What harm reduction really means

by Carl V Phillips

The best thing I have read about harm reduction in a very long time is this post at The Influence by Shaun Shelly, “The Harm Reduction Movement Needs to Rediscover Its Soul”. The post, the publication, and the author all focus on illicit drug harm reduction, but almost everything in it applies to tobacco harm reduction also. Read it if you fancy yourself a supporter of harm reduction. As I have noted here previously (example), many — I would say a large majority — of those who fancy themselves THR advocates do not really support harm reduction.

I will highlight a few bits. Shelly’s thesis is:

Officially, harm reduction can be described as ‘‘policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption’’ (Harm Reduction International, 2011).

In my opinion, this definition does not capture the true spirit of the original harm reduction movement. Harm reduction is about meeting people where they are at, without judgement, and helping them find them achieve their drug use aims (including abstinence) in the way that causes the least harm to them, irrespective of the current legal and policy framework.

I am not sure I agree that HRI (which had not actually yet changed its name from IHRA in 2011) gets to “officially” define anything. I can say that I have a few serious differences with them (despite being a long-time member the editorial board of Harm Reduction Journal, which is the semi-official journal of HRI, and which endorses a definition of “harm reduction” that basically the same as HRI’s). But from the THR perspective, you do not even need to go on to Shelly’s next paragraph to see the disconnect with the soul of harm reduction.

Almost every time you see the phrase “harm reduction” used in the realm of tobacco today, it is referring exclusively to the substitution of lower-risk products or policies to encourage that substitution. Moreover, this inappropriate narrow usage narrows further still: It is almost exclusively about substituting for cigarettes (e.g., I can think of only a couple of us who have tried to get some traction for extending it to substituting low-risk smoke-free products for the high-risk smoke-free products that are popular in South Asia). Also, due to the odd twists of history, these days the term is almost always used to refer specifically to substituting e-cigarettes for cigarettes, rather than substituting some other low-risk alternative. (Note that I expect that will change soon, with heat-not-burn cigarettes getting a lot of attention.)

This is a remarkably close parallel to Shelly’s lament that illicit drug harm reduction has descended into just being about getting injection opioid users to reduce their risk of catching or transmitting HIV.

But notice that the IHRA/HRI definition — and that of anyone else who really believes in harm reduction — refers to also reducing the “economic” (read: financial) and social costs of drug use. In the case of tobacco use, as with many drugs, the great majority of the financial and social costs come not from the drug use itself, but from government actions. Smoking is expensive because of taxes and restrictions on the free flow of goods. More social harms from smoking are caused by government restrictions than by the act itself. Unlike with illicit drugs, few people are imprisoned or executed over tobacco (though not none), but unavoidable punitive taxes are not necessarily less harmful than rolling the dice on a small chance of getting arrested.

And yet, many people who fancy themselves supporters of tobacco harm reduction actively support most of those caused harms. They actively support punitive taxes on cigarettes, social opprobrium heaped on smokers, prohibitions against publicans being able to offer smoking sections, etc. Indeed, those individuals often celebrate or advocate for the caused harms because they create further incentives for the only aspect of harm reduction they actually support, switching products. It reminds me of the Orwellian themes of about half the anti-smoking propaganda I see these days: “Quit because it is so expensive and forces you to take breaks from hanging with your friends!” Um, yeah, and whose fault is that? It is the same as those messages of “if you smoke weed, you might lose your student financial aid and future employment prospects, so don’t go saying it is not bad for you!” Needless to say, you will never hear a peep of condemnation of this hypocritical “concern” for users’ well-being from the faux supporters of harm reduction.

The bottom line is simple: Anyone who supports punishing smokers does not actually believe in tobacco harm reduction. None of those “but for the greater good we need to…” protests changes this. Causing harm is not harm reduction.

I would also add a clarification to the last words of IHRA’s definition, and rephrase it as “without necessarily reducing the consumption of that drug”. The soul of harm reduction does not say “we support reducing the harm, so long as people stick to using only the specific drugs we approve”, as might be considered to be conceded by the original phrasing. There is little interest in helping those who smoke use their chosen drug with less harm (even setting aside the caused financial and social harms). Indeed, there is active opposition to it. Heat-not-burn cigarettes are, arguably, a method of smoking, in contrast with the use of e-cigarettes or smokeless tobacco, which are alternative drugs that can be substituted. There is a lot of hostility toward the introduction of heat-not-burn products from many e-cigarette cheerleaders and others who pretend to support harm reduction.

I have not even gotten to Shelly’s thesis paragraph, where he points out that HRI’s techy and bureaucratic definition does not capture the soul of harm reduction. Most of the supposed support for THR does not even qualify as supporting harm reduction under the techy definition.

Many grassroots supporters of tobacco product substitution live up to the additional consideration Shelly presents, of meeting smokers where they are. At the grassroots level, where a lot of e-cigarette advocacy lives, people are really very good about this. The vape shop operator or friend who has switched products is usually all about appreciating the current experience of the smoker standing before him. This seems to contrast with Shelly’s point,

People who use drugs have been ignored by those who loudly proclaim they are “leaving no one behind.” (Then again, is it possible to leave behind people who were never recognized as part of the group in the first place?)

On the other hand, the contrast may not be all that great. Much of that meeting of smokers where they are is focused on how to most effectively persuade them to stop doing what they are doing. It is not without judgement (their current choice is usually judged to be something that should be changed). It is only about helping them find them achieve their drug use aims if those aims include quitting their current drug, one way or another. And it certainly does not consider that the current legal and policy framework might be the problem and should be in play.

Moreover, I said that was the grassroots level. At the level of the self-appointed grandees who have come to dominate e-cigarette advocacy (particularly in the UK, which has, perhaps unfortunately, come to dominate e-cigarette advocacy), there is not even that. Yes, there is attention to where people are, with respect to their drug use. But that is not about meeting them there. It is more like the attention devoted to figuring out what motivates vermin that are eating the crops, to determine how best to manipulate them into not doing it. Shelly makes what will be a familiar reference in the context of the e-cigarette wars:

…opioid substitution therapy programs designed in a way that makes them more a form of social control than an aid to those accessing them.

Shelly also notes:

Disturbingly, however, people who use drugs are being marginalized even within the world of harm reduction advocacy.

How many openly dedicated users of high-risk tobacco products are included in any discussions of tobacco harm reduction? The discussions are mostly among those who despise smokers, those who switched from smoking but are humane enough to not despise smokers though they despise smoking (yes, they are people who use drugs, but not the same drug), and only a small handful of nonsmokers who rise above being motivated by despite. When representatives of smokers are offered a token seat in the discussions, they tend to be cigarette industry employees or (my friend) Simon Clark from FOREST. None of them are smokers! I cannot claim any identity politics points here either: I am not a smoker, nor someone who quit smoking via product substitution.

Nevertheless, I have actively tried to build bridges to those who defend their choice to smoke and whose primary interest in tobacco harm reduction is eliminating the government-caused harms. Yes, they too are harm reductionists. They are key harm reductionists. Yet only the best-read of them even realize they are in the harm reduction space because of the aforementioned perversion of that term. Many smokers (mistakenly) think that harm reduction is their enemy because that term has been misappropriated by many who support harming them and merely want to “fix” their behavior by whatever means necessary. Smokers (correctly) think that they are marginalized in the discussion of tobacco harm reduction. They hate harm reduction. Some of them even take time out of their day to make clear they hate me, of all people.

Perhaps it is understandable:

I, too, am guilty of using this platform to sell compromise to policymakers. In pitching to them, I regularly use examples that show how HIV can spread from people who inject drugs into the wider community—drawing the conclusion that in order to protect the wider community, we need to protect drug users.

Not an exact parallel, but I am certainly guilty of trying to help THR “pass” in “respectable” quarters by pitching it as being the best response to the scourge of smoking. I think I probably leaned in this direction the least of any of my colleagues in the field. I would like to think anyone who was really paying attention to me would recognize my true commitment to harm reduction. But I understand that most judgments, especially these days, are made based on a few snippets, not an awareness of someone’s full corpus.

Finally, I particularly like Shelly’s observation,

The fact that US Drug Czar Michael Botticelli can receive a standing ovation at a harm reduction conference tells me that harm reduction has become mainstream and compromised.

There is a hint here that harm reduction has its natural home as an insurgency: mainstreaming results in it being compromised. At a gut level, I kind of feel like that is true, though theoretically it need not be. But the overt message is that someone whose role is mostly about judging, punishing, and preventing is no friend of harm reduction. “Pro-harm-reduction tobacco controller” is an oxymoron.

As I said, go read Shelly’s whole piece; there is more that should ring a bell. In particular, you will also notice those most responsible for destroying the real commitment to harm reduction are the UN/WHO and other powerful funders, a bunch of Western 1%-ers who pretend compassion while really thinking of most of the people in the world as, at best, serfs, and often merely as disease vectors. That also seems rather familiar.

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25 responses to “What harm reduction really means

  1. I was complaining to a close friend about the prohibition of smoking on huge campuses, and at beaches and huge parks that DO have parking lots and other safe places to smoke, and also about including vaping in bans originally passed based on cigarette butt pollution or fire danger. He agreed with me on not including vaping, but very vehemently and angrily disagreed about the smoking bans, saying “True or false: getting rid of smoking would be a good thing?” That’s, of course, a little bit like “Yes or no, have you stopped beating your wife?” But it was very difficult to answer. I started talking about prohibition not working, but he didn’t find that a very satisfying answer. He DID say he was tired of seeing cigarette butts everywhere, to which I answered that ANTZ have long and successfully agitated for the removal of appropriate receptacles — probably realizing this would be the exact effect. OTOH, as someone who still smokes 4/day (having dropped the other 20 by vaping) I still have to figure out what to do with butts, and I would like to see smokers carry mint tins as portable ashtrays, i.e. stop littering. But the person who taught me to stop littering was a loving person who was able to try to get me to change my 1960’s viewpoint of where butts go without nagging me about smoking (well, not very much.) I don’t know where to go with this, I find the disgust factor is insufficiently addressed by smokers, but I also think the ANTZ would try to outlaw carrying mint tins so that the disgust factor would remain as a recruiting tool. And I’m appalled at how many people think the end justifies the means. If banning smokers from using the facilities their taxes paid for, and their tuition paid for, would stop smoking from existing (it won’t!) then it must be good, right? This is NOT a minority opinion! I voted against money to maintain my county parks this June, because I am banned from enjoying them.

    • karryll, Fully and Totally agreed!

      Well, maybe with one slight addition: butts were an almost invisible problem before smokers were kicked out to the gutter. And you’re correct about the receptacles: the argument used against them was that they were “enabling” smokers and “encouraging” smokers. The argument was quite successfully used in a campaign that somehow convinced auto makers to largely do away with car ashtrays back in the 80s and 90s when smoking was still close to its old levels.

      The litter argument has a real basis, but its use is simply an excuse. If 100% of smokers popped 100% of their butts into mint tins, you would see, at most, about a 1% decline in complaints about outdoor smoking: the focus would simply switch to having to “smell the stench” when walking by a smoker, or having the smokers “modeling their behavior to The Children” (Heh, I’ve always found that argument amusing: The Children now get to see groups of happy, tipsy, smokers gathering around to flirt and chat outside of pubs all over the place… BECAUSE of the Antismokers!). Back in 2002 a good friend of mine, Gabrielle LeVecque, faced off on a broadcast program with a Regina from New Jersey who wanted smoking banned just about everywhere. At one point while she was ranting, Regina declared that smoking needed to be banned on beaches because of the “fire danger.” I think we proposed a solution: setting up little emergency fire stations every fifty yards along the beach where there would hang a bucket of water and a bucket of sand to put out the fires…

      – MJM

  2. Many people that say no one will be left behind don’t know how many people there are to start with!People are being left behind,now!

  3. “.. most judgments, especially these days, are made based on a few snippets..”

    ..and that is a sad fact that serves only to act as a catalyst to an increased state of ignorance, bad policies, and (as you have so eloquently stated) unnecessary harm to those who least deserve it.

  4. Roberto Sussman

    I have been a tobacco smoker for over 40 years (a dual user vaper in the last 6 months), so I have been many times in the receiving end of the heavy handed regulation on smoking prevalent (specially) in English speaking countries. It is also bad but not as bad in other countries or in my home country (Mexico). Also, it is depressing to see how those who sponsor and support this oppressive regulation use “science” as justification, even if a lot (if not most) of “tobacco science” is junk. I know this by having read a lot of medical literature and by being myself a professional scientist. For all these reasons I fully agree with your comments, both intellectually and emotionally.

    As you say, there is a basic fault and many inherent contradictions in any THR strategy that indulges on finger waging attitudes to smokers and/or accepts other elements of the Tobacco Control type of the psychological warfare waged against smokers. These contradictions are evident in most Public Health types who still peddle a lot of Tobacco Control dogma (the 400 thousand deaths, severe harm from SHS, etc) and reduce THR to merely “inducing” smokers to switch from evil cigarettes (the harmful product) to smokeless snus-like tobacco or e-cigs (the much much less harmful products). However, this faulty and contradictory form of THR should perhaps be seen as an unstable process that may improve in time. Perhaps, at least some of these Public Health types may evolve into a more consistent and humane form of THR, perhaps they may end up actively challenging the whole rotten building of Tobacco Control dogma. Only time can tell. Given the overwhelming financial power and political clout of the Tobacco Control religion-cult, any crack on its policies and ideology is a welcome (yet clearly insufficient) development.

    Another important (and annoying) fault in the THR approach by many Public Health types is their denial or dismissal of the “pleasure factor” in the replacement products (e-cigs or snus) and also in combustible tobacco smoking. This retrograde attitude is evident in many Public Health types promoting e-cigs merely as smoking cessation aids, with the explicitly desired purpose that the vaping ex-smoker will also quit vaping in due time. The possibility that smoking can be enjoyable, and that smokers may switch to vaping because it is also enjoyable (even if the vaper still smokes), is simply ignored or seen as something to be condemned at all costs (here enters the “gateway” stuff and “the children” arguments). In this important issues this type of THR is as puritanical as extreme Tobacco Control ideologues who peddle the goal of an “abstinence only” end game. A decent THR strategy promoting a tobacco replacement product must reject this puritanism with utter contempt. It must incorporate (first and foremost) the notion that smokers enjoy smoking and if they switch to vaping or snus they will get pleasure from them, and thus may keep doing it all their lives.

    There is yet another basic fault on the current THR debate. It focuses only on three products: the “bad” one, cigarettes, and the two “good” (or at least much much less bad ones), smokeless tobacco and e-cigs. There is total absence of mention or discussion of other forms of smoking or tobacco products, such as cigars, pipes and hookas. As far as I know, there are epidemiological studies showing that smoking cigars and/or pipes is less hazardous than smoking cigarettes (as long as the cigar/pipe smoke is puffed without inhalation). Needless to say, cigar and pipe smoking are very different habits and rituals from cigarette smoking. Cigar and pipe smokers form relatively affluent minority niches of (almost exclusively) men. I’m sure the economical and political factors involved in their regulation are different. Yet, none of this is ever discussed within a THR framework.

    Is replacing cigarette smoking by pipe/cigar smoking without inhaling a valid and/or commendable harm reduction avenue? I did this transition about 25 years ago and did notice a significant improvement in aerobic fitness and overall respiratory condition. In fact, vaping does have a lot in common with pipe smoking: both are based on bulky devices that are not disposable and both involve enjoying flavors and smells.

    • Carl V Phillips

      Changing the way the product is used can matter a lot. I thought about including this in the post, but left it out. It is a big thing for some drugs, but is almost never discussed for tobacco. It is pretty clear that mouth puffing causes less risk than inhaling into the lungs. That seems sufficient to explain the lower risk of pipes and big cigars, though there might be more to it. Cigarettes can also be mouth puffed, of course, presumably providing the same health risk reduction. E-cigarettes too, though it appears that any risks avoided by that are trivial. This is a harm reduction alternative that comes at the cost (for those who enjoy such things) of losing the inhaling experience and fast spike of nicotine uptake.

      I would guess that switching to mouth puffing, even doing it in a way (holding the puff long enough) that delivers as much nicotine etc., would result in less particulate uptake, which seems to cause a lot of the health risks at various places in the body. Obviously it would eliminate direct lung impacts. It probably would be about the same in terms of blood CO saturation, which would still mean a loss of aerobic fitness.

      • natepickering

        Since nicotine absorption in vaping is through the oral mucosa (as opposed to the lung tissue with inhaled tobacco smoke), my understanding is that mouth puffing results in higher nicotine uptake than does inhalation.

        Which, in itself, creates a rhetorical conundrum for the tobacco controller. If vaping is all about unreconstructed nicotine junkies getting their drug fix, how come almost everyone vapes in such a way that makes nicotine delivery less efficient and blood nicotine levels less concentrated?

      • Roberto Sussman

        “Cigarettes can also be mouth puffed, of course, presumably providing the same health risk reduction.” Yes, you can `mouth puff cigarettes’. Because of constraining circumstances and smoking bans I did it for a few years after I started to `mouth puff’ cigars and pipes. Notice that smoking a pipe or a medium/large cigar takes time, it cannot be done in quick “smoking breaks” outside around the corner. However, I stopped to `mouth puff’ cigarettes because it is not enjoyable (you can ask around, practically all cigarette smokers will agree with this). The pleasure from the cigarette is (as you say) getting the “fast spike of nicotine uptake” from deep inhalation, it is not the feeling of a pleasant taste and smell, which is absent in practically all cigarettes (including menthol ones). OTOH, the pleasure from cigar/pipes is precisely the pleasant taste and aroma lingering in your mouth and nose.

        Regarding nicotine intake, as far as I know nicotine from mouth puffed pipe/cigars is absorbed through the mouth tissues, so it is a much slower (and chemically different) process. But this is compensated by the much longer time it takes to smoke a full pipe or large cigar. I guess a similar process occurs in getting the nicotine uptake from e-cigs and snus.

        • Hi Roberto,

          Everything that you have described is exactly what I have been doing with my approach to vaping with e-cigs and dry herb vaporizers.

          Why not try mouth puffing with pipe tobacco in a dry leaf vaporizer (ie., if you’re concerned about being noticed in public, etc…)? That’s how I inevitably (by accident via the Ploom modelTwo) switched over to vaping entirely. As a former ultra-light cigarette smoker who used to inhale, I didn’t get the concept of not inhaling at first, but when I switched my technique (to not inhaling) I was blown away by the flavor (especially with the Ploom, which unfortunately is no longer available in the U.S.) so much that I actually began to enjoy it more than the cigarettes that I used to smoke. As you have noted, flavor plays a large role in making this technique appealing. This approach may not be for everyone (obviously), but I do believe that there are many smokers that would willingly give this approach a chance….if they even knew that such an option existed.

          At the end of the day, as has been noted here, choice is what matters.

        • Carl V Phillips

          Juliette already responded to most of this better than I can, so I will just respond re the biology side: Yes, nicotine from mouth puffing is absorbed directly through the oral mucosa (and a bit from where some of it leaks into the nasal mucosa or is inhaled). This is definitely less efficient than lungs, mostly because of the much smaller surface area and lesser volume of smoke that the nicotine can be scoured out of per puff — as you said, it takes some patience to get through the same amount of burned material that way, especially if you want to hold it long enough to efficiently extract the nicotine. I am not actually sure if, normalized for surface area, oral mucosa is less efficient at absorbing — it is pretty efficient — but the area+volume issue is huge. Snus is, of course, all oral absorption, and peaks much more slowly, with no spike. E-cigarettes have gotten pretty good at producing aerosol that gets into the lungs, but there is definitely still a substantial portion that deposits in the mouth and oral pharynx. I don’t actually know how efficient the absorption is from the deposited droplets compared to smoke in the mouth (efficient, but low-content) or snus (not as efficient, but a lot more content with the solid mass being there for a while). Anyone?

        • Roberto Sussman

          Hi Juliette, thanks for your feedback. As you say, many cigarette smokers are unaware that tobacco smoke can be puffed without inhaling, but switching from one to the other is not of everyone, more so if it involves smoking a different devise (from cigarettes to pipes/cigars) which necessarily requires changing the smoking “technique” (or the “ritual”). My son tried for years to smoke cigars but could not get used to avoid inhaling the smoke and the experience was very unpleasant, so he came back to inhaling cigarettes. He was never able to appreciate the “flavor explosion” that you mention with cigars or pipes. Fortunately, e-cigs afforded him the best of the two worlds: he can inhale deeply the vapor (similar but not identical to the cigarette experience) and AT THE SAME TIME enjoy flavors and smells. He has been already 2 months vaping without smoking cigarettes. It is a matter of personal choice and information, but given the current attitudes to tobacco use a lot of smokers will only get scare mongering advise.

        • Roberto Sussman

          Hi Carl, nicotine absorption through the oral mucosa from cigars (likely also from pipes or hookas) is indeed slower than absorption through the alveoles in the lungs from deeply inhaled cigarette smoke. Also, the cigar smoke is alkaline: has a higher pH than cigarette smoke. The latter is acidic. There are studies on all these issues. When not inhaling, the overall nicotine absorption in 1-3 daily large cigars or full pipes (a common moderate smoking rate) could be less than in smoking a daily pack of cigarettes. I don’t know to what degree cigar/pipe “mouth puffing” produces the same or less degree of nicotine dependence as in cigarettes or the if the craving is more a psychological dependence on the ritual.

  5. I switched from smoking to vaping. My pitch to smokers is money saved not health. I say don’t worry about quitting smoking just start vaping and see what happens. My experience is if you vape you will smoke less and if you never stop vaping eventually you’ll stop smoking because vaping is a superior experience.

    • Carl V Phillips

      Well, some smokers find it a superior experience. Some (apparently most) do not.

      In any case, you bring up another aspect of harm reduction that is not mentioned above (though it generally follows from some of what is above): It includes empowering individuals to make their own choices about what is best for them.

      • natepickering

        Just for a laugh, I decided to see how the Wiki article on e-cigs (which, for those who don’t know, is one of the most notoriously awful/incoherent/unreadable articles on Wiki) defines THR:

        “Tobacco harm reduction (THR) is the replacement of tobacco cigarettes with lower risk products to reduce tobacco related death and disease.”

        This sentence seems a good microcosm of the manner in which people (and not just the militant tobacco controllers who long ago hijacked this particular article) get the entire concept wrong. “Harm” is implicitly defined as only meaning disease and/or death, and it is further implied that “harm” can only be reduced by the total elimination of cigarette consumption.

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  7. Carl, thank you for writing this piece and making your numerous comments and tweets about my article. It was very flattering. Your commentary has also raised issues for me which I hadn’t thought about, and I am also not that familiar with issues around tobacco. So this has been very educational.

    One issue that is indirectly reinforced by your comments is that as we move towards decriminalisation of other drugs, we need to be very cautious of how we implement legalisation and regulation – using current models, as in the tobacco framework, we could end up with a situation where drugs are legal, but the framework is so restrictive or dominated by a few interests that it ends up being as invasive as prohibition.

    Thanks again for your very valuable input.

    • Carl V Phillips

      Shaun,

      I was happy to direct attention your way. Nice work.

      It is an interesting question whether decriminalized drugs will get the full tobacco treatment. Ironically, because they have been criminalized, there was not the long-march campaign to demonize them in the minds of normally open-minded people. A few people hate druggies, and more fear the people and the drugs, but most people are actually humane about it. So on day one of, say, cannabis decriminalization in Colorado, we would have expected (and saw) far less opprobrium than tobacco products face. On the other hand in the USA (don’t know about anywhere else) some of the same pseudo-“public health” zealots are starting to attack cannabis, so it might be in for a similar treatment (demonization, caused-harm via taxes and other restrictions, disinformation campaigns).

      • natepickering

        Anti-cannabis activism, though less ubiquitous and generally far less mean-spirited than anti-tobacco activism, shares most of the latter’s core personality traits, e.g. the reliance on gateway hypotheses, spurious emotional appeals about the supposed danger to “the children,” and trumped up concerns about “normalization.”

        The big difference, rhetorically speaking, is that there’s no equivalent “Big Tobacco” devil totem for anti-cannabis zealots to latch onto. Though from time to time, we do see some of them floating theories about how “Big Tobacco” is poised to dominate the legal cannabis market as soon as one exists (the implication being, of course, that tobacco companies can make any product deadly simply by putting their name on it).

        The really interesting thing is that, even though they toil in practically indistinguishable vineyards, there seems to be so little overlap between anti-cannabis zealots and anti-tobacco zealots. In fact, we see many ANTZ who are outright proponents of legalized cannabis, and don’t seem to recognize any inconsistency or incongruity in that stance.

        • Roberto Sussman

          Here in Mexico the legalization of cannabis is a hot issue. The authorities (including the medical establishment) are pushing for its legalization only “for medical usage”, not as a standard consumer product. It is not clear what are the implications of this in practice, but judging from some interviews and “leaks” from high ranking medics, a lot of us believe that the intention is to sell cannabis only with a medical prescription, only in pharmacies and only in “plain packaging”. Likely, it will be forbidden to smoke (or vape) it in all public spaces, indoor and even outdoor. The rector of the National University (himself a medic) declared it would be forbidden to smoke it in campus, which is ludicrous because thousands of students do it without his permission. So, it seems that the regulation of the “legal to be” cannabis may contain all the known elements of the Tobacco Control model, including the “children” moral panic and the stigmatization of users: if you go to the pharmacy to get your plain packaged marihuana, you are declaring yourself a “sick addict”, and thus probably most current users will prefer to get it extra-legally.

  8. ‘Harm Reduction’ began long ago with the introduction of filter tips. Did that introduction have no effect? And then, as I recall, The Canadian Government cooperated with Big Tobacco to produce a variety of tobacco plant which produced little tar.
    In my experience, as a life-long smokers (started at age 19 and now 77), the amount of gunge which accumulates in cig filters is far less than was the case, say, 20 years ago. But the important thing is what happened before filters became the norm. I smoked unfiltered cigs in the early 1960s.
    Richard Doll was was involved with anti-smoking, especially with German anti-smoking activists, before WW2. That is known fact. It is also known fact that he was financed by the Rockefeller wealth.
    I am not saying that his discoveries were wrong. I am saying that his discoveries were already ancient. The Germans had already worked out that inhaling toxic fumes was dangerous.

    It is what has happened in the recent past which has become dangerous. I mean Prohibition in its various forms. That includes the size of drinks in New York. The prohibition of big drinks there is ‘Prohibition’.

    ===
    There seems to be a desire, in the USA, and especially as is evident regarding ecigs, for ‘perfection’.

    There is no such thing as ‘perfection’.

    It is for politicians to understand that, and to reject ‘perfect’ solutions. Such solutions do not exist.

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