Nicotine without smoke Tobacco harm reduction: a report by the Tobacco advisory Group of the Royal College of Physicians

The Royal College of Physicians (RCP) report from 2016, titled "Nicotine without smoke: Tobacco harm reduction," discusses the integration of harm reduction strategies into NhS (National health Service) care pathways. The RCP's 2007 report on nicotine addiction and smoking cessation is referenced as the foundation for this approach, which has also been endorsed by Public health England and various health-related organizations.

The document focuses on the distinction between nicotine, which is addictive but not the primary cause of tobacco-related harm, and other harmful tobacco constituents. The safety of Nicotine Replacement Therapy (NRT) demonstrates that delivering nicotine without other tobacco components results in significantly reduced harm. Long-term nicotine use from NRT is uncommon and poses negligible harm compared to tobacco use. however, nicotine-containing products, such as NRT, are less satisfying to smokers and have modest efficacy in smoking cessation due to their less favorable nicotine delivery characteristics. The Royal College of Physicians has drawn several preliminary conclusions regarding tobacco control policy implementation:

1. The UK has made significant strides in tobacco control, but there is a need to learn from historical experiences with reduced-risk products, as similarities are emerging.
2. The recent developments in the tobacco industry, such as marketing campaigns and stated strategic priorities, suggest a shift towards new products, but it is not clear if this constitutes a fixed strategic direction.
3. The new generation of e-cigarettes can deliver nicotine levels similar to tobacco smoking, and as the technology improves, pulmonary absorption of e-cigarette vapor is likely to increase.
4. The impact of mass media campaigns on quitting behavior has been demonstrated, and their suspension in England has had a negative effect.
5. Tobacco control television advertising in England has been effective in changing tobacco use.

These conclusions seem to support the idea that the tobacco industry is shifting its strategies, and new reduced-risk products like e-cigarettes have potential. however, traditional tobacco control measures like mass media campaigns and television advertising have proven effective and should not be neglected.

Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016.