Yesterday, NNA trustee Lorien Jollye took part in a half day panel debate at the Royal Society of Medicine entitled “Regulation of Pleasure”.

It was an eclectic event which encompassed topics as diverse as illicit drug use and consumption of online pornography, and was attended by around 40 interested medical practitioners and students. Lorien’s contribution was to recount “My relationship with nicotine” and she received much interest from the attendees during the question and answer sessions.

Focussing mainly on her effortless transition to using e-cigarettes after all other means of smoking cessation had failed to deliver successful results in her case, she explained how vaping had transformed her and her partner’s lives because it was not only healthier but also fun. This was also touched upon by fellow speaker Dr Chris Russell of the Centre for Substance Use Research who described how traditional smoking cessation clinics are not enjoyable places for smokers to attend; “We are asking people to give up pleasurable products in ways which are not pleasurable”, he explained. 

This is something the NNA understands very well as put forward in an article here in February entitled “The Pleasure Principle”.

An holistic approach to vaping would recognise that its success as a popular alternative to smoking is not simply down to whether particular devices deliver sufficient nicotine to relieve cravings (although that is an important factor). To pretend otherwise is a mistake. Vaping is a thing of many parts, and the neglect of any one of them is to the detriment of the whole. It is a recreational activity in its own right and brings pleasures of its own.

Editor of Drug and Alcohol Today Dr Axel Klein had earlier set the scene for proceedings by referring to “the pleasure economy” into which licit and illicit drugs can be categorised. This economy is created by demand which has existed throughout human history and is – as Danny Kushlick of the drug use think tank Transform highlighted – one of the world’s largest markets.

Merlin Hay, the Earl of Erroll, further pointed out that every culture throughout history has always had a “drug of choice” and it is futile to believe that all drug use can be eradicated. Society regards certain drugs such as caffeine and alcohol as acceptable but at other times – most notably during Prohibition in the USA – has held different views. Therefore, the goal of regulators should not be to pursue a campaign of puritanism because it is doomed to failure, but instead to manage risk and implement policies which are beneficial to public health overall but which make allowances for the natural human instinct of indulging in pleasure-seeking behaviour.

An example of how this has been badly managed in the recent past was emphasised at the event by Jeff Stier of the National Center for Public Policy Research, who referred to the case of snus in tobacco control policy. In jurisdictions where snus is legal, remarkable benefits to public health have been observed across the board, yet snus is banned in the UK and throughout the EU except for Sweden. In what can be seen to be a real life ‘experiment’, the smoking prevalence rate in Sweden is now by far the lowest in the EU at around 8%, proving that well-designed harm reduction policies work. And work very well.

During her speech, however, Lorien advanced the opinion that harm reduction in the field of nicotine use has been hampered by an environment of ‘denormalisation’ towards smokers which is tainting the debate. “We wouldn't judge someone for having a cup of coffee, but we do judge people using nicotine”, she said to explain how negative attitudes towards smokers have led to a general distrust of harm reduction avenues such as e-cigarettes. These are often encouraged by certain factions within tobacco control who shun increasingly strong favourable evidence, refuse to sanction any other approach than medicalised withdrawal from nicotine, and who would prefer prohibition over sensible harm reduction approaches.

If we are to create better outcomes, then, the emphasis for regulators in the field of drug use should not be to forbid pleasure but instead to utilise it by embracing harm reduction as a tool which permits natural human instincts in a way that benefits society as a whole.

Regulating for lesser harm is a valuable goal to society, regulating pleasure out of existence entirely in order to do so is not achievable and is not in the interests of public health or the public’s enjoyment of life. Low risk tobacco and nicotine products fit into enlightened policy-making and it was heartening to see the Royal Society of Medicine hosting a wide-ranging event like yesterday and medical practitioners recognising that there is an alternative to an antiquated view of all drugs – including nicotine - as being inherently and incorrigibly bad.

Martin Cullip, NNA Associate