Conjoint Associate Professor at the School of Public Health and Community Medicine, University of New South Wales, Sydney and a long-standing member of the AMA himself , Professor Colin Mendelsohn, points out that curiously the effective harm reduction approach that is being adopted towards substance abuse, is not being applied to the most commonly used addictive substance of all, tobacco.
“As the AMA notes “substance dependence is a chronic brain disease” that involves compulsive or uncontrolled use. For those who are unable to quit, harm minimisation can play a valuable role in reducing the high mortality and morbidity from continuing drug use. Punishing substance users who have lost control of their drug use and are causing no harm to others makes no sense. These patients need help and support.” he said.
“Harm-minimisation strategies are an accepted component of drug treatment and are widely used in the drug and alcohol field. Examples include the use of methadone for heroin users and needle and syringe exchange programs. Different rules for tobacco,” added the professor, whilst pointing out that that where it comes to smoking the AMA has a “quit or die” attitude, as the use of e-cigarettes as safer alternatives is frowned upon.
E-cigs are the closest thing to an ideal alternative to cigarettes
He added that despite not completely harmless, the devices were found to be at least 95% safer than their combustible counterparts, and went on to quote Public Health England (PHE), who has stated, “in the interests of public health it is important to promote the use of e-cigarettes … as widely as possible as a substitute for smoking”. The professor added that the PHE has concluded that taking a harm reduction approach towards smoking, goes a long way in preventing “death and disability from tobacco use, and to hasten our progress to a tobacco-free society”.
AMA should be a leader in promoting harm reduction options for smokers
Mendelsohn said that the AMA’s position statement on substance abuse “supports the introduction of innovative policy models… that might reduce harms and improve outcomes for users and society” and ‘novel treatments”, needs to include e-cigarettes, adding, “The AMA supports decriminalisation of drug possession for personal-use offences. However, its policy does not extend to decriminalising the use of nicotine when used for vaping for tobacco harm reduction. By opposing the use of nicotine in e-cigarettes, the AMA effectively supports the current laws which criminalise a smoker who is trying to switch to a safer alternative.”
The public health expert concluded by pointing out that tobacco harm reduction is actually one of the three pillars of Australia’s Tobacco Strategy, however in practice this is not so, and as a medical organization, the AMA should take a leading role in changing this. “A compassionate approach supporting addicted smokers with harm-reduction treatments such as e-cigarettes, as the AMA recommends for other substance users, could be a first step towards saving the lives of thousands of Australian smokers.”
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