• People in drug treatment smoke at rates two to four times higher than average
  • Tobacco smoking may be as much as or more of a risk to health than use of illicit drugs for this group
  • Integrating harm reduction for tobacco with other support can improve health outcomes and support overall wellbeing

Two new publications from the Global State of Tobacco Harm Reduction (GSTHR) focus on the potential of tobacco harm reduction for people who use drugs, a group who smoke at rates far higher than the general population. ‘Integrating tobacco harm reduction into drug treatment and harm reduction services’ offers practical ideas and approaches for services to help clients cut down or quit, including by switching from smoking to safer, non-combustible ways of using nicotine. The companion Briefing Paper, ‘Smoking among people facing problems with drug use’ reveals the scale and impact of tobacco-related death and disease in this community.

Both publications demonstrate how tobacco harm reduction offers a low-cost, high-impact intervention for drug treatment and harm reduction services. Supporting tobacco harm reduction does not have to cost services anything aside from time. Giving accurate information about safer alternatives to smoking can reassure and empower people to make the switch for themselves. Anyone keen to deepen their knowledge about the approach and its evidence base can also take the GSTHR’s short, free online course, Understanding tobacco harm reduction.

The harms of smoking for people in drug treatment
Cigarettes kill half of all those who smoke long-term, and internationally, smoking rates among people in drug treatment are between two to four times higher than national averages. People who use drugs are at increased risk of dying prematurely as a result of smoking-related illness. Recent analysis of mortality data for more than 100,000 people who used heroin in England found that 63% died before the age of 70, compared to just 16% in the general population. Among people who used heroin, a similar number of premature deaths were caused by tobacco smoking (24%) as illegal drugs (28%). Attempting to address the high rates of smoking in this population therefore has the potential to lead to significantly improved health outcomes.

What is tobacco harm reduction?
Smoking is the most dangerous way of consuming tobacco and is the primary cause of tobacco-related death and disease. People smoke to use nicotine; in isolation from smoke, nicotine is a relatively low-risk substance. For people who either cannot or do not want to stop using nicotine, switching to nicotine vapes (e-cigarettes), heated tobacco products, Swedish snus or nicotine pouches offers a way to significantly reduce the harms to their health. All of these products are non-combustible: none burn tobacco, and some contain no tobacco at all. All deliver nicotine to the user at much lower risk than continued smoking.

A pathway to practice for tobacco harm reduction
‘Integrating tobacco harm reduction into drug treatment and harm reduction services’ provides approaches for frontline workers looking to address smoking among their clients. It offers ideas on how to introduce tobacco harm reduction to the service and equip staff with the confidence to tackle smoking through harm reduction. For those looking for more in-depth knowledge, the paper recommends service providers and their staff complete GSTHR’s free online course, Understanding tobacco harm reduction.

Paul Townsley, the CEO of Waythrough, a charity that provides free, confidential support for drugs, alcohol, mental health, housing and related areas, commented on the publications: “Drug and alcohol services do great work, the evidence for this is clear: these are interventions that save lives. Often, sadly, smoking and tobacco harm reduction is overlooked and unless there is a collective effort from treatment services over half the people who use services will die from smoking-related causes. There are simple steps we can all do to help reduce the impact and burden of this. Tobacco harm reduction is a valuable addition to the armoury to help people who have experienced drug problems to enhance their health and save lives.”

David MacKintosh, a Director of K·A·C, which runs the Global State of Tobacco Harm Reduction project, said: “Globally, drug services help hundreds of thousands of people avoid illness and death every year. The evidence shows that smoking rates among people who use drugs are much higher than national averages. We hope that these resources will help services and funders to reduce smoking, including by making use of the potential of tobacco harm reduction. This will play an important role in helping people live longer and healthier lives.”

Both publications will be made available in English and 12 additional languages.

Notes to editors

References for all data used in the press release can be found in the full Briefing Paper ‘Smoking among people facing problems with drug use’ and the Policy to Practice document ‘Integrating tobacco harm reduction into drug treatment and harm reduction services’.