Tobacco Harm Reduction IS Harm Reduction Part One
Why do public health principles so often stop when the substance is nicotine?
June 3, 2026
Introduction
World Vape Day and World No Tobacco Day fall one day apart. That timing makes the contrast hard to ignore. As I watched posts on social media over those two days, the contrast was even deeper than in years past.
In many areas of public health, harm reduction is treated as practical, compassionate, and evidence-informed. Public health organizations recognize that people do not always stop risky behaviors immediately, completely, or as professionals might prefer. They promote safer choices, person-first language, stigma reduction, and the meaningful inclusion of people with lived experience.
But when the subject is nicotine, those principles often seem to change.
This post looks at twelve well-known public health organizations and asks a simple question: Do they apply harm reduction principles consistently, or do those principles stop when the people affected are people who smoke, vape, or use other safer nicotine products?
The chart below compares how these organizations publicly approach harm reduction, person-first or stigma-aware language, and lived-experience inclusion in substance-use or related health contexts versus in nicotine contexts.
Key to the “report card.”
HR = harm reduction, not including commercial nicotine products
THR = tobacco harm reduction
PF/SA = person-first / stigma-aware language
LE = meaningful inclusion of people with lived experience
S/H = substances, or related health contexts, when substance-specific information was not found
N = nicotine
Conclusion
The pattern is difficult to miss. These organizations know how to use harm reduction principles, person-first language, and lived-experience inclusion when the subject is not nicotine. The question is why those principles so often disappear when the people affected are people who smoke, vape, or use other safer nicotine products. Harm reduction should not stop at nicotine.
Public health organizations may argue that nicotine is different because tobacco companies are powerful, profit-driven, and have a long record of deception. That history will never be forgotten, and it should not be. But profit and harm are not unique to tobacco. Alcohol companies profit from products that can cause addiction, disease, and death. Pharmaceutical companies profit from medications that can be misused, overprescribed, or diverted. Unregulated substance markets are also shaped by profit, exploitation, addiction, contamination, and risk.
In those areas, public health has learned to separate people with lived experience from the industries and the markets around them. It can protect policy from commercial influence while still listening to the people most affected. Tobacco and nicotine policy should be held to the same standard.
References:
Vital Strategies
[1] Engage communities: overdose prevention. Accessed June 2, 2026. https://www.vitalstrategies.org/overdose-prevention-engage-communities/
[2] Overdose prevention. Accessed June 2, 2026. https://www.vitalstrategies.org/overdose-prevention/
[3] A guide for people who use drugs, by people who use drugs. Accessed June 2, 2026. https://www.vitalstrategies.org/resources/a-guide-for-people-who-use-drugs-by-people-who-use-drugs/
[4] World No Tobacco Day 2025: grantees and partners honored for their tobacco control work. Accessed June 2, 2026. https://www.vitalstrategies.org/world-no-tobacco-day-2025-vital-strategies-grantees-and-partners-honored-for-their-tobacco-control-work/
[5] Tobacco control. Accessed June 2, 2026. https://www.vitalstrategies.org/tobacco-control/
[6] Vital Strategies; The Union. Toolkit for WHO FCTC Article 5.3: protecting tobacco control policies from tobacco industry interference. Accessed June 2, 2026. https://www.vitalstrategies.org/wp-content/uploads/The-Union-Toolkit-for-WHO-FCTC-Article-53.pdf
World Health Organization
[7] Meaningful engagement of people with lived experience. Accessed June 2, 2026. https://www.who.int/groups/gcm/meaningful-engagement-of-people-with-lived-experience
[8] International standards for the treatment of drug use disorders. Accessed June 2, 2026. https://www.who.int/publications/i/item/international-standards-for-the-treatment-of-drug-use-disorders
[9] WHO Regional Office for the Eastern Mediterranean. Drug-related harm reduction. Accessed June 2, 2026. https://www.emro.who.int/asd/health-topics/drug-related-harm-reduction.html
[10] Tobacco: e-cigarettes. Accessed June 2, 2026. https://www.who.int/news-room/questions-and-answers/item/tobacco-e-cigarettes
[11] WHO Framework Convention on Tobacco Control. Guidelines for implementation of Article 5.3. Accessed June 2, 2026. https://fctc.who.int/resources/publications/m/item/guidelines-for-implementation-of-article-5.3
[12] WHO urges governments to protect young people from addiction to tobacco and nicotine products. Published May 29, 2026. https://www.who.int/news/item/29-05-2026-who-urges-governments-to-protect-young-people-from-addiction-to-tobacco-and-nicotine-products
PAHO / WHO Americas
[13] Harm reduction. Accessed June 2, 2026. https://www.paho.org/en/topics/combination-hiv-prevention/harm-reduction
[14] Mental health and substance use. Accessed June 2, 2026. https://www.paho.org/en/noncommunicable-diseases-and-mental-health-nmh/mental-health-and-substance-use
[15] Do your share. Accessed June 2, 2026. https://www.paho.org/en/campaigns/do-your-share
[16] WHO position on tobacco control and harm reduction. Accessed June 2, 2026. https://www.paho.org/en/node/101813
Bloomberg Philanthropies
[17] Combating the overdose epidemic. Accessed June 2, 2026. https://www.bloomberg.org/public-health/combating-the-overdose-epidemic/
[18] First Pennsylvania, then the nation: how Bloomberg Philanthropies is taking on the overdose epidemic. Inside Philanthropy. Accessed June 2, 2026. Original link: https://www.insidephilanthropy.com/home/2019-8-5-first-pennsylvania-then-the-nation-how-bloomberg-philanthropies-is-taking-on-the-overdose-epidemic. Or archived link: https://archive.ph/54wuR
[19] Reducing tobacco use. Accessed June 2, 2026. https://www.bloomberg.org/public-health/reducing-tobacco-use/
[20] Bloomberg Initiative to Reduce Tobacco Use. Accessed June 2, 2026. https://www.bloomberg.org/public-health/reducing-tobacco-use/bloomberg-initiative-to-reduce-tobacco-use/
[21] Bloomberg Philanthropies launches new $160 million program to end youth e-cigarette epidemic. American Cancer Society Cancer Action Network. Accessed June 2, 2026. https://www.fightcancer.org/releases/bloomberg-philanthropies-launches-new-160-million-program-end-youth-e-cigarette-epidemic
American Medical Association
[22] Harm-reduction efforts needed to curb overdose epidemic. Accessed June 2, 2026. https://www.ama-assn.org/delivering-care/overdose-epidemic/harm-reduction-efforts-needed-curb-overdose-epidemic
[23] Substance use disorder how-to guide. Accessed June 2, 2026. https://www.ama-assn.org/system/files/bhi-sud-how-to-guide.pdf
[24] E-cigarettes and vaping: a public health epidemic. Accessed June 2, 2026. https://www.ama-assn.org/public-health/behavioral-health/e-cigarettes-and-vaping-public-health-epidemic
[25] AMA calls for total ban on all vaping products not approved by FDA. Accessed June 2, 2026. https://www.ama-assn.org/press-center/ama-press-releases/ama-calls-total-ban-all-vaping-products-not-approved-fda
American Public Health Association
[26] Defining and implementing a public health response to drug use and misuse. Accessed June 2, 2026. https://www.apha.org/policy-and-advocacy/public-health-policy-briefs/policy-database/2014/07/08/08/04/defining-and-implementing-a-public-health-response-to-drug-use-and-misuse
[27] Tobacco. Accessed June 2, 2026. https://www.apha.org/topics-and-issues/substance-misuse/tobacco
[28] Supporting regulation of electronic cigarettes. Accessed June 2, 2026. https://www.apha.org/policy-and-advocacy/public-health-policy-briefs/policy-database/2015/01/05/12/58/supporting-regulation-of-electronic-cigarettes
[29] Reimagining public health leadership for health equity: moving toward collective and community-centered applied practice. Accessed June 2, 2026. https://www.apha.org/policy-and-advocacy/public-health-policy-briefs/policy-database/2023/01/18/public-health-leadership
Public Health Association of Australia
[30] Illicit drug use policy position statement. Accessed June 2, 2026. https://www.phaa.net.au/common/Uploaded%20files/SIG%20documents/Health%20Promotion%20SIG/PPS%202025/0705%20-%20HP%20-%20Illicit%20Drug%20Use%20-%202025.pdf
[31] Vaping and tobacco controls in Victoria submission. Accessed June 2, 2026. https://www.phaa.net.au/common/Uploaded%20files/Submissions%202024/PHAA%20Submission%20-%20240405%20-%20Vic%20Vaping%20Tobacco%20Control.pdf
[32] E-cigarettes policy position statement. Accessed June 2, 2026. https://phaa.imiscloud.com/common/Uploaded%20files/SIG%20documents/ATOD%20SIG/PPS%202023/02-02_-_AToD_-_E-cigarettes.pdf
[33] Tobacco and Other Smoking Products Amendment Bill 2025: submission to Queensland Parliament. Published June 20, 2025. https://www.phaa.net.au/common/Uploaded%20files/PHAA%20submission%20-%20Qld%20Tobacco%20amendment%20bill%20v1.2.pdf
[34] Position statements on e-cigarettes. Tobacco in Australia. Accessed June 2, 2026. https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-15-position-statements
Australian Medical Association
[35] AMA formally backs pill testing trials. Accessed June 2, 2026. https://ama.com.au/sites/default/files/documents/220319_AMA_Formally_Backs_Pill_Testing_Trials.pdf
[36] Submission: illicit drugs and law enforcement. Accessed June 2, 2026. https://www.ama.com.au/sites/default/files/2023-02/AMA%20Submission%20Illicit%20Drugs%20and%20Law%20Enforcement.pdf
[37] AMA supports Australian Government’s stance on e-cigarettes and vaping. Accessed June 2, 2026. https://www.ama.com.au/media/ama-supports-australian-government%E2%80%99s-stance-e-cigarettes-and-vaping-%C2%A0
[38] Vaping is a ticking time bomb that must be defused. Accessed June 2, 2026. https://www.ama.com.au/media/vaping-ticking-time-bomb-must-be-defused
[39] AMA submission to the Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Bill 2024. Published April 12, 2024. https://www.ama.com.au/sites/default/files/2024-04/AMA-submission-to-vaping-reforms.pdf
The Union
[40] Tobacco control. Accessed June 2, 2026. https://theunion.org/our-work/tobacco-control
[41] Union position paper on e-cigarettes and HTP sales in LMICs. Accessed June 2, 2026. https://theunion.org/technical-publications/union-position-paper-on-e-cigarettes-and-htp-sales-in-lmics
[42] Ban e-cigarettes and HTPs in LMICs to prevent a new epidemic of nicotine addiction, says new Union position paper. Accessed June 2, 2026. https://theunion.org/news/ban-e-cigarettes-and-htps-in-lmics-to-prevent-a-new-epidemic-of-nicotine-addiction-says-new-union-position-paper
[43] E-cigarette statement. Accessed June 2, 2026. https://theunion.org/sites/default/files/2020-11/E-cigarette_statement_FULL.pdf
[44] Words matter. Accessed June 2, 2026. https://conf2022.theunion.org/wp-content/uploads/2022/05/stbp_words-matter_screen-ready.pdf
[45] Psychosocial counselling and treatment adherence support for people with tuberculosis. Accessed June 2, 2026. https://theunion.org/sites/default/files/2021-04/TheUnion_TBAlert_PsychosocialCounselling_April2021_webversion.pdf
[46] Community Connect. Accessed June 2, 2026. https://conf2024.theunion.org/community-connect/
[47] “TB has an image problem, but once you get to know a person who had TB, you will see how powerful their stories are.” Accessed June 2, 2026. https://theunion.org/news/%E2%80%9Ctb-have-an-image-problem-but-once-you-get-to-know-a-person-who-had-tb-you-will-see-how-powerful-their-stories-are%E2%80%9D
American Academy of Pediatrics
[48] Principles of harm reduction for young people who use drugs. Accessed June 2, 2026. https://publications.aap.org/pediatrics/article-abstract/147/Supplement%202/S240/34618/Principles-of-Harm-Reduction-for-Young-People-Who
[49] Principles of care for young adults with substance use disorders. Accessed June 2, 2026. https://publications.aap.org/pediatrics/article/147/Supplement%202/S195/34573/Principles-of-Care-for-Young-Adults-With-Substance
[50] Protecting children and adolescents from tobacco and nicotine. Accessed June 2, 2026. https://publications.aap.org/pediatrics/article/151/5/e2023061805/191063/Protecting-Children-and-Adolescents-From-Tobacco
[51] AAP policy calls for reforms to combat rise in youth e-cigarette use. AAP News. Accessed June 2, 2026. https://publications.aap.org/aapnews/news/6948/AAP-policy-calls-for-reforms-to-combat-rise-in
[52] E-cigarettes need stronger regulations. HealthyChildren.org. Accessed June 2, 2026. https://www.healthychildren.org/English/news/Pages/E-Cigarettes-Need-Stronger-Regulations.aspx
American Heart Association
[53] Management of infective endocarditis in people who inject drugs. Accessed June 2, 2026. https://professional.heart.org/en/science-news/management-of-infective-endocarditis-in-people-who-inject-drugs
[54] Words matter: body weight language & stigma awareness tool. Accessed June 2, 2026. https://professional.heart.org/en/-/media/PHD-Files/Education/CMKH-Obesity-Words-MatterFlyer_022626.pdf
[55] Quit smoking, vaping and tobacco use. Accessed June 2, 2026. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco
[56] Is vaping safer than smoking? Accessed June 2, 2026. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/is-vaping-safer-than-smoking
[57] Tobacco endgame and e-cigarettes. Accessed June 2, 2026. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/tobacco-endgame-and-e-cigarettes
[58] Smokers, especially those who start young, face higher risk of early death from heart disease. AHA News. Published October 28, 2020. https://www.heart.org/en/news/2020/10/28/smokers-especially-those-who-start-young-face-higher-risk-of-early-death-from-heart-disease
American Psychiatric Association
[59] Position statement on harm reduction. Accessed June 2, 2026. https://www.psychiatry.org/getattachment/94d3f1b9-3fbe-4150-855b-1dfc4923855d/Position-Harm-Reduction.pdf
[60] Resource document on harm reduction. Accessed June 2, 2026. https://www.psychiatry.org/getattachment/7af2a135-1a30-4820-b3bc-6f3bee143d40/Resource-Document-Harm-Reduction.pdf
[61] Tobacco and nicotine. Accessed June 2, 2026. https://www.psychiatry.org/psychiatrists/practice/professional-interests/addiction-psychiatry/tobacco-nicotine
[62] Position statement on tobacco use disorder. Accessed June 2, 2026. https://www.psychiatry.org/getattachment/bd7dd795-d243-492d-ae01-c86f4cc97316/Position-2015-Tobacco-Use-Disorder.pdf
[63] Practice guideline for the treatment of patients with substance use disorders. Accessed June 2, 2026. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/substanceuse.pdf
Until next time…
Notes:
I create these newsletters as a personal project. They are not affiliated with any current or past employers or groups with which I volunteer. I receive no financial compensation for my efforts to create these newsletters. Thank you to those who have offered to fund this project and compensate me for my time and effort. This is my gift to those interested in nicotine. Community service is important to me. Volunteering is something I have done since I was a child.