This is an open reaction to the opinion piece by Ms Helen Stjerna, ‘Time to revise the EU Tobacco Products Directive,’ where she criticized Harm Reduction policies, used to help addicted patients on a daily basis.
As a young idealist I was confronted with the world of drug addiction which ultimately shaped me to help those who can’t stop. Living behind the Iron Curtain, the knowledge available was very limited. After the fall of the communist totalitarianism, we went westward in search for a world free of drugs. This ideal was challenged after I co-founded the largest Czech drugs service provider and served as Czechia’s National Drugs Coordinator. Confrontation with the dramatic figures of tobacco, alcohol and illegal drugs use enlightened my views on the cause and solution to this pandemic.
A world free of addictions is utopia. On the contrary to bring a substantial change we need to prioritize science. Unfortunately, in the middle of political interests and big money, it feels like swimming against the tide.
While the war on drugs, alcohol prohibition trials, prohibition policies on gambling and tobacco keep failing reduce negative consequences on human health, we see the emergence of policies which are based on minimizing the harms, that help people without an unrealistic pressure on societal abstinence.
In the late 80s and early 90s, Dr John Marks and Dr Russel Newcomb started a revolutionary idea of opiate substitution and needle exchange in Liverpool Merseyside. Within a short time, Liverpool saw a sharp decrease in the number of HIV infections compared to its neighbouring city, Manchester. This was endorsed by the Thatcher government as an official policy to fight HIV.
Three decades later we gained a wealth of evidence that Harm Reduction approach is a constructive concept in the addiction policy that should be translated into regulations, laws and government budgets. Yet, while our society evolves and science opens more closed doors to knowledge, abstentionism is still present in the decisions of international bodies, such as the recently published European Beating Cancer Plan by the European Commission that pushes the false ideology of harmful addictive “pleasures” that we must push out forever.
Their approach ignores human psychology and sells a political and non-scientific decision. Our psychology is built on learning from responding to impulses, pleasures as well as unpleasant feelings. The demand for pleasures and excitements is part of our everyday behaviour. It is what makes us humans. While for most people, substance-linked excitement can be managed, for some it turns into uncontrollable problematic behaviour.
If we start looking at addiction behaviour as a mental health issue and focus on minimising harms, we allow humans pleasures through less risky alternatives, we begin to control addictive behaviour. We help those who cannot stop and set those who want to abstain on achievable path.
The example of a bottom-up revolution of a minimising risk-controlled market solution is the emergence of e-cigarettes, snus or the nicotine pouches. Even though many policy makers see it as a betrayal of the idea of a smoking free world, the introduction of a safer product in the nicotine-based industry brings an alternative to smoking cigarettes.
Thanks to the widespread use of snus, Sweden is the only country to have reached the WHO goal of reducing cigarette smoking to less than 20% of the adult population. Similarly, Public Health England (PHE) announced in 2015 that e-cigarettes were 95% less harmful than conventional cigarettes.
Unfortunately, the bottom-up harm reduction efforts that find support from national governments hit the wall on the supranational front. Member states bound by international agreements are forced to keep working with outdated policies. At the UN, the failure to amend the Single Convention on Narcotic Drugs 1961 leaves people dying of HIV/AIDS, hepatitis C, allows stigmatisation, mass imprisonment, and bars access to help for ideological reasons.
In addition, millions die prematurely because our response to the new evidence on tobacco harm reduction is disregarded by the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) that sets the only way forward and does not allow flexibility towards the obvious need to help people who suffer and die unnecessarily.
In the EU, the European Commission fragments the responsibility for substance addiction across different internal services, despite clear integratory trend in the member states. While the EU pays a lot of attention to the tobacco control, there is little done around effective interventions for heavy smokers, including a great denial of new evidence on new alternative ways forward that stakeholders urge the Commission to use.
It would make more sense to follow bottom-up trends and integrate responsibility to monitor addiction across addictive behaviours by the excellently equipped European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) that does so in the case of drugs already. This would provide data to gain a fuller picture and help decision-makers create better policies.
Contemporary research suggests that underage regular smokers and drinkers, are eight times more likely to develop illegal substance addiction. People deeply involved in pathological gambling often suffer from drinking problems and vice versa. There is no logic in separating the tobacco control from the alcohol, other substances and gambling when developing policies to manage addictions that are here to stay. Accepting this is a first step towards saving lives.