Scientists and tobacco harm reduction (THR) experts stressed that nicotine alone is not the cause of smoking-related diseases and that further studies are needed to know more about its potential therapeutic benefits.

Neuroscientist Dr. Paul Newhouse

"I have never in all my career as a doctor, not once, seen a nicotine-only, nicotine absent of tobacco, and nicotine causing illness. Not once," said specialist Dr. Garrett McGovern. Reflecting on 25 years in harm reduction, he noted that nicotine alone rarely leads to health issues.

Dr. Andrew Manson, a nicotine scientist, said the demonization of smoking has taken the pleasure away from nicotine. "Stress management, weight management, mood management, and the ability to focus on tasks are clear conscious and subconscious benefits for people using nicotine," he said. 

At the Global Forum on Nicotine, a diverse panel of experts discussed the complexities of nicotine use and its potential therapeutic benefits. Moderated by Clive Bates, director of Counterfactual Consulting and former director of Action on Smoking and Health (ASH) in United Kingdom, the panel included neuroscientist Dr. Paul Newhouse, harm reduction specialist Dr. McGovern, Australian general practitioner Dr. Carolyn Beaumont, and THR advocate Mark Oates.

Tobacco harm reduction or THR is a public health strategy to lower the health risks to individuals and the wider society associated with using tobacco products. Smoke-free nicotine alternatives, such as heated tobacco products (HTPs), vapes, and oral nicotine pouches, are considered part of THR. These products eliminate the process of burning tobacco and do not produce smoke. Instead, HTPs and vapes produce aerosol to deliver nicotine.

Dr. Alex Wodak, a general practitioner from Australia, stressed the need to help nicotine consumers switch from smoking to less risky alternatives. "We all know eight million people, thereabouts, die from smoking-related diseases around the world every year. That's equivalent to the population of Switzerland every year. Reducing that number as fast as possible should be the paramount objective of everyone," Dr. Wodak said. 

"To paraphrase Michael Russell, people smoke for the nicotine, but they die from the hostility to harm reduction,” Dr. Wodak said. 

Dr. Beaumont shared insights from her interactions with Australian smokers, revealing that many turned to vaping as a less harmful alternative to smoking.  She noted the significant improvements in health and quality of life that her patients reported after switching to vaping. "Essentially, I see that nicotine use will continue," she said.

Oates, speaking from a consumer and advocacy standpoint, said no country has successfully ended nicotine consumption. "I found no evidence of any society that started using nicotine and then just stopped and got to that nicotine-free society. We've only seen countries like Sweden transition to safer versions," Oates said, referring to Sweden's transition to snus, a nicotine pouch product. 

Dr. Newhouse of the Vanderbilt University Medical Center in the US stressed the need to better understand nicotine's effects on the brain and its potential therapeutic applications while emphasizing that its role cannot be simplified into a binary of good or bad.

"I think nicotine is a highly complex substance that has a panoply of effects on the brain," Dr. Newhouse said. "The long-term or short-term effects of nicotine on brain function are very state-and condition-dependent. We have to acknowledge and agree that no simple yes or no, black or white, up or down, good or bad characterization is going to help us."

"We understand that nicotine stimulates receptor systems in the brain that are important for regulation of mood, cognition, and a variety of neural functions. It changes the nature of neural circuitry in the brain. It turns out that the effects are very state-dependent. They're age-dependent, may even be sex-dependent. For many people, they will never want or need to use nicotine. But for some people, it may be useful," Dr. Newhouse said.