Exploring the Potential of THR Integration in Harm Reduction

Image source: Filter. The following article is written by Kevin Garcia, a harm reduction researcher at Filter.

The 13th National Injury Reduction Conference took place in mid-October in San Juan, Puerto Rico. Approximately 2,800 injury reduction experts from the United States and other countries attended the conference, which focused on topics such as preventing opioid abuse, drug testing, racial justice, and sex work.

I also joined a group focused on harm reduction in tobacco. Given the occasional differences between tobacco harm reduction and other forms of harm reduction work, it is crucial to have ongoing dialogue on how to keep them aligned. Including this issue in the group's discussions is significant.

Therefore, I took this opportunity to ask some of the attendees about their thoughts. Their answers reflected some obstacles to better understanding, their personal experiences with THR, and some truly encouraging interest in incorporating THR into their work.

Electronic cigarettes? Those things are too scary for you.

Unfortunately, after non-profit organizations and public health agencies in the United States launched a relentless campaign of misinformation about the use of e-cigarettes, some misunderstandings have persisted – even among those who are trying to reduce harm. "E-cigarettes? Those things are just too scary for you," said one anonymous participant who was smoking. Evidence shows that while using e-cigarettes is not completely risk-free, it is much less harmful than traditional cigarettes. For example, the Royal College of Physicians in the UK notes that the long-term harm from e-cigarettes is unlikely to exceed 5% of the harm caused by smoking. Other harm-reducing alternatives, such as oral snus and "heat not burn" tobacco products, are also available. Nathan Smiddy, a harm reduction educator with A New Path in California, is uncertain about some health issues despite using e-cigarettes himself. "I don't know if popcorn lung is a real thing. I've never researched it. To me, using e-cigarettes costs less than smoking and feels better." Smiddy's primary motivation for switching was economic, which is an inspiring fact for debates about e-cigarette and cigarette taxes. "To be honest, cigarettes are very expensive. I don't think I can afford them now. So I bought an e-cigarette and stuck with it. I started smoking/using e-cigarettes at 15 and I'm 30 now. I feel it's safer, but I have no evidence to prove it. My overall health and quality of life have simply improved from the switch. And I don't wake up coughing up phlegm." Harm reducers often speak candidly about their lack of knowledge about THR, which is a good starting point for discussion.

I have many customers who have switched to using e-cigarettes instead of smoking traditional cigarettes.

I don't fully understand its scientific validity, but I will speak candidly," said Gillian Garton, who serves as a medical case manager for the Red Project in Grand Rapids, Michigan, and emphasized that she is speaking only on her own behalf. "I do know that some people use vaping to reduce their cigarette consumption, or switch entirely to vaping because I know there have been some changes in health. I have many clients who have switched to vaping instead of smoking cigarettes.

In fact, she did the same. "I used to smoke a lot before, starting at around 15 years old. I have been trying to quit smoking for a long time, so I switched to using e-cigarettes mainly for my own health.

Garton acknowledges the recent trend of banning electronic cigarettes and the potential harmful consequences that may arise. "I am aware that there have been many legislative attempts to ban electronic cigarettes," she said. She pointed out that people's reaction may be: "I do not have the opportunity to use this type of electronic cigarette, so perhaps I have to buy tobacco, but I still crave an electronic cigarette.

When it comes to the ban, I didn't see a positive side, only a negative side," said Presto Crespo, a resident of the Bronx. "People will just go back to smoking. Or they'll make their own stuff; sometimes it might be safe, sometimes it might be harmful to the body.

During our group discussion, we debunked myths and discussed the necessity of integrating THR in a wider field. Following this, some attendees stated that they are now giving more consideration to these matters.

I hadn't given much thought to the issue before our group discussion," said Crespo. "I believe I may have succumbed to some misinformation about e-cigarettes, but as a general skeptic, I always thought that something seemed off and couldn't be entirely true. However, I do agree that it's the way big tobacco companies are getting the new generation addicted to their products," they continued. However, their perspective was challenged after seeing their roommate transition from smoking to using e-cigarettes. "It was helpful to see that he felt like he had better lung capacity and was no longer constantly coughing and spitting.

Despite this, when it comes to evidence, "I don't know if there is a reduction in harm when transitioning from cigarettes to e-cigarettes," Crespo said. "E-cigarettes are everywhere. But some people still believe that e-cigarettes can explode.

I know someone who cannot take any other medication because they are taking methadone, so cigarettes are their only option. When I suggested trying e-cigarettes to this person, they refused, fearing that they would explode in their face. This person is clearly misinformed and continues to consume these packaged cigarettes.

After this conversation, I gained a better understanding of why this falls completely under the category of reducing harm.

I do not regularly use drugs or smoke," said Dan Coello, the project director of NEXT Distro, a company that provides harm reduction supplies such as naloxone and syringes through online purchases and mail delivery. "Before attending the group discussion, my knowledge of harm reduction was almost nonexistent...I believed that many of the risks we dealt with in the harm reduction movement were simply a matter of overuse or overconsumption. After the lecture, I came to understand that this falls completely within the realm of harm reduction.

What are the prospects of including tobacco harm reduction (THR) as a means of minimizing the harm caused by drug addiction for those who are prohibited from using drugs? After all, in the US alone, smoking is responsible for almost 500,000 deaths each year – more than any other substance – and a high proportion of illegal drug users also smoke.

Yes, people haven't really noticed this, what I mean is that humans tend to focus very strictly on immediate benefits and risks, and we're not very good at long-term thinking. Therefore, I believe that theoretical ideas like, for example, a large number of people dying from lung cancer in the future, don't feel as immediate as the direct risk of overdosing on medication.

Garton agrees with this viewpoint: "What I want to say is that tobacco is not a top priority in the harm reduction movement. Additionally, the shame associated with smoking tobacco is not as great as the shame associated with using other substances. Focusing attention on issues with higher levels of stigma is out of touch. This is not to say that I believe harm reduction advocates do not care about THR, but rather that we have a bigger stigmatization problem when it comes to other substances.

I believe that THR needs to be taken more seriously within the human resources community," said Crespo. "We are very concerned about cases of overwork, where people become ill quickly. We are working hard to prevent these situations, but we also need to focus on the long-term well-being of our employees. I don't think this is being discussed enough.

Communicating with tobacco users is currently something we can pursue.

I don't think the actions being called for within the community have been fully realized yet, such as understanding what exactly we can do," Coello said. "One thing we can start with is connecting two different worlds, such as those who are passionate about reducing tobacco harm and those who advocate for harm reduction in general. Therefore, first and foremost, there needs to be solid communication and friendship. Then, although the legal status of drugs may differ, the overall values of harm reduction should be consistent. Everyone needs to have a shared understanding of what it is and what can be done to reduce harm.

We already know and understand how to communicate with people who use electronic cigarettes, and we can draw on that experience to communicate with people who use tobacco," he continued. "I am confident that many of our participants smoke or use e-cigarettes; we can leverage our ability to reach these individuals and offer safer alternatives to smoking or combustion-based tobacco use or methods of nicotine delivery.

Personally, I want to learn more and better understand THR, as well as how NEXT can specifically initiate such things," summarized Coello. "I am not sure if we have reached a stage where meaningful changes can be made, but I hope that NEXT can play a role in the future.

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