The edition for 5 January, 2013, included a three-page article about the concept of harm reduction in addiction to tobacco. If the argument is sound for heroin, why should it not be sound for tobacco? There are, after all, certain people who, come what may, will not give up their habit. It is true that, for the moment, smokers do not commit many crimes in pursuit of their poison but, if the argument about the connection between addiction to heroin and crime were correct (which, actually, I believe that it is not) – if, I say, it were true, then the time could come, if the price of cigarettes were increased much further in an attempt to reduce consumption, when smokers, who generally come, as do heroin addicts, from the lower economic reaches of society, would feel obliged to commit crimes in order to ‘feed their habit.’ No doubt criminal gangs would move into the trade in contraband tobacco. And, of course, second-hand smoke is the tobacco equivalent of the blood-borne viruses of heroin addiction.  

Now it so happens that substitute devices for delivering nicotine – the drug to which smokers are addicted – have been developed both by tobacco and pharmaceutical companies. They assist inveterate smokers to avoid the more harmful contents of tobacco smoke. Whatever the hazards of nicotine might be, they are much less when separated from the other contents of tobacco smoke. Hence the arguments for harm reduction for tobacco are very similar to those for harm reduction for heroin addiction.  

What, then, does the BMJ, so much in favour of harm reduction for heroin addicts, say about harm reduction for smokers? 

A broad perspective suggests potential problems [from a public health perspective].

Firstly, the new nicotine containing products are not intuitively appealing; smokers will need to be persuaded of their benefits. For public health there is a key benefit: it is easier to use them than to   quit. Here I interject that the same is true of the methadone or other substitute for heroin. But for most smokers quitting is the best option and should be presented as achievable and attractive.