Session 2: Nicotine and Public Health Policy Seminars

The post implementation review of the UK’s Tobacco & Regulatory Products Directive - the regulations that transpose the EU Tobacco Products Directive - coincide with the UK leaving the EU and follows the publication Green Paper ambition to make smoked tobacco obsolete. What opportunities arise as these three events collide. Martin will no doubt offer more questions than answers

Similar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. Ideally, a justification for an intervention on snus flavours should demonstrate that this would in fact be appropriate for the protection of public health, and that it is reasonable to expect that the benefits will outweigh the harms. We compared use of flavoured snus among snus users with different smoking status. The overall probability of using flavoured snus was .45 (95 % CI: .44–.46), highest among daily (.51, 95 % CI: .47–.54) and former daily smokers (.50, 95 % CI: .48–.52), and lowest among never smokers (.41, 95 % CI: .39–.43). Regulation that would ban or limit flavoured snus use may affect smokers – an at risk population - more than never smokers. These results will be discussed within a public health framework to consider potential costs and benefits from flavour restrictions on snus. We conclude that the health authorities should be mindful of the real-world complexity governing potential harms and benefits of flavour restrictions on non-combustible nicotine products.

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Nicotine is a cultural drug like caffeine and alcohol but nowadays much contested.  In certain places it looks like cannabis is filling its void.  Data on its harmfulness on the population level will be presented. Nicotine’s dependence potential is related to its administration form.  Roughly the dependence potential is associated with amount of behaviour that goes with administration of nicotine.  As much as there is a continuum of harm from nicotine containing products there is also a continuum of dependence.  In the low end of the of the continuum we have nicotine patches and in the high end traditional cigarettes.  Comparisons of dependence across some nicotine containing products and to caffeine will be presented

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This presentation will describe: 1) the need to “devaluing” combusted products to expedite quitting smoking or if needed, facilitate the uptake of less harmful nicotine-containing products (e.g., electronic cigarettes; 2) the importance of regulating less harmful nicotine products, and 3) the need to develop more effective nicotine replacement therapies.   The presentation will be framed in the context of the continuum of risk of nicotine-containing products.  To date, too little attention has been paid to how to alter the most deadly and addictive tobacco product, cigarettes, to reduce their use. Devaluing the combusted products could include reducing their appeal (e.g., eliminating characterizing flavors, sugars) and/or addictiveness (e.g., reducing nicotine in cigarettes).   This approach would facilitate the shift towards harm reduction products among smoker unwilling or unable to quit nicotine.  However, attention needs to be paid to the concerns associated with harm reduction products, particularly e-cigarettes.  These concerns include addicting youth to nicotine, serving as a gateway to combusted products and dissuading smokers from quitting nicotine products altogether.  Potential ways to allay these concerns surround e-cigarettes involve establishing product standards, reducing access and promotion to youth and more proactively discussing and providing treatments for the cessation of all nicotine containing products.  Finding more effective treatments for smoking and for cessation of e-cigarette use is clearly needed to shift smokers down to the products with the lowest risk and optimally to nicotine abstinence.

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