Why We Need Greater, Not Less, Access to Reduced-Risk Nicotine Products.

Cigarette smoking is the leading preventable cause of death and disease. Prolonged and repeated inhalational exposure to the chemical toxicants found in cigarette smoke is a known cause of cardiovascular disease, chronic lung disease, and cancer. Novel nicotine products, including e‑cigarettes and tobacco‑free nicotine pouches, reduce exposure to toxicants among those who smoke and switch to their use, reducing the risk of smoking‑related disease. Implementation of national strategies to reduce smoking‑related death and disease increasingly acknowledges the support that novel nicotine products can give to smoking prevention efforts. However, for such strategies to be successful, and for countries to achieve their 'SmokeFree' ambitions, these products need to be widely accessible to consumers. In a recent paper, Aremu and Ogugua called for restrictions on access to electronic cigarettes (e‑cigarettes) or electronic nicotine delivery systems (ENDS). While prescription‑only regulatory models were advocated, these risk constraining accessibility to those who smoke and have been shown to cause increases in criminal activity, systemic violence, and health risks associated with the proliferation of unregulated nicotine products. Prescription‑only regulation should be avoided due to the potential for these significant unintended consequences, although there is a place for prescription products in co‑existence with products available through general consumer routes. Instead of banning or placing restrictions on purchasing, the use of reduced-risk nicotine products among unintended users, such as youth, can be mitigated through innovation and technology. This would ensure that access to reduced-risk products among those who smoke would best serve tobacco harm reduction efforts and population health.