A former Journalist whose journey towards Tobacco Harm Reduction started after he quit smoking with the help of vaping device. He believes One Size fits all approach in Tobacco harm reduction doesn’t work and we need to expand the bouquet of options available.
From sensitising lawmakers about harm reduction as an effective intervention strategy in tobacco control to seeding and encouraging more research in this field, creating mass awareness among tobacco users and taking the legal recourse when needed, Samrat, through his organization, Council for Harm Reduced Alternatives (CHRA), is spearheading the Tobacco Harm Reduction movement in India. Samrat shared the insights of his journey as a Tobacco Harm Reduction advocate with Buziness Bytes
- How did you get into Tobacco Harm reduction?
Vaping devices helped me in giving up smoking and I noticed a significant improvement in my health too. Going forward, I met more people with similar experiences and realised that for people who are finding it difficult to quit smoking, transitioning to vaping can significantly reduce harm and help in giving up smoking habit. Some of us got together to form an organisation to advocate for tobacco harm reduction. Our initiative is not limited to risk-reduced alternatives for smokers, rather it is also for those who use smokeless tobacco products such as khaini, gutkha etc.
- What is the vision of your organization?
Our aim is to address the crisis caused in India by tobacco which claims 13.5 lakh lives annually resulting into economic loss of over Rs 1 lakh crore. Tobacco usage in India should be seen as an addiction which requires evidenc-based policies to address the crisis rather than being framed purely as a moral issue. Since, the tobacco users require effective and practical support to quit it therefore alternatives should be appreciated instead of appealing them to quit it on the basis of their willpower.
- What initiatives/ Programs have been taken by your organization towards THR?
Since we started in 2016, we have focussed on four key aspects – sensitising lawmakers about harm reduction as an effective intervention strategy in tobacco control to seeding and encouraging more research in this field, creating mass awareness among tobacco users and taking the legal recourse when needed.
We have held numerous public campaigns, press conferences and made representations to various authorities across the country regarding the same. We have strong social media presence wherein we build a platform for smokers to help and consult each other, much like an AA support group, on their journey to quit smoking.
- What initiatives are you planning to undertake?
The ban on e-cigarettes imposed by the government without even understanding the population-level health impact has made our work even more difficult, however, we continue to reach out to parliamentarians with the latest scientific researcha nd empirical data from other countries which are benefiting from THR. A lot of people questioned the logic for allowing the far more deadlier conventional cigarettes and bidis being sold in open while banning the less harmful alternative.
We expect the tide to turn in favour of THR as more people in key positions have started to see the benefits, especially in a country like India where healthcare access it low and hence requires a greater focus on harm prevention.
- What kind of response have you got while undertaking the initiatives?
We have received mixed responses. While most people accept that there is no ambiguity about the harm reduction potential of technology-based nicotine devices, there remains a concern about their uptake among the youth and non-smokers.
However, a blanket ban calls for even more harm as a huge chunk of population is denied access to potentially life-saving options. We have proposed a middle path, which is being followed in many developed countries. We have proposed of coming up with stringent policy measures to address non-intended use while encouraging adult tobacco users to make healthier choice.
The awareness among the public is increasing that it is now possible to quit smoking with the help of a device rather than just waiting for willpower to overtake the urge or by just banking on the gums which don’t work for most of the people.
- Have you ever got into any trouble while implementing any of your activities as you taking head on with the tobacco and pharma lobby? Do you have any specific incident to share?
Since vaping is relatively new, both the tobacco and pharma industries have not been able to figure out how to monetise it, and it threatens to upend the businesses of the both – undercutting the use of cigarettes on one hand, while also making use of nicotine gums as quitting aides less popular. The opposition from both the sides is because of this only and both weild tremendous influence on policymaking too. Also the Indian government has a lion’s share, almost one-third, in the country’s largest cigarette maker, ITC. Though it is difficult to share a specific instance but, without doubt, we feel their pressure and presence in all our activities.
- Do you seek/receive support from the government?
We have, but not publicly. While in private many admit to the benefits of THR but we are yet to see wide public recognition. This is perhaps because policies are set from the top and many are reluctant to speak up.
- Do you think the existing infrastructure for Harm reduction is enough to reduce the death rate?
A lot of work needs to be done on this front. THR needs to be built into our tobacco control programmes, offering help to the users who are finding it difficult to quit through conventional means. Nicotine gums and patches are not affordable to majority of tobacco users in India and there is an urgent need to subsidise them. Further, we need more cessation and support centres, and we need these centres to treat tobacco use as an addiction and not a question of willpower alone, providing a range of additional services, from gums to risk-reduced alternatives, since once-size-fits-all approach doesn’t work and we need to expand the bouquet of options available for quitting.
- What are the major roadblocks for THR in India?
The first major hurdle is the acceptance that THR works. While India has one of the most progressive policies when it comes to opioid and other addiction, the tobacco control space is still reliant on morality-based arguments and does not focus enough on scientific evidence and solutions. Insisting on total abstinence and elimination of tobacco use, while a noble goal, is not the most practical one and at current rate of decline in use, will take nearly a century to achieve, during which time millions will die. It is therefore far more pragmatic to look at well-proven harm reduction methods whereby current users who cannot or won’t quit to atleast reduce harm to themselves and those around them. In the desire to create a perfect world, we should not lose focus on the ore achievable target of creating a better world. This is a well-understood concept in addiction treatment, and it is high time it is adopted for tobacco use which is causing tremendous destruction.
- What suggestions would you like to give to the government?
The first step the government can take is to lift the ban on research in this space. More scientific data will help further our understanding and should thereafter form the basis of tobacco control policies. The recent ban does not include consumption, which means while it is allowed to vape, there is no way to get them. We would suggest creating a mechanism through which adult vapers can access these devices and adult smokers can switch to them to reduce harm. Ultimately it is the responsibility of the government to ensure the country’s 27 crore tobacco users are given adequate support and options.