Poland without cigarettes? Experts on the directions of the national anti-smoking policy

The epidemic overshadowed by the pandemic

Poland is coping poorly with the addiction to smoking, which the World Health Organization (WHO) has for years called an "epidemic". Every year, as a result of smoking, around 7 million people die worldwide and over one million non-smokers who have been passively exposed to cigarette smoke.

In Poland, there are about 80,000 people due to smoking. deaths annually. According to the Eurobarometer of the European Commission, only 12% of our smokers said they quit. It is one of the three lowest rates in the entire EU. There are 3 specialist smoking cessation clinics in our country. About 800 patients use their services annually.

Nearly 8 million Poles smoke actively, and 14 million are exposed to passive smoking, i.e. second hand cigarette smoke. Meanwhile, the excess mortality in Poland in 2020 was one of the highest in the EU. On average, 1/5 of all deaths per year in our country are attributed to active, but also passive smoking.

- Cigarette smoking is the most important factor in the loss of healthy life years, and our risk of premature death and loss of quality of life is 15% higher for women and 25% higher for men than in other EU countries - emphasized Dr. Grzegorz Juszczyk, director of the National Institute of Public Health - PZH.

Good example from New Zealand

Prof. K. Filipiak suggested that Poland should follow the example of New Zealand in its anti-smoking policy, which set itself the goal of educating a smoke-free generation. New Zealand has adopted a package of far-reaching changes to the law, implementing the so-called the harm reduction strategy.

New Zealand wants to become a country free from cigarettes and other smoking tobacco products. By 2025, the country's smoking percentage is expected to be less than 5%. Currently it is 13%.

- The National New Zealand program fights this addiction, incl. by gently inducing smokers to switch to the less harmful than cigarettes, e.g. using tobacco heaters, in order to switch to a world without cigarettes in the future - explained Prof. K. Filipiak.

The concept of the so-called harm reduction, or reducing the population harmfulness of tobacco smoking by using less harmful forms of nicotine administration in patients resistant to pharmacotherapy, is also an accepted methodology in other countries, including in the United States.

The New Zealand government has set a goal to eliminate smoking within this decade. From 2025, the level of nicotine in cigarettes will be reduced and the number of points of sale will be reduced. Addiction therapy centers will also receive more funds. In turn, from 2027 people born after 2008 will no longer be able to buy cigarettes in this country. The New Zealand Ministry of Health also conducts educational campaigns aimed at smokers to get them to switch to nicotine vaping products: e-cigarettes and tobacco heating systems that do not emit cigarette smoke.

It is smoke, not nicotine, that is carcinogenic

- Smoking is a concern of 3 areas of medicine: oncology, cardiovascular disease and lung disease. However, it is not nicotine addiction that is the health problem in these 3 areas, but the compounds produced by smoking tobacco. It is not nicotine that is the problem and I would like to emphasize this clearly - emphasized prof. K. Filipiak.

The main cause of disease among smokers is the toxic substances that are released in cigarette smoke when a cigarette is burned. About 70 of them are carcinogenic. Nicotine is not on this list - it is not a carcinogen according to the International Agency for Research on Cancer (IARC).

- Replacing the combustion process in tobacco heating systems and e-cigarettes by heating the nicotine substrate eliminates smoke and tar. It reduces the formation of carcinogens by 90-95% compared to tobacco smoke - emphasized prof. K. Filipiak.

The British experience

Prof. Marek Postuła, a cardiologist from the Medical University of Warsaw, noticed that the United Kingdom, along with France, also introduced a harm reduction policy.

- The very switching of patients to less harmful products is a desired direction, but not 100% effective. However, the method without the support of doctors, the entire prevention and education program will not work - he said.

UK data show that hybrid interventions that rely on GP-assisted patient education in combination with pharmacological intervention and products that are less harmful to smoking are the most effective.

- Such an intervention increases the effectiveness of quitting the addiction by 3 times. However, if we leave the patient only with the recommendation to buy nicotine patches or gums at the pharmacy, the effectiveness of quitting smoking increases only by 1.5 times. Breaking the addiction is very difficult. Out of 100 patients who make their own decision to quit smoking after a year, only 4 to 6 will not smoke. Thanks to a complex support program, this coefficient increases and per 100 smokers after 16, he quits the addiction - calculated Prof. M. Postuła.

He added that in the UK, of the 2.5 million smokers who use tobacco heating systems, half have quit smoking.

- This means that tobacco heating systems can be a bridge to the UK target of 5% smoking by 2030, said .

Poland without cigarette smoke

Dr. G. Juszczyk from the National Institute of Public Health - PZH would like Poland to quickly develop a national strategy: Poland without smoke. In his opinion, it is necessary to start with prevention in the group of children and adolescents. Cigarettes - despite the excise tax hike at the beginning of the year - are still too cheap and their financial availability remains relatively high. Education about the harmfulness of smoking is also necessary.

- For smokers who can be persuaded to quit or less harmful systems, we should have a specific offer from the perspective of the health care system based on guidelines, data analysis and scientific consensus, i.e. providing comprehensive health support to those who want to quit smoking - he noted and informed that such guidelines are being developed. WHO together with Cochrane Polska, under the leadership of prof. Małgorzata Bały in Kraków, is preparing a consensus model of nicotine addiction treatment.

- For patients who have been motivated to quit smoking and have agreed with their doctor at some stage that all support methods are exhausted, we will consider using two strategies: endgame parting with nicotine and harm reduction. P Looking at the experiences of New Zealand and the UK, as there is no general consensus at the EU level yet, we will be faced with deciding what to recommend to patients. H arm reduction, as an attempt to support the withdrawal from addiction, despite the harmfulness of nicotine and a short period of epidemiological observation of people using these innovative products, will be an important element in this discussion - announced Dr. G. Juszczyk.