Experts: Confusion about nicotine prevents adoption of harm reduction

Scientists and physicians emphasized that false beliefs about nicotine are a major barrier to smokers adopting reduced-risk alternatives.

Two hundred experts from 51 countries, participating in a panel discussion at the 8th Summit on Tobacco Harm Reduction: Novel Products, Research & Policy in Athens, expressed a collective message: tobacco policies worldwide must be rooted in science—not ideology—and should embrace harm reduction as a crucial public health measure for those unable or unwilling to stop smoking.

As a public health strategy, tobacco harm reduction seeks to lessen the damage caused by conventional smoking through safer alternatives such as e-cigarettes, heated tobacco, and nicotine pouches. While complete cessation is the ideal outcome, experts emphasize that these reduced-risk alternatives provide a realistic, evidence-based path forward.

In a summit last year, Dr. Konstantinos Farsalinos, a physician and researcher based in Greece, said scientists must take the lead in clarifying nicotine’s true impact to counter widespread misconceptions. Without such efforts, these false beliefs will continue to mislead both medical professionals and the general public into viewing nicotine as a major health threat.

Scientific studies indicate that nicotine, despite its addictive nature, is not the chief culprit behind the health risks linked to smoking.

For his part, Dr. Giovanni Li Volti, a professor of Biochemistry at the University of Catania in Italy, studies show nicotine is “perfectly safe” for heart health and unrelated to conditions like recurrent stroke. He pointed out that the existence of nicotine replacement therapy would be contradictory if nicotine itself were harmful.

Li Volti pointed out that, despite strong evidence, widespread misunderstanding about nicotine persists. “It reflects our failure as scientists to properly educate the public,” he said, emphasizing the need to separate nicotine’s impact from the harmful effects of smoke.

He also cited high-quality epidemiological studies showing no increased risk of heart disease or cancer from nicotine itself.

Dr. Rohan Andrade Sequeira, underscored the consequences of poor communication around nicotine. The Mumbai-based consultant cardio-endocrine physician cited heavy reliance on local oral tobacco, which fuels high rates of oral cancer in India. Given that NRT succeeds in just 7 percent of cases globally, Sequeira explained that most users revert to old habits, lacking safer options. He believes nicotine pouches could offer India a pathway toward healthier change.

Highlighting Sweden as a striking example, Damian Sweeney of the New Nicotine Alliance Ireland noted that while nicotine use in Ireland matches the EU average, its primary form, snus, has helped slash smoking rates to just 5 percent, the lowest in the region. He emphasized that this success underscores the power of harm reduction, and cautioned that misleading narratives about nicotine and low-risk products pose dangers comparable to smoking.

In terms of the value of consumer input, Sweeney urged users of novel nicotine products to communicate their positive experiences to decision-makers. Farsalinos echoed concerns about misinformation, referencing a 2017 study he conducted where just 5 percent of smokers recognized the reduced harm of e-cigarettes compared to smoking. “If they’re misinformed,” he said, “they won’t even attempt to quit using safer alternatives.”

Citing clear evidence, former Action on Smoking and Health (ASH) director Clive Bates asserted that non-combustible nicotine products are far less hazardous than smoking. He argued that the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has veered off course, and is now actively resisting harm reduction strategies. Bates urged like-minded FCTC member nations to form a united front to challenge the WHO and its secretariat. He advocated for the inclusion of harm reduction and an end to what he termed the current “fanaticism” surrounding nicotine.

According to the panel, the scientific community needs to maintain clear, evidence-driven communication across all media. Meanwhile, the media must play its part by dispelling misinformation and ensuring balanced reporting on harm reduction strategies.

The summit was organized by SCOHRE, the International Association on Smoking Control & Harm Reduction, on 30 September and 1 October 2025.