Mr D. Sweanor, Canada

Of the various forms of nicotine-containing products, tobacco, the most harmful (dirtiest) nicotine delivery system, is the least regulated. Tobacco products are cheap, widely promoted and easy to get, whereas alternative nicotine preparations are subject to strict regulatory control as pharmaceutical products.

This has created the “nicotine maintenance monopoly” in which nicotine causes dependence and the delivery vehicle causes the disease and the existing regulatory system forces all who want or need nicotine on an ongoing basis to get it from tobacco products. The health toll is quite high, but the potential to reduce this health toll is also significant, as most of the 1.15 billion cigarette smokers want to quit, or otherwise reduce harm.

Thus, there is a huge potential market but the present legal environment does not allow ´clean’ alternatives to replace the ´dirty’ nicotine delivery system. Regulatory change would be required to promote greater access to nicotine dependence treatment products and a wider range of indicated uses of these products for smoking reduction, temporary abstinence and longer-term substitution.

Only then will tobacco companies lose the ´nicotine maintenance monopoly’. To this end, drug regulators should enter into dialogue with nicotine experts, tobacco control experts and pharmaceutical companies.