June 15, 2020
While Dr. Mark Tyndall considers himself an “accidental voice in the vaping world”, he is no stranger to harm reduction. In fact, he’s a bit of a rock star in harm reduction circles, having been involved with opening the first safe injection site in North America and now leading and breaking new ground with My Safe Project, an ATM-style machine that allows drug users who have registered with the program to access a safe supply of hydromorphone. Dr. Tyndall spoke at the GFN20 on the subject of “Tobacco harm reduction: ensuring we learn the lessons from history.”
Dr. Tyndall spoke on the traditional approach of public health authorities to smoking and smokers. “...in public health we’ve relied on shaming, exclusion, nasty pictures on packages and taxation. Besides humiliation, inconvenience, and financial hardship, it’s unclear what this has accomplished.” As he points out, celebrating a decline in smoking rates (and therefore the status quo on tobacco control) is missing the point- the numbers are lower because people are dying. “Of course the prevalence is slowly going down as we watch people die.”
Having spent decades working with drug users who all also smoked cigarettes, Tyndall heard about vaping around 2012 and found the innovation exciting- the textbook definition of harm reduction. “In the case of cigarette smoking we know that 50% of people die from chronic use.” Vaping is not only a considerably less risky option, it’s an attractive one. “The amazing thing about vaping was that for many people it was even more attractive and satisfying than cigarettes. Yet eight years later, who would have thought that throwing a lifeline to people who smoke cigarettes would be so contentious? It should have been a slam dunk.”
If he sounds frustrated on this point he’s in good company but he’s also had a lot of history with this exact kind of pushback against harm reduction more generally. He notes that, “Whenever there is an abstinence-based option, the default is always abstinence. Just say no.” Many of us former smokers are familiar with the laments from friends and family to “just quit.” Show some self restraint, exercise some control, eat some carrots. While one might hope for a more sophisticated approach from public health, it’s simply not the case.
This, Tyndall says, ignores the reality that people use and like using substances. They sometimes become dependent on those substances and can’t or don’t want to quit. Safer products and ways of using them are necessary, safer by any degree.
There are a great many lessons to be learned from the broader harm reduction community. Dr. Tyndall lists six reasons why harm reduction is not supported. The moral argument (“drugs are bad”), the assertion that harm reduction promotes drug use, the “it sends the wrong message to youth” argument, the argument that it enables drug users, the financial argument (we’d rather spend our money on worthy recipients/causes), and finally- it’s bad for communities (the not-in-my-neighbourhood movement). All of these will be familiar to people in the vape advocacy space.
He says that tobacco harm reduction has the additional hurdle of people (in public health and the broader public) believing that, “The status quo is working already and vaping just complicates things.” Of course, as mentioned, in order for us to accept that the status quo is indeed working, we have to take the deaths of smokers as a measure of success. As there are fewer of us to count, the prevalence of smoking will continue to slowly decline. It’s up to us to advocate for smokers ahead of their deaths, to proclaim victory only when fewer people are dying. And this ties back to Tyndall’s own experience. “Change comes from the bottom up.” He credits much of the movement in harm reduction to the hard work and activism of drug users and sees a similar activism and passion among people who vape.
Another obstacle, he adds, is the “fear of big tobacco.” While acknowledging the predatory practices of tobacco companies he asserts that some involvement is necessary and that “...taking some moral high ground with so many lives at stake only hurts the people who are dying from smoking.” We must engage with tobacco companies in order to facilitate the long-term goal of displacing their primary product. No different than when Deputy Prime Minister Christia Freeland asserts that of course the heads of the oil and gas industry need to be involved and actively engaged in climate control plans- because they are Canada’s biggest emitters. Here too, we must call on tobacco companies to address the harms they have profited from and work towards lower harm products- not because we trust them implicitly or are seeking some great Kumbaya moment but because it’s the reasonable thing to do. The more quickly that tobacco companies can produce and successfully market a product to replace the deadly cigarettes that they have been selling, the better. “It should be noted that some of the most respected voices in the vaping movement are people who have spent their lives fighting tobacco companies but understand that no engagement means no progress,” Tyndall says.
“Cigarette smoking is by far the greatest self-inflicted health crisis of our time. Even the worst global models for Covid19 deaths are insignificant by comparison.” Advocates are aware of the urgency. You see it on Twitter and on Facebook with people taking to the platforms daily to advocate for vapers and smokers, to share and spread information, to organize events and calls to action. You see it at rallies, and in the response to online petitions, and in letters to elected officials, and in response to negative campaigns. And if it seems like never quite enough, Dr. Tyndall is someone all too familiar with the formidable challenge of changing hearts and minds in government and in public health. But he is heartened by the grassroots response, reminding us that, “The role of drug users and direct community action has been critical to the harm reduction movement. For vaping, the passion shown by people who have truly had their lives changed must be heard.”“At the end of the day access to vaping is simply a human right. People have the right to access a safer product, much like they have the right to supervised injection sites and HIV medication.” However, he warns that, “Helping smokers is never going to be politically popular. It must be approached as any other issue that impacts a minority of people.” But if he can point to one thing that he has learned in his years of harm reduction it is persistence. Dr. Mark Tyndall has it in spades and, I believe, we as a community are capable of the same resolve. Watch the full speech here and follow Dr. Mark Tyndall on Twitter.
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