A tale of two epidemics: drugs harm reduction and tobacco harm reduction in the United Kingdom

Abstract

Purpose The purpose of this paper is to compare the response to HIV/AIDS and drug use (drugs harm reduction) with tobacco harm reduction. Design/methodology/approach Analysis of historical and contemporary sources, combined with personal knowledge of key stakeholders in the history and development of both fields. Findings Both drugs harm reduction and tobacco harm reduction share a similar objective – to reduce health risks for people who are unwilling or unable to stop using their drug of choice. Both also share a broader public health aim of helping people to make healthier decisions. Drugs harm reduction – as a response to HIV/AIDS – included the adoption of a wide range of radical harm reduction interventions and was a public health success. It became an established part of the professional Public Health agenda. In contrast the Public Health response to e-cigarettes and tobacco harm reduction has ranged from the negative to the cautious. A recent Public Health England report is exceptional for its endorsement of e-cigarettes. Originality/value Highlights contradictions in Public Health responses to drugs and tobacco; and that public health interventions can be implemented without and despite the contribution of professional Public Health.