Global forum on Nicotine 2019 was a diverse gathering of 600 delegates⁠—directly impacted people, advocates, scientists, public health experts, clinicians and social workers, and industry representatives, who also attended an accompanying tech convention⁠—from 70 countries on every continent except Antarctica. Delegates at the Global Forum on Nicotine were left in no doubt of the scale of challenges facing tobacco harm reduction (THR).

Despite the potential of safer nicotine delivery to save more human lives than any other harm reduction initiative, the hostility, lies and bad policies⁠—from punitive taxation to severe restrictions to outright bans⁠—being aimed at THR are daunting.

Imagine if all that has been done to reduce HIV incidence was to preach abstinence without other strategies to curb this epidemic by now the total number of people that will be living with HIV would have been quadruple of what we have now. In as much as quitting smoking is what we desire to eliminate preventable deaths from smoking-related illnesses, it is important to disseminate information on safer alternatives that can successfully help smokers quit and improve their health.

Here are some of the take home messages:

1. Nicotine offers improvements in some areas of attention and working memory, but downsides when it comes to stress and mood. The potential risks of pure nicotine are broadly theoretical, with only dependence being well-established. Alternative sources of nicotine help smokers quit, but always attracts opposition. I met with many previous smokers that have successfully quit smoking with alternative sources of nicotine such as snus, ecigarettes, etc and many said they have tried Nicotine Replacement Therapy but not successful with it.

2. One of the conference speakers did a review of 41 studies and he concluded that nicotine genuinely improves fine motor abilities and aspects of attention and memory, showing benefits on six of the nine areas he considered.

3. Long-term effects of nicotine – particularly later in life – suggest that smoking is linked to (although doesn’t necessarily cause) worse cognitive functioning over the long term. There are also downsides of smoking when it comes to stress (smoking doesn’t reduce stress, as many people assume) and mood (with a link to depression, which appears causal because people improve after quitting).

4. Cancer is a strange and awful misconception as regards nicotine use, because nicotine is generally not considered a cause, however there are some effects of nicotine (e.g. promoting cell growth) that could theoretically lead to cancer. Nicotine doesn’t cause cancer and it is not a sole and complete risk factor for cancer. (Supported claim by Cancer Research UK). People smoke for the nicotine but die from the tar. Tar is the combusted particulate matter produced by burning of tobacco in the act of smoking. Tar, but not the nicotine, is toxic and damages the smoker’s lungs over time through various biochemical and mechanical processes. Nicotine and other substances and even the medicinal products are not risk-free. It was reiterated that e-cigarettes are SAFER alternatives to conventional cigarette smoking.

5. Collaboration between healthcare professionals and the vaping industry could help in the fight against smoking. Evidence continues to emerge that shows the effectiveness of vaping (use of ecigarette) for quitting smoking. Claims about “particulates” in vapour are unhelpful and betray an ignorance about everyday sources of airborne particles. I met with some vapers and the general review on their improved state of health when they quit smoking and start vaping is remarkable.

6. Bad science on vaping is ubiquitous, but can be rebutted by attacking the repeated errors rather than every individual claim. There is ample evidence to show that smokeless tobacco has a massive potential for reducing smoking-related harm. Emphases were also laid on wrong/bias methodologies used in some studies.

7. My project mentor, Prof Marewa Glover (she is an expert in smoking cessation in pregnancy), explained that nicotine use in pregnancy isn’t perfectly OK, but encouraging switching to safer nicotine products, when quitting isn’t possible could immediately reduce risks.

8. Attention is shifting towards Africa as the smoking rate is decreasing in the developed countries but increasing in Global South. Harm reduction is rooted in providing adequate information to people who use drugs and the risks associated with them.

9. Tobacco harm reduction messages are targeted at adult smokers and individuals that want to quit smoking. The use of smokeless tobacco products are never targeted towards never-smokers. It has been well documented and claimed that e-cigarettes are 95% safer compared to conventional cigarette – Public Health England.

It is exciting to have been supported with project grant, being a scholar of Knowledge Action Change, to carry out a project to bridge the knowledge and awareness gaps on tobacco harm reduction in Nigeria.

It is time for #Africa to embrace tobacco #harmreduction and let’s create a smoke-free world.