On May 17, Filter hosted a panel entitled “Tobacco Harm Reduction, Vulnerable Populations & Health Justice” at New York University, attended by students, harm reduction advocates and Filter readers.

Panelists included Dr. Sheila Vakharia, a researcher for the Office of Academic Engagement at the Drug Policy Alliance; Senior Editor Helen Redmond, LCSW of Filter; and Dr. Marewa Glover, the director of New Zealand’s Centre of Research Excellence on Indigenous Sovereignty and Smoking.

The discussion concerned the imperative for approaching nicotine use from a harm reduction perspective—particularly regarding the marginalized communities who smoke the most.

Sheila Vakharia, Helen Redmond and Marewa Glover.

Here are three key takeaways from the event:

1. Panic around the US teen vaping “epidemic” sidelines the pressing issue of harm reduction for marginalized populations.

“We have these narratives of, ‘What about the kids?'” when it comes to vaping, said Vakharia. But she noted that Monitoring the Future, the annual US survey driving teen vaping alarmism, doesn’t account for frequency and other variables that might suggest an “epidemic.” Instead, it merely captures broad indicators, like whether a respondent vaped in the last 30 days.

For Vakharia, the survey’s results have been sensationalized by media to push a tobacco control agenda without attending to the finer nuances of the issue—or even making clear whether there is an issue on anything like the suggested scale.

In part because of the fear of nicotine’s impact on youth, broader social determinants of health that are routinely considered when it comes to controlled substances are dropped from considerations of vaping. “All the drivers of smoking—the racism, the poverty, the marginalization—are taken out of the [tobacco control] discussion,” said Glover. “And we need to put that back in if we are to address the harms of smoking.”

In short, Glover advises that we need to stop and ask why people are smoking in the first place—and then meet them “where they’re at.”

2. Prohibitionist tobacco control is often just another articulation of oppression.

Prohibition is by definition a tool of social control. And in a global society shaped by racism, classism and colonialism, it’s little wonder that tobacco control regimes have become entwined with oppressive social processes.

Vakharia noted, for example, that the turn towards “smoke-free” buildings in the US has a tendency to hit poor communities of color the hardest, by becoming another a driver of criminalization. “If you live in public housing, you aren’t afforded the right to smoking [or vaping], and you risk homelessness,” she said, referencing New York City Housing Authority’s (NYCHA) “smoke-free” policy for common areas—one implementation of a nationwide shift directed by the US Department of Housing and Urban Development. Smoking is prohibited in leases, and can lead to eviction.

Glover expressed that tobacco control directly impinges on indigenous sovereignty, in terms of both cultural practices and bodily autonomy. Additionally, as she previously noted in an interview with the Guardian, tobacco control policies inflict economic damage on indigenous communities. For example, a 2016 hike in New Zealand cigarette taxes disproportionately impacted Māori women, who have the highest smoking rates in the country and now pay out increasingly large sums to the government. For Glover, these inequities are a continuation of the process of colonization.

3. Technology makes tobacco harm reduction a reality—but we need better messaging.

Having once worked in tobacco control, Glover recalled that she, along with the rest of that community, was skeptical that harm reduction for tobacco was even possible—especially when it came to pregnant women. “We didn’t do harm reduction because didn’t believe we could do less damage,” she said. But with the rapid development of vaping products in recent years, she has turned towards harm reduction because she sees that it does drastically reduce risks.

“Smoking cessation— ‘Just stop!’—just doesn’t work,” said Redmond, referencing marginalized populations, such as people with mental health diagnoses, that continue to smoke in large numbers despite traditional cessation messages. “The tobacco control program is very abstinence-based. And that doesn’t work for vulnerable groups.”

However, public health messaging in the US and elsewhere has been virulently anti-vaping; the public is also misinformed about other risk-reduced nicotine products, such as oral snus.

Even the US harm reduction movement, which should be passionately supporting this public health intervention in the face of almost half a million smoking-related deaths in the US each year—a figure that dwarfs the opioid-involved overdose crisis—has sometimes been lukewarm.

“Smoking hasn’t been a part of the harm reduction family,” said Redmond, “and it needs to be.” She pointed out that nicotine, consumed through risk-reduced products, is “a maintenance drug, like methadone or buprenorphine.”

In the UK, a far more receptive environment for vaping, over 3 million people now vape—over 90 percent of whom have either quit smoking entirely or are in the process of switching.

Redmond, who facilitates a New York Harm Reduction Education support group to helps marginalized smokers make the switch to vaping, explained that e-cigarettes are more effective and popular than nicotine gum and patches because they still offer the ritual aspects of smoking, such as the hand-to-mouth motion, that people find soothing. A recent study showed e-cigarettes to be roughly twice as effective as traditional nicotine replacement therapy in helping people to quit tobacco.

Top photo: Helen Redmond

Panel photo: Sessi Kuwabara Blanchard