Dual use, double standard
Tobacco harm reduction opponents have myriad rationales for withholding from smokers vital information about safer products. One common objection is that smokers will become dual users (of both cigarettes and smoke-free substitutes), and never achieve abstinence.
While scientific evidence rebuts such dual use allegations, tobacco opponents are not dissuaded. They further claim that safer tobacco products simply aren’t necessary, given the availability of nicotine medicines; those, however, work for only 7% of smokers (see here and here).
Interestingly, nicotine medicines are used concurrently by a small percentage of smokers. A 2003 study reported that 10% of smokers in the GlaxoSmithKline “Committed Quitters” program were dual users at 12 weeks after enrollment, and 2% were dual users at 24 weeks.
There are several differences between smoke-free tobacco products (like snus and e-cigarettes) and over-the-counter pharmaceutical nicotine products:
- Smoke-free tobacco is affordable; pharmaceutical nicotine is expensive
- Smoke-free tobacco is perceived as recreational; pharmaceutical nicotine is seen as medicine
- Smoke-free tobacco delivers nicotine/tobacco satisfaction; pharmaceutical nicotine does not
Smoke-free tobacco and pharmaceutical nicotine are identical in one respect: They are both candidates for dual use with cigarettes. Criticizing the former while giving a pass to the latter is an unacceptable double standard.