The Controversy of Tobacco Control Policies in India
Due to various health and ethical reasons, the use of psychoactive substances is subject to regulation by society or government. In general, Indian society tends to discourage the use of psychoactive substances for pleasure. Although humans have been using psychoactive substances to alter their mental states since ancient times, they are only allowed to use substances approved by the state or society. This is reflected in the policies and attitudes towards various psychoactive substances.
In 2019, India banned all types of e-cigarettes based on the recommendation of the ICMR committee. The committee consisted of renowned doctors and scientists from various disciplines, but lacked the presence of behavioral scientists and addiction experts. This implies that those with knowledge of tobacco or ENDS addiction were not part of the committee that proposed the ban.
In most studies on tobacco use disorders, it is common to find a lack of participation from psychiatrists and behavioral scientists.
This situation occurs because authorities often do not acknowledge tobacco as a part of the class of psychoactive substances. In the case of other psychoactive substances, such as alcohol or drugs, they are clearly considered addictive substances, but this is not the case with tobacco. Whenever tobacco policy is discussed, the perspectives of addiction experts and behavioral scientists are not given the attention they deserve.
Strategies for managing psychoactive substances can be broadly categorized into supply control (strategies that involve controlling the availability of the substance), demand reduction (strategies that aim to reduce the need for the substance), and harm reduction (strategies that aim to minimize the negative consequences of substance use). Of these, harm reduction is considered the most pragmatic approach since reducing 80% of the harm caused by substance use is better than reducing none of it at all.
The supply-control strategy is the most popular strategy, despite its lack of effectiveness. Most law-abiding individuals believe that "prohibition" means unavailable. Unfortunately, this is not the case. Prohibition actually means that the government is not regulating the substance. The consequences of prohibition are foreseeable - criminals and organized crime control the supply of this substance.
If I buy a bottle of whiskey in Delhi, I can reasonably assume that I am purchasing whiskey. However, this is not the case in the prohibition states of Bihar and Gujarat, where the sale of alcohol is banned.
If someone buys an electronic cigarette in Delhi, they cannot be sure of what substance they are actually getting. The e-liquid used in electronic cigarettes contains high levels of nicotine and various other chemicals. If the government were to regulate them, they could closely monitor the quality of the products people are consuming. Despite the ban, are electronic cigarettes really unavailable in Delhi? Can anyone be held accountable for the ingredients in the e-liquid?
Do people in India use electronic cigarettes? Yes, there are millions of people who do. But if the ban is strictly enforced, they will revert back to smoking traditional cigarettes and other tobacco products.
Any discussion about whether electronic cigarettes should be regulated as harm reduction products should take into account the authorities' actions in relation to combustible tobacco products. When doctors are compelled to sit down and discuss research on harm reduction products, no one pays attention to what happens to people who have been using combustible cigarettes for years.
If we account for inflation, the price of combustible tobacco has remained constant over the past two years. While almost all basic commodities have increased in price, combustible tobacco has remained unchanged.
There are various methods to reduce the risks and harms associated with the use of any substance. Products being used can be altered or simply the environment of consumption can be changed to decrease associated stigma and discrimination. Therefore, various methods can be applied to the use of psychoactive substances including tobacco. One possible method may be encouraging the use of lower risk products.
Drug addiction is a persistent problem, and it is necessary to provide alternatives for those afflicted. In our daily lives, we are familiar with examples of harm reduction, such as using condoms, wearing helmets while riding a bike, and wearing seatbelts while driving. Not drinking and driving is also a widely accepted, promoted, and encouraged behavior. However, when it comes to tobacco, such measures are lacking.
Sweet words of a drug-free or tobacco-free world will not get us anywhere, as people will find ways to obtain nicotine. Whether we like it or not, this is a human demand. Some people simply cannot quit smoking, and we need to have empathy for them. Some rely on tea or coffee to stay alert and energized, and we should stop judging them.
We need to empathize with those who believe they cannot work without nicotine and require it in some form. Both policy makers and medical professionals seem to lack this empathy. It is true that the currently available products for nicotine delivery may not be entirely satisfactory. The products on the market may have some issues, but with a ban, we will be shutting down all potential research and development.
If products that reduce harm are considered possible alternatives, research can still be conducted to achieve improvement. Nicotine can be further regulated and harmful substances such as nitrosamines can be reduced in such products to make them less harmful and relatively safer.
While individuals are sympathetic towards those suffering from cancer or heart diseases, those addicted to tobacco receive no support. This causes them distress and they require help, compassion, and sympathy.
The Indian government has officially recognized harm reduction as a method for dealing with mental drugs. Other countries and regions have also been promoting and encouraging various types of harm reduction methods.
For example, some countries allow "drug consumption rooms" where individuals can use their own drugs within facilities that provide nursing assistance. This ensures that if problems arise, their lives can at least be saved. One might wonder if this is encouraging drug use. However, the focus here is on saving lives rather than making moral judgments about an individual's actions.
Our laws do indeed prohibit certain products that are harmful to health. This is not a moral stance against the use of psychoactive substances, but simply emphasizes the health outcomes. Therefore, policies such as bans unintentionally increase the harm caused by psychoactive substances. The ban on opium products seems to have led to the heroin epidemic in the country. We are currently banning electronic cigarettes, while more harmful combustible cigarettes continue to be widely available. This mistake has inadvertently maximized harm.
Unfortunately, there is still strong resistance to reducing the harm caused by tobacco. In the midst of moral, scientific, and commercial disagreements, we need to sit down and find solutions. Doctors need to work in multiple ways to gather evidence and avoid accusations of conflicts of interest.
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