Recently, the concept of tobacco use as a chronic disease is increasingly discussed; as repeated cessation attempts are required to ultimately succeed in quitting. The strategy includes convincing patients to make repeated efforts to quit smoking so that they can ultimately remain abstinent for increasingly longer periods of time. Unfortunately, the majority of smokers do not make a quit attempt and thus continue to smoke until some of them are ready to change at some later point in life. Along the way, they continue their exposure to tobacco smoke.
Many smokers have difficulty considering quitting because they use nicotine as a form of self-medication; not just to prevent the symptoms of nicotine withdrawal but for the antidepressant effect or the improvements in cognition that they experience.
New data on "Nicotine Sampling" or "Structured Quit Attempts" suggest that even patients who say that they are not ready to quit can modify their smoking behavior.
The National Health Service of Great Britain recently approved a guideline supporting the use of nicotine containing products to assist smokers in remaining abstinent, reducing their smoking level or just quitting on a temporary basis. Building on these concepts, Health Republic Insurance of New Jersey has approved a policy on Tobacco Harm Reduction.
The choice architecture for smokers is now altered. Harm reduction represents an intermediate state between an active quit attempt and continued smoking. The concept of Tobacco Harm Reduction is not without controversy. Electronic cigarettes are also being discussed as a form of tobacco harm reduction. Health Republic’s policy Is limited to FDA approved medication.