Confidence in nicotine for tobacco harm reduction—Bridging the policy–practice gap

Decades of research show that constituents other than nicotine are the harmful agents in tobacco products. This knowledge is incorporated into the nicotine regulatory policies of countries leading in tobacco control, such as the UK and New Zealand. Alternative nicotine products, such as nicotine replacement therapy and e-cigarettes, are now endorsed in the UK by a number of healthcare bodies in a tobacco harm reduction approach that encourages tobacco users to completely switch to a less risky nicotine-containing product. The potential role of 'clean' nicotine alternatives to reduce the harms from tobacco is, however, not being translated into practice. Many healthcare practitioners still bundle tobacco, cigarettes, smoking, cancer and nicotine into one, thus preventing them from supporting their patients to make informed choices on safer nicotine alternatives. This misperception among healthcare professionals, in turn, is a hurdle to effective tobacco control policymaking in many low- and middle-income countries and effective cessation support everywhere in the world. Nicotine confidence based on nicotine literacy among the key decision-makers should start with reforming medical curricula and myth-busting in the lay media to include factual statements about nicotine and public health policy discussions on the principles of harm reduction.