Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here?

Editorial for a thematic series of Harm Reduction Journal which explores the issues surrounding the current state of tobacco harm reduction at global and local levels. Tobacco harm reduction (THR) refers to strategies designed to reduce the health risks associated with tobacco smoking but which may involve the continued use of nicotine. The health consequences of tobacco smoking are well documented; if current trends continue, it has been estimated that globally, a billion lives will be lost to tobacco smoking in the twenty-first century. However, although some countries have embraced the concept, THR has not been, and is not, widely accepted or implemented, with heavy sanctions on reduced risk nicotine-containing products (including e-cigarettes, snus and heat not burn products) in many countries. Mike Russell famously stated ‘smokers smoke for the nicotine, but die from the tar’. Despite the ringing clarity of this message that it is the thousands of toxicants and numerous carcinogens in tobacco smoke that leads to premature death and disease, many years on, the science of ‘cleaner’ nicotine-containing products remains heavily contested. Nicotine’s long association with combustible tobacco continues to mar social political dialect surrounding the use of nicotine products for harm reduction. A correction was issued on 16 July 2018, also available to download.