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GFN23: Day 4

Covering the highlights from Day 4 of the Global Forum on Nicotine in Warsaw, Poland, the final day

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The Global Forum on Nicotine (GFN) took place in Warsaw, Poland. Celebrating its tenth anniversary, the event opened up to four packed days of workshops and presentations, attended by experts in tobacco harm reduction, advocates and consumers. The final of the four days saw Dr Roberto Sussman deliver the Michael Russell Oration, and session discussing the changing face of nicotine, the role of nicotinic systems in brain disorders, the tobacco control playbook, and what the next decade might bring for tobacco harm reduction.

Presenting his view on a rigorous critical evaluation of tobacco and nicotine science, Dr Roberto Sussman said: “We have to be very firm. When we argue with the [anti-vaping] side, we have to argue with information. When they say 'there's a vaping epidemic with the youth', we have to say 'no, there's no vaping epidemic'. If you want to talk about a vaping epidemic, we talk about politics. But there is no science in that. If we say 'unfortunately, there's a vaping epidemic but fortunately it's decreasing' then we are playing into their narrative."

The panel discussing ‘The changing face of nicotine’ heard from Dr Paul Newhouse. He said: “We understand that nicotine stimulates receptors systems in the brain that are important for regulation of mood, cognition and a variety of neural functions. It turns out that the effects are very state-dependent, they are age dependent and may even be sex dependent. I suspect that for many people, they will never want or need to use nicotine. But for some people it may be useful. It may turn out to be important for their cognitive performance or regulating their mood or managing anxiety. I suspect for a certain percentage of the population, nicotine will be helpful."

GP, Dr Carolyn Beaumont added: “I tend to reflect on an overuse of the word addiction. Addiction is a very strong term, and even though it can be defined in a few different ways, the common thread is that it’s causing some sort of harm, whether it’s breaking the law to get the product or it’s tearing families apart. It’s perfectly reasonable to say smoking is an addiction because we all know about the death and disease associated with cigarettes. But if you just take the nicotine part of it, what’s the harm?"

Dr Garrett McGovern, a GP specialising in addiction medicine, expressed: "As a doctor the old adage is do no harm, and I don’t see a huge amount of harm with nicotine. It certainly seems to have benefits for some people. We do need to change the narrative a bit and start doing research to see what the benefits are."

The final comment went to Dr Alex Wodak, who paraphrased Michael Russell: “People smoke for the nicotine, but they die from the hostility to harm reduction."

Considering ‘The role of nicotinic systems in brain disorders’, Professor Paul Newhouse spoke about his pilot trial in the early 2000s to give transdermal nicotine to patients with mild cognitive impairment.

We saw an improvement in attention as well as a significant and sustained improvement to memory,” he said. “These were very promising results and we were pleased to see this. It was safe and we had no significant adverse effects. We found it also reduced weight a few pounds and there were no significant cardiovascular effects.”

Dr Konstantinos Farsalinos called research in this area “really exciting”, adding that he sees us “still at the beginning in terms of the therapeutic applications of nicotine.

The prospects are there, but there are problems. The main one is that people don’t like doing research with nicotine. There have been a lot of hurdles for scientists who have been working with nicotine for neurological problems. There is a lot of prejudice against nicotine.”

After lunch, attention turned to ‘The tobacco control playbook’.

Gerry Stimson, Emeritus Professor Imperial College London and co-founder of the Global Forum on Nicotine said: “There are people that want to police the Framework Convention on Tobacco Control, want to police article 5.3, which is meant to protect policy from the tobacco industry, but it's really become kind of a petty, paranoid, persecutory policing by tobacco control activists, and it's a process of delegitimising and excluding and so on.”

Dr Konstantinos Farsalinos added: “Tobacco harm reduction is mostly a political issue unfortunately, and a very small part is science. What has been unprecedented is what Gerry [Stimson] mentioned: the users are excluded, not only excluded but they treat them in a totally disrespectful way, with irony, with saying that they have conflicts or they've been paid by someone to say that, and unfortunately Gerry, I think it's the same story that happened with HIV and AIDS, and with people who use drugs, twenty or thirty years ago.”

Looking to the future, the final session, ‘Tobacco harm reduction - the next decade’ heard from Dr Colin Mendelsohn.

We’ve made it very clear in Australia that bans don’t work. We all know that bans and prohibitions and harsh restrictions don’t work. We have a huge black market and criminal gangs, and huge issues with enforcement and youth vaping - how much more information do we need to be clear that this is the wrong approach? We’re all aware of it, but unfortunately, closed-off political leaders, Fiona Patten excepted, are unwilling to open the door to that information,” he said.

Joel Sawa, a consumer advocate from Uganda offered a positive perspective: “Over the next decade, I see a time where we have more involvement of the medical fraternity, where clinicians will be able to deal with patients from a more informed point of view. I would like to see a time when the World Health Organization comes to the table and has these discussions, and has meetings where consumers are present, and develops more consumer-oriented policies. I also see a time where there will be more campaigns - ‘nothing about us without us’ - where the voice of the consumer will be louder than it has been before.”

Jon Fell, consultant in the tobacco and nicotine field, said: “Does nicotine have benefits? I thought Professor Paul Newhouse’s session was fantastic. You can consider that as a distraction from what tobacco harm reduction is about, but I think that if you do begin to rehabilitate nicotine, that will be helpful, that will help counter a lot of the misinformation that even the medical profession have about that villain ‘nicotine’ being the major problem. Then we can also maybe have a more nuanced debate about addiction - about whether nicotine, as opposed to smoking, really does meet the classic definition of addiction, as being something that brings additional adverse consequences with it.”

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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 vape companies to develop content for their websites.

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