Adopt harm reduction strategy instead of GEG

KUALA LUMPUR: International and local experts recently came together at the Harm Reduction Conference 2023 advocating for the adoption of harm reduction strategies to reduce smoking prevalence, rather than pursuing an outright prohibition of less harmful alternatives like vape.

They said tobacco harm reduction can play a huge role in helping the country become a "smoke-free country", by reducing the number of smokers to five per cent of the adult population.

They added that this can be made possible if the government embeds the tobacco harm reduction approach in its policies and strategies to reduce smoking rates.

One of the strategies involves the recognition of e-cigarettes or vape as an effective smoking cessation tool and encouraging smokers to quit smoking by switching to vaping.

This is not to be misunderstood with promoting vape, as experts said vaping was not meant for recreational use by non-smokers because its end goal is to help cigarette smokers break free from the habit.

This was discussed during conference themed Empowering through Harm Reduction, which was hosted by the Malaysia Society for Harm Reduction (MSHR) and Unesco.Close to 300 participants attended the conference, locally and virtually.

Speaking during conference, New Zealand's Centre of Research Excellence: Indigenous Sovereignty & Smoking Dr Marewa Glower said tobacco harm reduction was about reducing the number of deaths and diseases caused by smoking.

This, she said was largely preventable because the diseases and deaths were a result of a behaviour that is modifiable.

"Around the world, smoke-free has been defined as five per cent or below smoking prevalence which is New Zealand's current goal. Sweden is close to reaching that goal with 5.6 per cent.

"But, for anyone who's worked in medicine, particularly with dependence-forming drugs, the understanding is that not everyone will be able to stop (smoking).

"This is why we have the five per cent goal which is more pragmatic and realistic rather than aiming for zero smokers," she said.

The harm reduction strategy in Sweden, Marewa said, is called the 'Swedish Experience' which is a concept of switching smokers to 'snus' that has proven its effectiveness as a smoking cessation tool.

Snus is a tobacco product originating from a variant of dry snuff (smokeless tobacco) and is placed between the upper lip and gum for extended periods, as a form of sublabial (under the lip) administration.

"We are now down to eight per cent smoking prevalence and experiencing a rapid reduction since the government passed the vaping regulation and now, people are switching (to vape).

"Japan is another country that has experienced a rapid drop in smoking prevalence when the heated tobacco product was introduced in the market.

"So there is a lot of epidemiological evidence and population level evidence showing that this (tobacco harm reduction) works," Marewa said.

Advanced Centre for Addiction Treatment Advocacy president Dr Arifin Fii hopes the government will take learnings on harm reduction from countries like New Zealand and the United Kingdom, and implement them in Malaysia to reduce the smoking prevalence in this country.

At the same time, he also shared his concern over the effectiveness of the Generational End Game (GEG) policy, which is being currently being reviewed by the Parliamentary Special Select Committee (PSSC).

Arifin said there was no clear indicator of what sort of challenges GEG would bring as it was still relatively new across the world.

"We do not know what challenges we are going to face and Malaysia's readiness to face these challenges must also be considered.

"We don't want a policy being made just to end up being a waste of money. So, it has to be properly thought. I think it will take many years before they decide to proceed with the GEG," he said.

MSHR chairman Professor Dr Sharifa Ezat Wan Puteh said despite vaping being less harmful than conventional cigarettes, it also had its risks.

"The issue I keep stressing about is in Malaysia, is there is no proper regulation. What happens if they unknowingly buy dubious vapes from the so-called illegal or black market?

"The contents may be altered and there might be contaminants. We want users to use 'proper' or legal vapes and then transition to something less harmful.

"We have seen in the news of people concocting their vape mixtures with drugs or cannabis liquid."

She said the government could look into established reports or guidelines which were already made available by other countries, citing examples such as New Zealand, Australia, Japan and the United Kingdom.

Dr Sharifa also said that harm reduction does not only look at the prevalence of people smoking but also the effects of the illnesses brought by smoking.

"For example, if you have heart disease, cardiovascular or respiratory problems and lung cancer, these are all attributed to smoking.

"So if you reduce smoking, by right, the number of diseases will also dwindle. But that will be seen in the long term, meaning that you can only see (the result) in the next five to 10 years from now. it is going to be a long-term objective.

"Ultimately, the result is to see them stop smoking and vaping altogether. But the problem lies when at some point, they could end up being a dual user (someone who smokes and vapes at the same time).

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