About 1.1 billion people worldwide smoke. Half will die prematurely, unless they stop. But political and public health efforts to control cigarettes have been "grossly inadequate," according to epidemiologist John Britton. Writing in The Lancet, the University of Nottingham professor observes that while nicotine is the addictive component in cigarettes, it is the other toxins in smoked tobacco that kill.
So, he argues, if smokers cannot quit, safer nicotine products must be made available as alternatives. He says current medicinal options are expensive, tightly regulated and woefully inadequate. "At the moment we have nicotine products on the market, but they are all pretty poor by comparison with smoking as a source of rapid high dose nicotine." He observes, "I have yet to meet anyone who says, 'That was fantastic, felt just like a cigarette.'"
Britton proposes giving smokers more potent nicotine substitutes for tobacco, in much the same way heroin addicts trying to quit get methadone. "We could end up with just as many people addicted to nicotine in society as we have at the moment, but that nicotine addiction is not going to cause any serious harm to the great majority of them."
'Snus,' an oral smokeless tobacco banned by the European Union, is widely used in Sweden to help people quit smoking with considerable success. And, Britton notes, "there is very good evidence there that the availability of an alternative nicotine source has been instrumental in getting their smoking prevalence down to easily the lowest in Europe and I suspect the lowest in the world."
Britton calls for countries to enact policies that acknowledge the relative health advantages of smokeless tobacco, and make it more widely available as part of a public health campaign.