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s2smodern

Harry Shapiro Director DrugWise

There has been much hum on the wires about the FDA seeming to put reduced nicotine cigarettes (or Very Low Nicotine Content -  VLNC) front and centre of its revised tobacco control strategy. Invariably there are arguments for and against. So here is my brief take on the debate.

VLNC advocates argue that a VLNC will stimulate quitting because the cigarette will not be delivering its essential ingredient – nicotine. There is a hope too that if young people take up VLNC cigarettes, they are less likely to become lifetime smokers again because the product will not be satisfying. And VLNC may be a pathway to quitting perhaps in the same way that moving heroin users onto methadone and then gradually reducing the dose of methadone does help some people become free of drug use altogether.

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s2smodern

Harry Shapiro Director DrugWise

Tobacco harm reduction is on a roll right now – and I don’t mean a roll-up. Let me count the ways.

The big one of course is the announcement by Scott Gottlieb on the FDA’s revised approach to THR. Here is the full FDA news release

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm568923.htm

The FDA has shifted to a more neutral position on e-cigarettes and similar products through a recognition of the role that THR plays in reducing the harms of using nicotine via cigarettes. It is saying that adults who want or need nicotine can get it from much lower risk products; that there will be rules and standards for e-cigarettes; that the Center for Tobacco Products will reconsider aspects of deeming of reduced risk products while pushing back the compliance period for e-cigarettes from 2018 to 2022.

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s2smodern

Harry Shapiro Director DrugWise

Since attending the 2016 GFN Conference in Warsaw, I have heard all sorts of dark tales about the Framework Convention on Tobacco Control (FCTC), the Framework Convention Alliance (FCA) and the Conference of the Parties (COP). The FCTC adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003 came into force in 2005 and seeks "to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke”. The FCA is an international civil society consortium of around 500 organisations, mainly NGOs who act to support the maintenance and development of the FCTC. The COP is an annual gathering of FCTC signatories, the FCA and other observers.

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s2smodern

Harry Shapiro Director DrugWise

This week some further reflections on the links between drug and tobacco harm reduction.

There are many interventions from a public health or health and safety perspective that could be called harm reduction – seat belts, crash helmets, speed limits, safer drinking levels, smoking bans. But as Ethan Nadelmann was at pains to point out at the GFN conference, harm reduction is not just another name for public health or health and safety. It sits at the intersection between public health on the one hand – and human rights and civil liberties on the other.

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s2smodern

Harry Shapiro Director DrugWise

GFN 2017 – report of the rapporteur Harry Shapiro

Being a conference rapporteur is not like taking minutes; it is more impressionistic, trying to pick up threads and themes, getting a feel for the event - and of course, listening in to private conversations. 

It would be hard not to start with Ethan Nadelmann’s impassioned Michael Russell Oration. I’m not going to try and summarise what he said, because you can visit the GFN site to view all the marvellous videos shot and edited by one of the unsung heroes of GFN conferences, Jon Derricott.

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s2smodern

Harry Shapiro Director DrugWise

A meta-analysis published in the Journal of the American Medical Association received widespread publicity as it purported to demonstrate an ‘association’ between teen vaping and later smoking. http://jamanetwork.com/journals/jamapediatrics/fullarticle/2634377

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s2smodern

Harry Shapiro Director DrugWise

For those of you fortunate enough to be there, I hope you enjoyed the Warsaw GFN conference as much as I did. There was a very rich and diverse mix of science, technology, law, public policy, health and advocacy. Something for everyone in an excellent venue where all the logistics ran with quiet efficiency.

My contribution as conference rapporteur will be published later, but here are just a few headline thoughts.

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s2smodern

Harry Shapiro Director DrugWise

Well, not quite ‘in the News’ more my news – or rather vignettes from an ordinary life that have wider implications.
I was sitting outside a café with my wife and the guy on the next table was ‘enthusiastically’ vaping. ‘I hope that’s not toxic’ said my wife as the vapour wafted our way.’ So I put her right on that one and then she said ‘Mind you, it smells quite nice’.

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s2smodern

Harry Shapiro Director DrugWise

As I’m writing this, more news is emerging about the terrorist attack in London Bridge, an area I know well having worked round there for many years, often shopped in Borough Market and frequented the cafes and restaurants in the area. So my mood is not what you would call bright, but even so I thought I’d start this week’s missive with an amusing slot about the vagaries (or should that be vaparies?) of Australia’s e-cig laws.

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s2smodern

Harry Shapiro Director DrugWise

My attention was caught this week by a series of exchanges focussing on whether nicotine was less addictive when delivered via an e-cigarette than a cigarette or whether you were simply swapping one equally harmful addiction for another. The conversation was sparked by Professor Linda Baud seeking materials to use in addressing barriers among smokers to switching away from cigarettes.

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s2smodern

Harry Shapiro Director DrugWise

Now that he has been confirmed as the new FDA Commissioner, the heat is on Scott Gottlieb to torch the FDA deeming regulations that themselves threaten to set a match to America's vaping industry. (OK enough of the inflammatory metaphors). As a consequence of the new appointment, the industry has won a significant reprieve in the administration's decision to delay implementing the new FDA regime.