Comment intégrer, dans les pratiques, l’accompagnement et les outils de la consommation à moindre risque ? Le cas du tabagisme

Health professionals recommend to avoid smoking. But in the light of the controlled consumption concept, the question whether just reducing the number of cigarettes smoked per day has emerged. This strategy has only moderate effects on health and only on secondary clinical and biological parameters without any measurable impact on morbidity and mortality since 1) it is not the daily consumption level but the number of years of exposure that determines the risk of diseases and 2) while smoking less cigarettes, smokers compensate with extracting a higher level of nicotine from a cigarette along that of other toxic products. Only the option of combining nicotine substitutes would eventually avoid this pitfall. As in the case of other substances, starting with only lowering smoking rather than abstinence would have beneficial effects before an ulterior move toward abstinence. Thus, smoking reduction could be considered an intermediary step or a transition toward nicotine abstinence. Products delivering nicotine other than smoked cigarettes are reviewed: snus (powdered tobacco), inhalers, vaporizers, electronic cigarettes.