A sample of a heated tobacco product.

The introduction of heated tobacco products (HTPs), considered a harm reduction approach, has reduced cigarette sales in Japan by 30 percent in a span of three to four years.

“Since 2014, three heated tobacco products have been launched officially nationwide in Japan and these have been penetrating 25 percent [of total smoking population], and this product has been successful to reduce cigarette smoking in Japan so far by 30 percent in three to four years,” Dr. Kumamaru Hiroya, a preventive physician specializing in smoking cessation, said.

Dr. Hiroya, the Vice Director of the AOI Universal Hospital in Kawasaki, said this decline in consumption was not observed after years of trying nicotine replacement therapy (NTP).

He said in contrast with NTPs such as nicotine patches which proved ineffective in reducing the smoking rate in Japan, the commercialization of HTPs like IQOS from Philip Morris International (PMI) in 2014 led to a significant decrease in cigarette sales.

HTPs are non-combustible alternatives to cigarettes that closely mimic the rituals of smoking without combustion process. These electronic devices heat, instead of burn, specially-designed tobacco units to release nicotine-containing tobacco vapor. Results of scientific studies show that tar and carcinogens found in tobacco smoke, causes the death and disease associated with smoking, and not nicotine.

In the United States, the Food and Drug Administration authorized the marketing of IQOS, the tobacco heating system of PMI, as a modified risk tobacco product (MRTP) on July 7, 2020. 

The FDA authorized the marketing of IQOS in the US with the information that the IQOS system heats tobacco but does not burn it, and scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces the body’s exposure to harmful or potentially harmful chemicals.

HTP users account for about 30 percent among Japanese male smokers and 25 percent among female smokers, while dual use of cigarettes and HTPs remains low at 6.9 percent among male smokers and 4.8 percent among female smokers, noted Dr. Hiroya. 

Meanwhile, the initiation to HTP use among 60,000 Japanese junior high school students was very low at just 0.1 percent belying fears of youth uptake, according to a study by Tottori University Medical School funded by Ministry of Health and Welfare.

Mark Dougan, Director of Transformational Health of the business consulting firm Frost & Sullivan, said the case of Japan, being the world’s largest market of HTPs, deserves to be studied because of the significant reduction in cigarette sales in the country.

He said they we’re focusing on the Japanese market because novel nicotine tobacco products (NNTPs) have been commercially available in Japan since 2014. It’s by far the world’s largest market.

Dougan noted that HTPs are based on the principle of eliminating combustion by heating tobacco at about 350 degrees Centigrade or less instead of burning. 

“While these products are clearly not risk-free, they do have the potential to serve as a complementary strategy to existing smoking-related interventions” for smokers who are otherwise unable or unwilling to quit cigarettes, said Dougan.

Smoking remains the leading preventable cause of death globally with more than 7 million people dying of smoking-related diseases each year. Dougan said the number of tobacco users worldwide declined only marginally from about 1.4 billion in 2000 to 1.34 billion in 2018.

“There is a significant group of smokers in both developed and developing countries who are unable or unwilling to quit using current approaches which is often quite ineffective in actually helping people to quit,” Dougan said.

The use of NNTPs, according to Dougan, is often seen as an appropriate intervention for helping them to stop smoking. “The use of NNTPs is based on the principle of harm reduction, specifically tobacco harm reduction.” he said.

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