasised the importance of recognising that not everyone will quit using substances such as tobacco.

"Harm reduction focuses on saving lives rather than condemning individuals. There are many interventions available to support this approach," she explains.

Dr Manyeki stressed the need for practical, context-specific solutions tailored to Africa's unique circumstances, noting that various harm reduction methods can be effective.

"We cannot expect tobacco smokers to quit overnight. That is why we are introducing safer alternatives to smoking. We are committed to educating people, meeting them where they are, and understanding the factors that contribute to their addiction," she said.

Dr Manyeki further explained that the harm reduction journey should focus on supporting individuals without judgement, offering alternatives that help them progress at their own pace.

Professor Issa Wone, Chairperson of the Senegalese Alliance for Non-Communicable Diseases, highlighted the importance of prioritising qualitative data over quantitative data when developing policies on harm reduction.

"We should use qualitative data to design more effective interventions. Harm reduction is an approach that focuses on promoting healthier behaviours rather than punishing individuals, helping them gradually reduce their risks."

Professor Wone also advocated for policies that encourage the abandonment of harmful behaviours rather than penalising people. Acknowledging the many harmful substances found in tobacco, he supported the use of nicotine as a safer, innovative alternative to traditional smoking.

Alternatives for tobacco users

• E-cigarettes/Vaping: Produces vapour instead of smoke, reducing exposure to harmful substances.

• Nicotine Replacement Therapies (NRTs): Includes gums, patches, and inhalers to gradually reduce nicotine dependency.

• Smokeless Tobacco: Products like snus offer nicotine without combustion, though they carry their risks.

• Heated Tobacco Products: Devices like IQOS heat tobacco without combustion, reducing harmful emissions.

• Behavioural Support and Counselling: Programmes help manage the psychological and behavioural aspects of addiction.

• Prescription Medications: Drugs such as varenicline (Champix) help reduce cravings and withdrawal symptoms.

Panelist from different parts of Africa provide insight on harm reduction during the 4th Harm Reduction Exchange in Nairobi. (Justine Ondieki)

Addressing challenges and youth uptake

While harm reduction offers promising alternatives, critics warn of risks such as normalising nicotine use, particularly among young people.

In response, the Kenyan Senate introduced a bill in 2024 to strengthen tobacco control, building on the Tobacco Control Act of 2007.

The new legislation targets emerging products like vapes and nicotine pouches and aims to curb youth tobacco use through stricter advertising regulations, expanded health warnings, and stronger enforcement.

Nicotine remains highly addictive and poses significant health risks, contributing to diseases like cancer and cardiovascular conditions.

Although harm reduction strategies support safer alternatives, experts agree that more research is needed to understand their long-term health impacts fully.