Perspectives from GFN24 – Day 1

Opening comments from the Keynote speech, Professor Dr Andrzej Fal, head of the Department of Allergy, Lung Diseases and Internal Diseases at the National Institute of Medicine in Warsaw, told the audience: “I do not remember in the history of homo sapiens, any culture that wasn’t smoking things and drinking [alcohol]. I’m not quite sure that we can stop doing that, so that’s why harm reduction are the words that will go with us forever.”

“The direct costs of smoking include healthcare spending. But there are also the indirect costs such as those people who drop out of the workforce because they get sick as a result of smoking and can no longer work.”

Dr Fal advocated for the use of fiscal tools to help people move away from smoking, including making prices higher for tobacco and lower for safer alternatives like vapes.

“We do not question harm reduction in hard drugs. So why should we question harm reduction here? But we also need to find tools that ensure that this is harm reduction, and not harm spreading,” he concluded.

In the following workshop, Uladzimir Pikirenia, a Belarus-based psychiatrist specialising in public health told attendees about the need for harm reduction due to smoking’s impact on those experiencing mental health issues.

“It seems that we punish those who smoke. And I would say that’s a global problem. People with schizophrenia live around 15 years less than the overall population. The main reason for this is diseases brought on by smoking,” Uladzimir said.

“On average, 70 - 90% of people with schizophrenia smoke, similar if slightly lower rates among people with bipolar disorder, and similar again for people with depression.

“If we talk about cancer risks for people who consume drugs, it's a depressing topic - because most do not live long enough. They die from other diseases - injecting damages their circulation system and increases their stroke risk, with smoking then increasing this sevenfold.”

This isn’t a new theme, Dr Sharon Cox has been studying how vaping can help disadvantages groups for a number of years in the United Kingdom. 

Alla Bessanova, a coordinator of the Expert Feminist Council of Eurasian Network of People Who Use Drugs, continued the theme of harm reduction for the disadvantaged, saying: “Kyrgyzstan used to lead the way in harm reduction within Central Asia - needle exchange was launched in 1999, and substitution therapy in 2002 - but that’s sadly no longer the case. Harm reduction isn’t just needle exchange and prescribing; there should be rehabilitation centres, which we don’t have since 2019, for example.”

Alla told us about how the economy is impacting on tobacco harm reduction approaches: “With tobacco harm reduction in Kyrgyzstan, I think it is going to be difficult. One third of the population is below the poverty line. If people are worrying about how to feed their children, how can you persuade them to take care of their health?

“Realistically, it will depend on civil society to tell people about harm reduction for tobacco. From the government’s point of view, it’s a product that brings in revenue from excise tax. Politicians have been saying some questionable things about vapes recently - for example, this week, one member of the government argued for a huge fine for vaping in public places.”

Gintautas-Yuozas Kentra, a media professional from Kazakhstan, emphasised the cost aspect at play: “Unfortunately, many health professionals lack both context and understanding of harm reduction. But really, this is an issue of cost. The treatment of cancer is much more costly than an outreach campaign, than providing people with good information. Combating the effects of tobacco smoking or drug use is costly.”

Also, when it comes to ensuring safety, Kazakhstan faces a problem with illicit products from China.

“Counterfeit vapes are a problem. Kazakhstan does not regulate vaping products so instead, the government is simply banning them. This opens the door to counterfeit products. After the ban comes into force, the authorities will clamp down on official sellers - and we will see another surge of poor quality, fake products,” he said.

“Under Prohibition in the US alcohol didn’t simply disappear. Bans mean we don’t know what kind of ingredients will be in a vape tomorrow. The right path is the introduction of technical regulations and control. The risk of bans is that a law is passed, but the products continue to be sold but without any control. We must expand our vision. While being prudent, we must not hide behind bans.”

Dave Cross

Journalist at POTV

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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous start-ups to develop content for their websites.