A survey of GPs (general practitioners) in the UK and Sweden revealed that some hold the view that one of the greatest health risks from smoking is nicotine. This belief likely influences health advice to smokers when considering whether to recommend the use of alternative nicotine products.

Nicotine is the addictive component of tobacco smoke, but unlike some other constituents of tobacco smoke, it is not carcinogenic and according to the UK Royal College of Physicians, 'medicinal nicotine is a very safe drug.'

Switching to alternative nicotine products such as nicotine gums and electronic cigarettes can, therefore, help many smokers quit smoking or cut down, thereby reducing exposure to tobacco smoke and the associated harm. But the views held by some GPs in both the UK and Sweden may influence their willingness to recommend the use of alternative nicotine products to help smokers quit outright or to cut down to quit. This could have some impact on the successful implementation of the UK National Institute for Health and Care Excellence's guidance on harm reduction approaches to smoking. This guidance advocates broader use of nicotine replacement therapies and clearly differentiates between the risks associated with cigarette smoking and those of using nicotine products. This guidance also proposes that the education and training of practitioners should 'include the principles and practice of tobacco harm reduction.'

The survey, commissioned by British American Tobacco, involved administering an online survey to assess the knowledge, perceptions and attitudes to tobacco and nicotine products of healthcare professionals in the UK and Sweden and to understand what types of advice in relation to the use for alternative nicotine products are being offered to smokers.

'It is our belief that smokers should have available to them products that are satisfying and deliver nicotine in a safer way without the harmful toxicants in cigarette smoke,' said Dr David O'Reilly, Group Scientific Director at British American Tobacco. 'And those responsible for giving advice to smokers on different tobacco and nicotine products must be able to provide accurate and meaningful information on their different risk profiles.'

The study participants (100 UK, 120 Sweden) were asked about the risks associated with tobacco and nicotine products, smoking cessation and tobacco harm reduction approaches, and influential sources of information.

The UK was chosen because its tobacco control policies include progressive tobacco harm reduction approaches. Sweden was included because in this country, a switch from smoking to snus use by Swedish men has resulted in significant reductions in lung cancer mortality as well as that of other smoking-related diseases. Snus is a smokeless tobacco that is placed under the upper lip. Although snus carries substantially fewer health risks than cigarettes, the sale of snus is prohibited in the UK.

The majority of survey respondents (96% UK, 98% Sweden) said that they regularly discussed smoking cessation with their patients, but less than half believe that long-term NRT is preferable to smoking (31% UK, 48% Sweden).

The survey findings show that a substantial proportion of GPs (40%) believe nicotine to be the first or second riskiest component of cigarettes, incorrectly identifying it as more harmful than smoke. Many (44% UK, 56% Sweden) also wrongly believe that nicotine in tobacco products is associated with cancer, while 15% in the UK and 22% in Sweden believe the same for pharmaceutical nicotine.

'Although GPs clearly understand that smoking is more dangerous than NRT use, it is worrying that so many associate nicotine with cancer. It is also unclear whether the perceived risk of nicotine in tobacco and NRT is because of this association with cancer or because of its ability to cause addiction', said lead researcher Dr Sudhanshu Patwardhan, Medical Affairs Manager at British American Tobacco.

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The results of the survey are published in a Harm Reduction special issue of 'Drugs & Alcohol Today', 2013, 13 (issue 2)