Harm reduction is about making better choices, not perfect ones

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Dr. Mark Boom, president and CEO of the Houston Methodist hospital system in Texas, suggests in a recent piece in The Hill that proponents of vaping are simply ignoring evidence that vapor products are not 100 percent safe.

Of course, people in the vaping community do not think that e-cigarettes are 100 percent safe. And if these products were found to increase the incidence of teen smoking of combustible cigarettes, we don’t want that either.

However, Boom appears to misunderstand the philosophy of harm reduction. Boom no doubt would encourage his patients who use intravenous drugs to, at the very least, use clean needles, rather than sharing. If he did not, he would be grossly abusing his privileged position as a healthcare authority. Similarly, applying a harm reduction philosophy by encouraging smokers to switch to e-cigarettes could save the vast majority of the 480,000 lives taken by combustible cigarettes every year.

As Boom rightly points out, e-cigarettes do, in fact, contain toxins. These are, however, at a very low concentration in the excipients – the products that make up the aerosol suspension that delivers the active ingredient of nicotine. What he neglects to add is that the excipients in nicotine liquid are strikingly similar to those in asthma inhalers. We certainly wouldn’t suggest to an asthma patient to forgo their medication because they are also inhaling toxins.

As a pharmacologist, I would encourage every person who ingests toxins to stop doing so. Of course I would. But my years in addiction research have made clear that you cannot simply tell someone to not pick up that cigarette, syringe or beer. Until that is possible, we have to encourage people to make better choices – which, unsurprisingly, is very easy to do.

When people do things we don’t approve of, we often write them off as not caring about their own health or personhood. Having worked at community organizations that distribute clean needles to curb transmission of infectious disease, naloxone to reverse overdoses and HIV drugs to prevent new infections, it is clear that people do recognize the risks they take everyday and embrace opportunities to reduce consequences associated with risky behaviors.


Image by Grey Carnation

 

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  • Fr. Jack Kearney

    The Royal College of Physicians believes vaping to be at least 95% safer than smoking. Vaping is an evidence-based tool for smoking cessation, and if Dr. Bloom really wanted to help smokers he would hand out ecigs to his patients, as do addiction counselors like me…..

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