Harm reduction for smokers — can new nicotine products play a role?

Harm reduction strategies aim to minimize the health and social consequences of psychoactive substance use. Recently, electronic cigarettes (e-cigarettes) and heated tobacco products have been promoted as “safer” alternatives to conventional cigarettes. Evidence regarding their safety is inconsistent: while some studies suggest lower levels of certain toxicants, many indicate substantial health risks, including exposure to novel toxic compounds absent in traditional cigarette smoke. Long-term effects remain unknown. The growing use of these products among adolescents, young adults, and never-smokers, combined with messaging framing them as harm reduction tools, raises significant public health concerns. Moreover, these products often perpetuate nicotine dependence rather than support complete cessation, unlike evidence-based interventions such as nicotine replacement therapy (NRT). Economic interests of the tobacco industry further complicate their promotion. Current evidence does not support e-cigarettes or heated tobacco products as legitimate harm reduction tools. Public health priorities should focus on proven cessation strategies, regulatory control, and preventing initiation among youth.