From smoke to safety: How safer alternatives are key to India’s smoking cessation success

Dr Amrita Singh, Senior Vice President, Paras Health emphasises that as India confronts its national tobacco crisis, the introduction of innovative, science-backed harm reduction strategies appears essential

India, a country grappling with a monumental tobacco crisis, is home to over 100 million smokers. Despite rigorous de-addiction efforts by the government, the goal of smoking cessation remains elusive for a significant portion of the population. The pressing question is: why? Perhaps the answer lies in the conventional methods we’ve relied on for too long. In contrast, many developed nations have shifted their focus to safer alternatives like nicotine replacement therapy (NRT), and nicotine pouches, Heated Tobacco Products (HTPs) and other safer alternatives with remarkable success. Could this be the missing link in India’s strategy?

The tobacco burden in India

India’s struggle with tobacco is no secret. According to the latest National Family Health Survey (NFHS-5) conducted between 2019 and 2021, approximately 39 per cent of men and 4 per cent of women in India are current tobacco users. Specifically, the survey indicates that about 10.7 per cent of men smoke cigarettes. This data highlights the ongoing challenge of tobacco use in the country, emphasising the need for effective public health strategies to address this issue¹.

Despite ongoing efforts, the high prevalence of smoking continues to strain our healthcare system. Tobacco use remains a leading cause of preventable deaths, accounting for over 1 million fatalities each year². Lung cancer, cardiovascular diseases, and respiratory disorders are among the most common illnesses caused by smoking, which leads to significant financial and health burdens on the country. It’s clear that our existing cessation efforts need a fresh approach.

A global shift: The success of safer alternatives

Across the globe, countries like Sweden, Japan, and the United Kingdom have achieved significant reductions in smoking rates through the adoption of safer alternatives. Sweden, for example, has reduced its smoking rate to just 5.6 per cent by introducing nicotine pouches and snus, and is on track to become the world’s first smoke-free nation³. Japan has also witnessed a massive 52 per cent decline in cigarette sales following the widespread use of HTPs⁴. These examples are not mere anomalies; they reflect a shift in tobacco control strategies that India can learn from.

Why India needs to reconsider her strategy

While India has taken commendable steps, such as banning e-cigarettes; however, we must acknowledge that prohibition alone has not been effective. In fact, bans on these products have fostered the growth of a dangerous black market, with young people increasingly exposed to unregulated nicotine devices. It’s time we look at global success stories and embrace a more balanced approach – one that regulates and encourages the use of harm reduction products, rather than pushing them underground.

Heated Tobacco Products (HTPs) offer smokers a less harmful alternative by heating tobacco at lower temperatures than traditional cigarettes, producing fewer toxic chemicals. Countries like Japan and the UK have shown that regulated introduction of such products can not only reduce smoking rates but also prevent the dangerous, unregulated sale of e-cigarettes⁵.

A roadmap for India: Introducing safer novel alternatives

India, with one of the largest tobacco-using populations, needs to move beyond traditional cessation methods like Nicotine Replacement Therapy (NRT), which have limited reach and awareness, particularly in rural areas⁶. HTPs, nicotine pouches, and other scientifically validated harm reduction alternatives must be introduced under a strict regulatory framework. This could be a game-changer for millions of Indian smokers who have failed to quit using conventional methods.

By making these products accessible under stringent regulations, India could prevent the rise of illegal markets and provide smokers with safer alternative options to quit smoking gradually. Countries like Sweden and Japan have shown that it’s possible to cut smoking rates drastically without pushing smokers into an unregulated grey zone.

Time and need for policy reform towards a smoke-free future

As India confronts its national tobacco crisis, the introduction of innovative, science-backed harm reduction strategies appears essential. A pivot toward regulated HTPs and increased access to NRT could significantly reshape the landscape of tobacco use within the country. The experiences of Sweden and Japan illuminate a viable path forward, demonstrating not only the potential for reduced smoking rates, but also fostering a healthier, smoke-free generation.

This is time for India to embrace a new approach to tobacco cessation—one that empowers smokers with safer alternatives and acknowledges the complex realities of addiction. By fostering a supportive framework for smoking cessation initiatives, we can truly take strides toward a healthier society, breaking the cycle of tobacco dependence once and for all.

References:

1. National Family Health Survey (NFHS-5) 2019-21: https://www.nfhsindia.org/nfhs-5-report

2. Global Burden of Disease Study, 2019: https://vizhub.healthdata.org/gbd-results/

3. Tobacco Tactics, Swedish Harm Reduction: https://www.tobaccotactics.org/article/the-swedish-experience/

4. Global State of Tobacco Harm Reduction Report, Japan Case Study: https://gsthr.org/resources/briefing-papers/cigarette-sales-halved-heated-tobacco-products-and-the-japanese-experience/

5. UK Government Evidence Review: https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review

6. National Health Portal, Nicotine Replacement Therapy: https://www.nhp.gov.in/