Tobacco harm reduction: the devil is in the deploymentBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8412 (Published 17 December 2012) Cite this as: BMJ 2012;345:e8412
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Hastings et al. summarise well the dilemmas associated with tobacco harm reduction, and rightly conclude that the devil is in the deployment.
The use of Nicotine Replacement Therapy (NRT) by smokers for harm reduction outside of established guidelines may already be widespread (1). Certainly locally we have seen a significant increase in NRT use without a corresponding increase in measured quits.
Therefore better management of harm reduction through NICE guidelines (2) is welcome. But the implementation will be difficult and will need to be monitored carefully. In particular the NHS reforms in England potentially create the additional complication of tobacco control being funded by local authorities but much of the financial saving falling to NHS Clinical Commissioning Groups (through reduced NHS activity). Health and Wellbeing Boards will need to quickly develop the maturity to manage this, and ensure they deliver better outcomes for tobacco control.
1. Levy DE, Thorndike AN, Biener L, Rigotti NA. Use of nicotine replacement therapy to reduce or delay smoking but not to quit: prevalence and association with subsequent cessation efforts. Tob Control 2007;16:6 384-389 doi:10.1136/tc.2007.021485
2. National Institute for Health and Clinical Excellence. Tobacco: harm reduction approaches to smoking, 2012. www.nice.org.uk/nicemedia/live/13018/61198/61198.pdf.
Competing interests: No competing interests