Extending THR into other disciplines and communities, is essential. Obvious targets are in the fields of drug use and mental health - evidence is clear concerning levels of smoking and associated health risks - but there is need to engage more widely. The panel addressed the barriers to extending reach, including how can we dispel myths and tackle miscommunication? What role does the media have in the process? Who are the key opinion leaders and groups, what are the initial steps in reaching out and how can we support ongoing dialogue?
Transcription:
00:11 - 05:35
[Martin Cawley]
Good morning and welcome to the last but one session at GFN25. My name is Martin Cawley. I am, I guess, an independent management consultant now, but I spent my career in the health and social care sector in Scotland. working with people with drug and alcohol issues, people involved in the criminal justice system, people with mental health problems, people who are marginalised for lots of different life choices or situations that they found themselves in. So I have a background to a degree, but tobacco harm reduction, I have to admit, is not my specialist subject. However, I will try to navigate this session in a way that makes it the most engaging and interesting that we can. I'm sure there'll be other people join us as we go along, but we'll kick off as it is. We have four colleagues at the table here, and this format will be similar to the discussion formats that we've had in previous sessions. I'll do some introductions in a minute, but I'll ask each of my colleagues here to speak for five minutes on this subject matter, which is basically who else should be in the room? How can we engage better? How can we create a better dialogue and a more consistent and perhaps less adversarial dialogue with the key stakeholders that are involved in tobacco harm reduction? That's the theme for today. So each of my colleagues here will talk for a few minutes and then we'll get a bit of a conversation going in the room. We're scheduled to have about an hour and a half. Whether we are able to last that long, given the numbers in the room, I don't know, but we'll be very flexible. One of my jobs as chair is to try and manage our time accordingly. I have to admit I'm not very good at that. Being a Scot, I can talk for Scotland, basically, talk for a long time. And actually, I was speaking at a conference once And I had 15 minutes to speak and I realised that I was watching the chairperson getting really anxious and nervous and agitated because I had been over my time by five minutes. I was about 20 minutes, so I could see the chair getting really upset and anxious about this. And so I turned and I apologised. I said, look, I'm really, really sorry, but I don't have a wristwatch on and there's no clock in the wall. And someone from the back of the hall shouted, yeah, but there's a calendar on the wall behind you, mate. So I'm very conscious of time. We'll try and make sure that we manage our time accordingly. My wife asked me before I came here about the conference. She said, what's it about? I said, tobacco harm reduction. She said, who's going to be there? I said, well, these are some of the leading thinkers across the world in this theme of tobacco harm reduction and tackling the harm of smoking, looking for safer alternatives to smoking. And she said, well, who are they? And I said, these are the senior leaders, researchers, academics, clinicians from across the world. These are the movers and shakers in this field. And she said, well, why are you going? What are you doing there? And I said, well, they've asked me to facilitate a session, so I'll go along and try my best to do that. And she said, well, for goodness sake, please don't try to be over-intelligent. Please don't try to be overly charming. And for God's sake, don't try to be funny. Just be yourself, she says, just be yourself. So that's a regular endorsement I got from my wife about why I'm here today. Can I introduce Michael Stoney, who's on my far right? Michael Stoney is one of the most senior and experienced leaders in the Scottish Prison Service. He's presently the governor of Scotland's largest prison, which is Barlinnie, based in Glasgow. And Mick will convey his views from a perspective of that environment and how harm can be reduced in relation to the prison population. Next to Mick is Sharifa Ezat Wan Puteh. and I hope I've pronounced that Sharifa properly. Sharifa will come from a much more clinical physician, public health, health economics perspective. She's held many positions in Malaysia and is a highly respected, highly experienced and well-recognised figure in her country and beyond, and even in this room, to many of you. To my left is Garrett McGovern. Garrett is a GP based in Dublin and works with a population of people who come from deprived communities who experience some of those marginalised issues that I think are very thematic and important and focus on the work that we do. And lastly, we've got Adriana Curado, who is from Lisbon in Portugal. And Adriano will come from a consumer community advocate perspective. She's worked in the drugs field for many, many years and is highly respected in her field in her country again and beyond. So the contributions that we have on this theme about how can we elicit these voices and use them to infiltrate the other stakeholders that are involved in this field of tobacco harm reduction. Okay, so that's the ground rules. Without further ado, I think, maybe Sharifa, let's start with you. I think the audience would be really interested in hearing your perspective, particularly from that, the bridge between policy, lived experience, and the economics that sit behind this issue.
05:36 - 10:43
[Sharifa Ezat Wan Puteh]
Thank you very much, Martin, and thank you for the opportunity. Very good morning. I think the issues of harm reduction, I'm coming from a sort of LMIC, Malaysia is so-called upper middle income. Most of our policies are referred by Ministry of Health. We are sort of a very strict government country and we look up to WHO. We are one of the signatories for WHO FCTCs. and most of the so-called health policy are governed by the Ministry of Health. Of course, they are debated in the parliament and things like that, and the consumer groups would actually, you know, they have their voices as well. But most of it are really coming, it goes down to the Ministry of Health, and what policies are involved are usually emulated from other developed countries, so OECD countries and so forth. Coming to Malaysia, most of this they look upon, let's say, Australia on tobacco control, Australia has one of the highest or very strong stringent tobacco control, and most of these are looking into DR, mean Australia, New Zealand, and also UK. We were colonised by Britain for so many years. Everything is based on NHS and so forth. But having said that, we are very strong in harm reduction. very strong. We have methadone replacement therapy, needle exchange program, hard for HIV, LGBT high-risk groups and so forth. But if you talk about THR or tobacco, this is very much looked down after and when we don't have a chance. Most of us, me coming from a so-called a public university as a researcher, as academic, of course we train students and so forth, But we also have an NGO. I'm leading the Malaysian Society for Harm Reduction. We have tried to engage with not only consumers, but also with the doctors as well. Now, we have done many, many rounds of talks with them. Generally, the GPs and addiction specialists, from my personal view, they are very attentive, and they know the problem, because some of their patients do not get off addiction from tobacco. Even though they are having lung cancer, they are having COAD, they cannot breathe, but they just cannot let go of the cigarettes. Then, hence, they look after the NRT, which is what we call the traditional cessation in Malaysia as well. It doesn't really work. Most of the success stories are basically rhetoric. Most of these are either very much controlled groups. Real-life evidence shows that it's not really very high, the success rate of NRT in Malaysia. And we need an alternative. This is where we start talking with the GPs, with the addiction specialists, and some of them have come on board and helped us as well. However, having said that, with so many success years, the issue comes about with another policy, which is tobacco control enforcement. What happens is that we have a huge avalanche of illicit products, unregulated. I know this is a big issue with many countries as well. To show how big is the problem is that almost 60% of our tobacco are illicit. That's tobacco. We don't know how big is the percentage for vapes and all. I can assume it's almost as big as that, about 50% as well. Most of the illicit vapes would come from mainland China, some of the nearby countries as well. And what happens is that the enforcement is not very strong. We don't even have a regulation for e-liquid, meaning that if you look at EU or UK or Australia and so on, most of the e-liquids are being tested, quality controlled, but also toxicology reports. So what happens in Malaysia, we don't have that yet. So the influx of all these vapes on the market creates a confusion not only among the consumers but also among doctors because most of the illicit vapes are being tainted by drugs, including amphetamine, ecstasy. The recent is fentanyl, that creates a big hoo-ha among the states, and most of the states now are trying to ban vaping. Basically, it's to curtail the issues of epidemic among the youth. When that happens, there's also a new law that regulates tobacco products, but also vapes, shisha, hookah, which is a big thing in Malaysia as well. And it creates such a stringent regulation, which is in a way good, you know, because it deters the smoking and vaping and so forth. But another aspect is that you cannot talk about vape as well. You cannot promote that. It cannot be seen as a smoking cessation. So what happens is that most of us has gone underground, including the doctors, because we are not able to talk on that. We are going to be penalised in a way. So, hence, you know, the future does not look well at this point in time, but we hope that, you know, we have more opportunity to speak out in this problem because the people that have no intention to quit is actually quite huge as well in Malaysia, yeah, among the users.
10:44 - 11:10
[Martin Cawley]
There are a number of themes there that deserve further explanation, but I think maybe best just to hear from our other panel members and then we'll perhaps explore some of that a bit further. Garrett, from your perspective. And you work in the heart of Dublin. You know the communities, you know the people. These are regular attenders at your clinics and your practice. So from your perspective, where is their voice best heard and come to the table?
11:10 - 18:26
[Garrett McGovern]
Well, I think, I mean, I'm in this addiction specialism, I suppose, for nearly 30 years now. And what is interesting really is the fact that we've never really taken smoking seriously. It's never talked about. I don't think I've ever been to a clinical multidisciplinary meeting when anyone's ever mentioned the word smoking, which is quite interesting. If you talk to patients and you have that little brief intervention, often they'll say, well, you know, come on, doc. I got off injecting heroin and I'm doing much better now. I'm bringing my tablet use down. I mean, it's one of my little enjoyments. And, you know, then when you start to talk about patients who, like I've had patients who over the years have developed very direct problems from smoking and And we know what all those problems are. The most common are COPD, emphysema. And maybe I'll just tell you some of my experiences. And I've often told this story, and anybody who's heard it, I'm sorry that you have to hear it again, but it's a story that I like to tell because it really will kind of centre... what one of the problems we have in Ireland about misinformation about electronic cigarettes and indeed safer nicotine alternatives. So I have a lady, she's since passed away, which is very sad. She had COPD. She had recurrent pneumonia from one of her lungs was particularly bad and prone to infection. And she had to get a pneumonectomy and get the lung out, which improved her health. But she could never really crack a cigarette habit. She was smoking between 30 and 40 cigarettes a day. She could hardly walk from here to the end of the room without being extremely breathless. She was on all sorts of things, domiciliary oxygen, the whole shoot and match nebulisers. She was on everything. One day, when I was in the clinic, she was seeing her respiratory specialist in follow-up after getting her lung taken out. And she came in, I think, late morning to my consultation. And I said, how did you get on with the... He said, yeah, he's very happy with me, everything is good. I said, did the issue of smoking come into the conversation? Because I know you've found it very difficult to give up smoking. He says, no. He says, I need to get away from cigarettes. And I said, did he ask you about what you've tried over the years? And I said, oh, yeah, I've tried the gum. And she didn't try the tablets. She didn't want to go on the tablets. And she tried doing it herself. And I said, did the subject of electronic cigarettes come into it? And they said, it did. I said, I asked him a specific question, what about electronic cigarettes? And he kind of recoiled and said, under no circumstances take electronic cigarettes or try them. And if you do, you're no better off than smoking. Now, this is somebody who is very, very versed and experienced in lung health and the damages of smoking. And this person... who gave the information across. And this is a very authoritative person. And I struggle. I struggle with this. And I struggle with it a lot anyway. And we all struggle with this. The whole session this morning was about misinformation. I mean, the theme of this every single year is misinformation. How could anybody give that advice to somebody? And particularly somebody so vulnerable who'd lost their long life. who has COPD, who's a heavy smoker. And I see this across the board in my country. You mentioned electronic cigarettes, and either you have a few different groups of people in my profession, you have people who are very hardened in their view about the harms of electronic cigarettes, as far as they see it, And then you get other people who lazily enter the debate. They don't read very, very much. And they arrive at conclusions about the popcorn lung, about youth epidemic, nicotine and the developing brain. And it's almost, common sense is almost impenetrable in these people. And I don't know whether there's a herd mentality to this. I struggle. People say, I've asked me, what's the medical profession's view to safer nicotine alternatives? Things like snus and pouches and electronic cigarettes. And I said, that's a great question, but I actually don't know the answer to that because there's a few thousand doctors in Ireland, but there's only actually a few who talk about this. I stand to be corrected. There may be other doctors in Ireland who are fairly vocal about electronic cigarettes. I don't know who they are because I haven't met them. So I'm very vocal about safer nicotine alternatives. And there's a group, unfortunately, in number greater than me, but not much greater in number. So we're talking about four or five fairly prominent doctors in Ireland... who, without too fine a point, laid the boot into electronic cigarettes. And I think what we all agree on, and this is the horrible part of this, is that one of those stories with the two lungs going up, and there's more and more of it now on social media, popcorn lung, to reverse the sort of damage that that does to the consumer, because at the end of the day, this topic today is about who else should be in the room, Well, if nobody else is in the room, the person who should be in the room is the person who is the smoker, the smoker who wants to quit. We had a tobacco bill in Ireland, I think last year, the year before, And consumers, their voice wasn't heard. That's astonishing. You'll remember anyone who works in the drug field, the slogan was always nothing about us without us. In this space, there's everything without us because they kind of believe the state way of doing it is you're gonna do it our way because our way is best for you. And we're looking at some, like every year at GFM, this is my third GFM, I think I was talking to Clive Bates about this, you sort of get more pessimistic. We do great work here, but disposables now in the UK and Ireland have been banned. And the big one now is flavors. That's the last sort of bastion defending electronic cigarettes. If flavors get banned and there's a tobacco-only flavor in the country, it's just obliterated it as an intervention. It would be gone. So I think we've got a lot of battles ahead. And we're all talking about what we need to do. And we all kind of talk about we need to get the truth out. We're not doing probably anything different than we've always done, but I think somebody said it this morning. It might have been Konstantinos. We're losing that battle, that misinformation battle. We're kind of losing. We've got to think of more inventive ways of countering the BS, to be honest with you.
18:26 - 19:10
[Martin Cawley]
Thanks, Mark. Whilst you've presented a pessimistic picture there, I think when we get into the question session, let's try and do that with the theme of hope and aspiration and opportunity because the change or the shift in momentum has to originate from that basis. Adriana, you're well experienced in the drug and alcohol world and well experienced in the harm reduction world where you had to fight those battles many years ago where harm reduction methods and services and routines are much more established and effective now. So from your perspective, how can that learning be enhanced, embraced, and developed more in the tobacco harm reduction world?
19:11 - 24:43
[Adriana Curado]
Thanks, Martin. And it's great to be here and to have the opportunity to, I think my role here is to speak how we can engage more armed reduction community into tobacco armed reduction. so i want to start by saying something that is very well known that this community is heavily affected by tobacco smoking but somehow we we are not really addressing this problem as as Garrett already said. I think many times I think about that, I think we have normalized tobacco use with our clients. And many, many times, tobacco is left out of our reduction conversations. But I think we clearly need to change that. And I want to talk about, because the armed reduction movement is evolving, it's not the same that it was in the 90s or in the 80s, so I think it's becoming a truly intersectional movement that looks at multiple layers of risk and vulnerability and that goes to the roots of social inequalities. And it's also a movement now that understands very well the need to come together across multiple causes and struggles. So at this point, I don't see any reason to divide harm reduction into separate silos, depending on the substance. Tobacco should be part of the conversation, just like opioids, stimulants, alcohol, and many other substances. And we have this, I think it's very powerful, grassroots and consumer-driven movement that certain we need to give voice to the people. And we are grounded on the urgency of saving lives, of improving quality of life and well-being. And we are relying on human rights, on evidence and on participation. But I think, and I wanted to talk a bit about this, the problem we are facing on the ground, and I'm now thinking in armed reduction services, conventional services, It's something else. So, of course, we can raise awareness in the community. We can train frontline staff in tobacco harm reduction for sure. And there is a lot of interest. But if we don't have the safer products, safer nicotine products available, if we are not able to give them for free to people who use drugs, to people who are living in the streets, to people who are facing very tough conditions in their lives, we are not achieving the change we need to achieve. And we need long-term support because this is not only about changing behaviors or about individual choice. It's about collective shifts and about changing a culture. And just to finish, I want to say something about, I want to push back on something that I keep hearing, that is, harm reduction for illicit drugs is well accepted, but for tobacco it's not. In part, this is true, because we have a lot of harm reduction programs, but we still don't accept the main, the core harm reduction measure that is touching the illegal drug markets. We still don't accept that, that we need to regulate, as we do not accept still that safer nicotine products are a legitimate public health strategy. So we are still stuck in this prohibitionist mindset. And we all know that a drug-free world is a mirage, and people will continue to use nicotine. And they will continue to use alcohol, opioids, and many other substances. So this is not something to be feared or demonized. It's something to be regulated with quality standards, with safety for consumers. So we need to make sure that people have safer choices and are not left with the most harmful once. Thank you.
24:43 - 25:31
[Martin Cawley]
Thank you indeed. Michael, a large percentage of the prison population were smokers. Thank you. They come from often deprived backgrounds and areas of high deprivation and poverty. Scotland introduced the smoking ban many, many years ago. So alternatives were something that was very much in the attention at the forefront of the prison services' mind at that point in time. So from your perspective, how... How has that landed? What's the prison population's views on vaping opportunities within prison? Is there things changing? Is there contraband that comes into play in that respect? So just a few comments from yourself to help the audience understand the perspective in that world.
25:32 - 31:41
[Michael Stoney]
Thanks, Martin. Just for context... The prison I work in is a large adult male prison. It holds 1,400 individuals on average. It's designed for 987, so there's a fair amount, 40% overcrowding, which does compress and cause further issues in terms of when you get to make decisions such as removing tobacco-based products. We, around about 2018-19, we decided through some research studies and some pressure from staff unions and other groups about the quality of the air purity. So we did some research on the fine particulate matter as a proxy measure for secondhand smoke and the results were very conclusive that we need to do something. So the decision was made to remove tobacco from prisons and make prisons smoke-free. That was a good decision but caused major concern for the operational practitioners such as myself. The reasons why we decided to look at could we introduce vapes, was there any operational or security issues that that would cause? And the reason we were doing that was not one for, or was not driven by giving people an alternative in the sense of harm reduction model. It was more about we like to keep roofs on prisons. And we didn't want the roof to come off when people reacted badly to the decision to remove tobacco from prison. So tobacco has been a long-standing prison currency. It is intrinsically involved in prison culture. So it was a matter that governors and fellow governors were really concerned about. Do we have a viable alternative? So at that point we started to consider introducing the vapes. We also increased our access to nicotine replacement therapies and others. So prisoners started to make legitimate choices about 44% increase in uptake on nicotine replacement therapies prior to the removal of tobacco. We also decided to offer vapes for free in the initial phases. Three months prior to the tobacco being removed, we issued vapes to everybody who wanted one and the free pods. We continued to do that right up to the point of implementation. and post-implementation what we did was for a year to subsidise and gradually increase the price of these products until within a year it became normalised. What we saw remarkably was no incidents whatsoever in the prison, no reaction to the removal of tobacco, and vapes readily and well adopted immediately in the prison, which was to great surprise how well it went. It has continued to go well. So some of the follow-up studies, just to give you some context, which made most people pretty happy, was within one week of removing tobacco, there was an 81% reduction in fine particulate matter. and within six months that rose to about 91% to totally clean air. Also the other indicators we saw, we've seen a 9% reduction in prescriptions for respiratory issues as well across the prison. The other bit we were concerned about because we tended to see And the consumers in this room will probably tell me in terms of support for people. We often used tobacco as a mental health support for new admissions coming in. They were really struggling, chaotic, under pressure. So what the staff would do is give them a cup of tea and a cigarette, and it calmed people down in their first night. and gave us less cause for concern in terms of suicide risk and other aspects of mental health. But we see no increase in mental health referrals or prescriptions post-tobacco. So the vapes did seem to have the exact impact we were looking for. The decision making, just to give a context, I don't know if it's relevant to this group, prisons operate on legitimacy and power. If I make decisions in prison, they have to be wholly legitimate or individuals will vote through action. And that action is never often nice. So we have to be very careful of not abusing power and making decisions legitimate. So this seemed to be a well-accepted, legitimate decision and well-formulated. That was accepted by the prison population. And the reason why you worry is, to give you context, between 6 o'clock and 9 o'clock at night, I have 72 staff in the prison and there are 1,400 people. So if anything goes wrong, the odds are not in our favour. And that's why we need to always maintain that balance of legitimacy and power. But some of these arguments are reflective of what I'm hearing this week in terms of consumer and the people who won't listen, and the science and the people who won't listen. There seems to be lots of mirrored issues to explore. The other bit, just before I finish, is I wondered why I was in the room, to be fair. I've took a lot away from this few days, especially on what we've ignored as transition to the community. We've not done anything regarding supporting people making a transition to community. I'm developing and building a new prison and we've tried to consider every aspect of that prison in terms of salutogenic processes, biophilic design, green space everywhere, but not once I've had a conversation about smoking, tobacco, reducing harms. So this timing has been very good in terms of our prison design and our thoughts about reintegration and re-entry to society and supporting people through What I'm hearing from the consumers in this room is a very passionate and powerful response.
31:42 - 33:39
[Martin Cawley]
A fascinating insight into that world, Mick, and again, there are themes popping into my head that I think are worth exploring further. You know, the thoughts just occurred to me, ladies and gentlemen, that there are two Glaswegians and a Dubliner on the panel here, and we're renowned for our accents being very difficult to understand, so this must be a tough gig for the translators this session, I have to say. But we'll do our best to try and speak slowly so that you understand us as well as possible. So, you've heard some four really interesting and slightly different perspectives there, and I think there was a common thread permeating throughout, in relation to the acceptance potential of, are seeing tobacco harm reduction in the same way as any other harm reduction mechanism and not segmenting various substances for different reasons. That being the case, if we accept that smoking is bad for you, tobacco or alternative nicotine products are less harmful for you, it seems like a very simplistic argument. So why is it so challenging? to overcome these misperceptions or misinformation or to engage the right people in the right room at the same time. Maria said that this morning, it's understanding those in your supply chain. That wasn't our words, but that's the way I was thinking about it. But you work in any industry, understanding the needs, issues, agendas, motivations of those in your supply chain. And the better you do that, potentially and arguably the more successful you'll be within your business opportunity to get In this subject, that feels a really difficult barrier to overcome. So why is that? Let's have a conversation about that. Any questions from the floor? Yes, gentleman there. There's a microphone coming shortly. Oh, no, there you go.
33:39 - 35:30
[Alexandro Lucian]
Thank you. My name is Alexandro Lucian from Brazil. Before I ask the question, I have to give a little background. I was here, I think, the first time six years ago in the introductory session. My first question was why the World Health Organization was not here at the time. I think Clive Bates answered that it was really a challenge. Coincidentally, the last few days I was, because I am an activist in Brazil, I stopped smoking thanks to vaping in 2015 after 15 years of smoking more than three packs a day. So vaping saved my life. So I work often in engaging in social media and I was engaging with a female doctor, I think was a pneumologist. saying that vaping has more nicotine than cigarettes. I was answering and giving all these sources. And then after a few iterations, she blocked me and deleted all my comments. So my question is, what to do when the other party doesn't want to be here? But the question is, who else should be in the room? And I think the other party must be in the room. But they are not willing to. to be here? This is my first question. The second question is, since six years ago, the question is the same and the answer is the same. They are not here. So the panel thinks that this is going to change somehow, and what can we do to change that? Because we, yesterday Inácio was saying that we want them to be here. We are not invited to their events, but we want them to be here, they won't come because they are not willing to be here. So what to do about it?
35:31 - 35:41
[Martin Cawley]
This was touched on by Konstantinos in the last session, of course. Sharifa, maybe rather unfairly, I'm maybe going to ask you to make the first contribution.
35:42 - 38:41
[Sharifa Ezat Wan Puteh]
Thank you very much. I have the same questions. I have the same questions. Anyway, we do what we can. I think number one is that the consumer association or groups must be strong. We need to maybe talk to them, liaise with them, in a silent manner or with our own engagement or whatever entities that we are able to do, talk to the consumer groups. Some of the consumer groups are very, very strong in certain countries. In Malaysia, some of the consumers who are pro-government are very strong, less on THR consumer groups, but we need to engage with them and we need to empower them so that they will be able to ask good questions to their parliament members, to their stakeholders and so forth. And for them to actually request the liberty or the options to choose, that means there are options which are including alternative tobacco products. They must demand that this alternative be present in the market, or at least available for them, either through prescription, maybe like Australian model and so on. But they must demand that the options be available for them. The consumer groups are very important. I think these are some of the most important strengths that we need to tap into. They have a say, and sometimes we just have to liaise with them to say that this is your right to demand certain extra resources options that's available rather than maybe traditional NRT or quit smoking clinic. Besides that, especially for people who are not able to quit using the traditional or the usual manner. I think that's one, the consumer group. The second part is that if we are able to talk to some other medical fraternity that is on board with us. Some of the medical fraternity or friends or basically people who work in this area, they are around, but we are not able to reach them for certain reason. So they might come on board and help us in our course as well. I've seen that happening. Of course, they might have certain positions after some time, but I think we need to find and continue finding certain friends in our fraternity and so on. I do understand that's an uphill battle. Example for my country, a lot of the The associations are very pro against THR, but there are certain associations or certain physicians or doctors, especially doctors who see, example, patients who we see OED, lung cancer, that cannot just stop smoking, so they know the actual situation. And we need to engage with them, and we need their voices, because if not, they will interpret the one that advocate as being paid by the tobacco industry and so on. It's basically just you, you and you, you know? So you have to get other people as partners as well. Yeah, I think that's my two point.
38:43 - 38:57
[Martin Cawley]
Adriana, would you like to add anything there? I mean, I think what we're hearing there is elevate the user voice through a human rights lens in many respects and target the right audiences to listen as best as possible.
38:57 - 40:07
[Adriana Curado]
I totally agree to what has been said about the consumer movements, but I was thinking in another strategy to involve policymakers into the discussion and the policymakers that are in these high positions in the international bodies and national governments. Maybe we need to do the same that we did for drug policy, is that to bring former policymakers into a kind of a commission. They can be advocates and they can reach out their peers. I don't know if this was already done. is to invite former presidents and former prime ministers in some countries to be advocates in this field. I'm not sure if this work out, but I think politicians many times won't come here because they are not between peers, maybe.
40:08 - 40:51
[Martin Cawley]
The question was very specific. I was actually looking around the room there to see if Gerry or Paddy were in, and Paddy just left not so long ago there. Jess, Jess, I'm sorry to target you in many respects. But in the framing of the agenda, when you're thinking about who to invite, when we're looking at the contributions from the various stakeholders that are concerned, so in those planning stages, I know there have been attempts to try and engage a different audience. So where do you think, from a GFN perspective, those major barriers have been and what attempts have you tried to navigate a way through that? Can we have a microphone down the front here?
41:00 - 41:45
[Jessica Harding]
Yes, we do try very hard to encourage people in other areas to come to GFN. I think the biggest barrier to it is the toxicity of this debate, to be honest. People fear that they will suffer reputational damage if They come here to talk about consumer products that are unfortunately associated with an industry that deservedly has a bad reputation for what they have done in the past. I think that's the major barrier.
41:45 - 42:06
[Martin Cawley]
And the stigma that's associated with that. Sir, I apologise that we wouldn't be able to specifically answer your question to get the World Health Organisation here, but what you've heard back is a range of different avenues to try and infiltrate a bit further and a bit deeper. Yes, sir. Gentleman at the front here.
42:11 - 43:17
[Danil Nikitin]
Hello, Danil Nikitin from Kyrgyzstan, from Glory Foundation. So I do feel that we, I mean, just answering the question, who else should be there in the room? Religious leaders. So just a couple days ago, Vladimir, you were speaking about it. I mean, those are people, Christian leaders, Muslim leaders. For example, let us take the Muslim community. During Ramadan month, for 30 days, people who used to smoke, giving them those safer alternatives maybe would be a relevant solution. And maybe religious leaders should be advocates who would be able to promote this idea. For Christians who are practicing fasting restrictions throughout the year, for them it also can be a solution. And, I mean, why not try? Religious leaders from Central Asia, from Middle East, from Europe, If they meet somehow at a separate round table, or maybe at this forum, maybe next year's, why not explore?
43:17 - 43:47
[Martin Cawley]
Again, there's a view for looking at institutional organizations to try and engage a population of people through those communities. You can see a logic in that. I think some of the themes that we've touched on are those institutional barriers that are policy, a strategic policy in public health perspective. So there are two ways in my mind to think about that, at that strategic level, but also at that grassroots level, yeah. So that's a helpful contribution. Yes, the microphone here.
43:48 - 44:25
[Cecilia Kindstrand]
Cecilia from Swiss Match. I think, sort of, I'm based in Brussels and I've seen it from a political perspective from Brussels, and... I think when it comes to the broader scope of harm reduction, it's often endorsed by the left side, whereas tobacco harm reduction has been sort of endorsed by the right side, where you have more freedom to choose kind of argumentation. So my question is, do you think that there is an issue of bringing tobacco harm reduction into the broader harm reduction discussions because it's politically tainted?
44:27 - 47:31
[Garrett McGovern]
Thank you. Absolutely, I do. I don't know what the delay is. We were in Bogota and there's been a bit more at the Harm Reduction International Conference. There's a bit more discussion. I think it's been neglected by the wider harm reduction family. I don't know why. We know how many people every year die from tobacco-related illnesses and we also know how many people who use drugs die particularly opioids, people on substitution treatments, 80, 90% of people smoke. I often say to my patients, it's a very morbid conversation to have, but if something else doesn't get you, probably the biggest risk factor that will contribute to your death is gonna be cigarette smoking. I don't know why it has not taken on. It wouldn't take much. It's such a conversation that is very, very easy to have. I think we're changing a bit. I think we're beginning to enter that space now, and it's long before time. And you raise an interesting point about the right in terms of tobacco harm reduction and the left. That's very, very true. And I would make this point that many of the people in my own community of drug harm reduction are kind of anti-vaping or not really well disposed towards vaping. And when I got involved in this area, which is about 10, 12 years ago, it made complete sense to me. And all the sort of principles of drug harm reduction were the same. So, you know, we all know about needle exchange and supervised injecting centers and heroin assisted treatment and opiate substitution treatment and all those things. We know that that reduces harm and it reduces death. So here we have a product that does a kind of a similar thing. I mean, it's very, very different in many ways, but it does a similar thing. I thought it would have caught on in the wider harm reduction space. Not only probably has it not, certainly at the rate I would like to see it happen, but also some of them are anti-vaping. And dare I say, these are people who fought, some of them warriors, for drug harm reduction for decades, and yet they'll come back and say, oh, isn't that more harmful than smoking? It's just lazy. I mean, if we were to adopt that view with opiate substitution treatment, you know, we just see bodies in the streets. But for some reason, it seems to... One of the things I will say about tobacco, which is very different than the other drugs, is... One of the reasons I think that smoking isn't taken seriously is because it's probably the only addiction where really, by and large, the harms are to one's health. If you look at all the other drugs, their life can unravel. Very, very few people's life unravels because of smoking. It's a personal health thing. And I think because of that, people do not take it as seriously as maybe they ought to.
47:31 - 47:32
[Martin Cawley]
Adriana, do you want to...
47:33 - 49:02
[Adriana Curado]
add anything to those points I think I already addressed a bit I don't see any reason for this divide honestly and I think the scenario is changing and we are bringing in And Bogota conference is an example. It's more, now I have more space for tobacco reduction. And honestly, I don't, but it's different bubbles, maybe. I don't see any of this anti-vaping near my circle, so... And when we work on this community initiative in Lisbon about tobacco harm reduction, and I spoke to a lot of other colleagues in harm reduction, we did some training together, and I saw a lot of interest. Because we are also among people who work in harm reduction, we also have a lot of smoking among staff so people were really really picking up the products as well and asking questions and asking for advice and so I my experience it's the opposite I don't see any anti-vaping impulse let's say so I think things are changing
49:04 - 49:10
[Martin Cawley]
Okay, we'll move on. I think we've got another question down here at the front. Just in the front row here.
49:15 - 50:33
[Attendee]
Maybe you just answered my question, Adriana. You know, Portugal decriminalized all drug use in 2001, and they have been a beacon for the world, right? Decriminalizing support, don't punish. And I'm just wondering in Portugal if vapes and tobacco harm reduction is really being embraced because, again, leading the world in decriminalizing and support don't punish people who use drugs. I would have thought that Portugal might be leading in tobacco harm reduction because you've had decades of we help people who use drugs. throw them into prison. So I'm just wondering, and I know that Jao Gulau, who is sort of the drug czar in Portugal, he's either a smoker or he vapes. And what is the landscape in Portugal in terms of tobacco harm reduction? Because again, just pioneering a new way to work with people who use drugs. So I know it's a big question, but I'm just really curious. Adriano?
50:35 - 52:24
[Adriana Curado]
The problem is that the National Drug Agency takes care of illicit drugs and alcohol. But tobacco, it's a completely separate public health program, very under-resourced, underfunded with just a few people. They don't even manage to update data on smoking. So this National Drug Agency, they could take tobacco, I agree, and it would be more easier to put harm reduction as a core strategy into tobacco interventions and programs and policies. But there is this divide, institutional divide, and it's been difficult. And in my short experience in tobacco harm reduction, we tried to reach out some senior top officials in the Ministry of Health to talk about this, and they were just... suspicious and the reason is that what Jess already mentioned they are thinking that they can be contaminated by this industry plot so they don't even want to hear about it and I think we are also have a problem in the medical professional We are not having health professionals to get good quality information. They are spreading many times. I'm sorry to say this, but they are spreading misinformation.
52:26 - 53:01
[Martin Cawley]
Mick, I'm going to ask you a very specific question. But before doing that, I'm just going to challenge your own thinking a wee bit. So have a thought in your own head about why are you in the room? What's your personal motivation for being here And secondly, an ally to that, if there was someone in your network that you think isn't on board with your way of thinking and looking at this, who would you invite along to try and help, you know, build the momentum further? So have a think about that and maybe just come and ask a couple of people in the audience and see what kind of responses we get. Mick.
53:02 - 54:13
[Sharifa Ezat Wan Puteh]
Can I just say something as well? I think in some of the countries, including in my country as well, tobacco or basically tobacco harm reduction is being seen as a propaganda of big tobacco. Even though it has started by small, medium-sized companies, just local vendors producing e-cigarettes and so forth, but in the end, when the big tobacco also started producing e-cigarettes, e-cigarettes and vape. So the local vendors are being swiped off as saying that, okay, this is a big tobacco industry as well. So when that happens, nobody wants to engage and talk to us about harm reduction as a whole. And when we start talking about harm reduction, they say that this is a propaganda to get youth being addicted, when at the same time, what we're trying to say is that this would work especially for smokers who are not able to quit, who are just not successful to quit. It's seen as an alternative. So they have the propaganda saying that tobacco harm reduction is a harm for the population and it backfires on us when we try to engage with them. So that is another aspect.
54:13 - 54:53
[Martin Cawley]
The framing of the message becomes really, really important. And the session a couple of days ago engaging the media within that context I think exposed some of those issues. Michael, I'm just thinking about the example that you gave earlier on where smoking was ceased in the prison, where you introduced alternatives to that. There must have been a range of stakeholders that you had to engage to navigate your way through that in the build-up. So who were they and what sort of observations did they make? Or was it a general acceptance that this is the most positive thing to do? Or was there kickback at any point?
54:54 - 55:56
[Michael Stoney]
I think there was a fair bit of engagement with the primary stakeholder, which was the prisoner. So that was our main focus of concern. We did have good partnership with NHS at the time in terms of their extra support in nicotine replacement therapies and trying to put in something that would help us over that hump of introduction to that. Interestingly, I think, to answer the previous question and Garrett touched on it, I think there's an unconscious bias that there's no need for some harm reduction. And the only example I can give is my own unconscious bias, which I touched on earlier, was I'll put in place true care packages about housing, benefits, social supports, opiate replacement therapies. They all have to be in place. But I've never once considered that I've got through default of being in prison. Some days became smoke-free and using vapes. And I've never once considered a true care package to support that health change.
55:58 - 56:15
[Martin Cawley]
It's quite strange. And some people that you see coming back into prison who maybe have been on, maybe it's perhaps a couple of steps removed from the relationship, but has their smoking cessation continued post-liberation and then perhaps when they've come back in?
56:16 - 57:09
[Michael Stoney]
I think it's variable and I think it has reduced so they would maintain vaping but also access potentially smoking but there's a conscious choice on so most of the people in prison are from deprived backgrounds very poor economically and they will access choices they suffer a lot of life triggers they don't cope very well with life in general and the triggers may lead them towards whatever substance they can get a hold of including tobacco but they do maintain vaping at the same time so there's some level of harm reduction in there and some conscious choice to do that and when people come back in and we speak to them they'll tell us that but the trouble is they're concerned they're accessing black market cigarettes and things which is a concern for us Thank you for that.
57:09 - 57:15
[Martin Cawley]
Gentleman here in the second row, question Did you put your hand up there Fiona as well? I'll come back to you
57:17 - 58:20
[Rohan Pike]
Hello, Rohan Pike from Australia, embarrassingly. My question is also for Mick. Thanks for your presentation. Congratulations on the program. I wouldn't underestimate your value to this audience or a broader audience. It's a great case study. Hopefully it continues and you'll learn more things. But my question, you touched on it just at the end there about the illicit market. When you talk about legitimacy for the prisoners and, you know, They're now used to products that you've provided cheaply. Where are you going to go with the new vape and tobacco bill that the UK is bringing in? And is this going to inhibit your ability to provide products, flavours, et cetera, that the prisoners want and need? In the general public, as you say, they can go to the illicit market, but are you going to provide illicit products to the prisoners, or how are you going to get around that in terms of the legitimacy?
58:21 - 59:14
[Michael Stoney]
We're slightly clever. Only slightly clever. Are you sure about that? Through our prison shop, what we tend to do is add profit to certain products and reduce profit or cost at cost. So when it comes to vaping, there is no profit attached to the prison, but we will add profit. We need to achieve somewhere between a 5% and 10% profit within the prison shop to maintain it. But we add profits onto other items that may be not used so often to evidence the balance of profit. So we cheat a little bit in terms of doing that for things that we think are more legitimate to maintain low cost so that people would make their choices. And that's how we've navigated around it so far. There's always pressures on that, obviously, to try and continue that.
59:15 - 59:33
[Martin Cawley]
We've got quite a bit of time left, and I wouldn't labour everything, but does anyone want to ask any questions of these quite unique circumstances within prisons where we're touching on it? Anybody want to ask any follow-up? Fiona.
59:33 - 61:39
[Fiona Patten]
Thanks, Matt. Also from Australia, I'm sorry. But I've got a couple of comments, but also I think the... harm reduction via the prison system, we've got some of the most vulnerable communities going through that system and being touched by it, I think, is really impressive. In Australia, where we have a smoking ban in our prison system, we provide some patches when people come in. But I think in the research that we were looking at, 90% of former smokers coming out of prison start smoking again. So the patches, I mean, So it's great evidence to show that the patches did not work as a long-term reduction. So I'm still interested in how that's working for the prisons, but also whether you're seeing similar changes in behaviour with opioid replacement therapy. as well, because obviously that's part of it. But I just wanted to make two quick comments about who should be in the room. And I really liked this idea of religious leaders. I thought that was kind of out of the box and quite an interesting idea. And I remember when I was trying to get a supervised injecting room up and running in Victoria, in Australia, I got the religious leaders in the room and got their support. And the other group I had to get into the room was law enforcement. Now, I wonder whether there's room for law enforcement to be in this room. I mean, we've got former police officers like Rowan here, and former police officers are always so much better than they... Yeah, well, we've got Rowan in the room, but whether that is another group of people that should be in this room or could be in this room, because certainly in a place like Australia, they've been set up to fail. to try and regulate and to try to enforce a prohibition that has been absolutely impossible to enforce.
61:41 - 62:01
[Martin Cawley]
I'm thinking about both Mick and Garrett here because you'll both be involved in community planning initiatives where the police, you'll be sitting around the table with people at all levels of community planning, including the police. Are there conversations that are beginning to unfold at those gatherings? Mick, you first maybe.
62:02 - 62:19
[Michael Stoney]
Not necessarily in this area. Everybody's got their own individual perspective on matters, so people are more concentrated and focused on their own things, police or policing. Support is not maybe the first port of call.
62:19 - 62:33
[Martin Cawley]
Still very segmented thinking? I think so, yeah. But if you look at the broader determinants of health, the absence of illness is only just one determinant. There are so many others that are part of that process. Any contribution you'd like to make?
62:35 - 64:15
[Garrett McGovern]
Fiona knows what's happening in Australia, so there's a very, very direct involvement with the police. We are about to see the impact of disposables being banned, and God forbid that we lose flavours, then it is going to be a policing issue because people are going to illegally obtain these things in order to be able to use electronic cigarettes. This is the thing. I don't call them unintended consequences. I call them predictable consequences. Everyone says, oh, they'd be unintended. They're absolutely predictable, what happens when you prohibit anything. We know it from the wider drugs world, how devastatingly disastrous that has been. We seem to continue to make the mistakes. We're getting little pockets of this great work that they've done in Portugal. In my own country, we have a supervised injecting room, which is a step in the right direction. We've recently had a citizens' assembly on drugs. Maybe we need a citizens' assembly on tobacco. Maybe that might be a good idea. So I think the police are going to be involved, if not now. the whole thing at the moment is everything is quite quiet the sky hasn't fallen in because disposables are available or flavours it's a fairly calm market and we know this from alcohol and believe you me there's no bigger champion of dealing with alcohol related harm and all that that entails but at least you can go and enjoy a drink without persecution and harassment and yes of course the police can be involved that's not due to the legality of the drug yeah
64:16 - 64:43
[Martin Cawley]
I'm thinking about the introduction of the supervising jet to the clinic in Glasgow, which was only four months ago now. There was a whole range of community engagement in the lead-up to that, Fiona, so drawn parallels from what happened in Australia and in other places. And if you take a step back from that and look at it now, that's broadly been quite successful, to be perfectly honest, because you're anticipating some of those antagonistic views or opposing views. Sorry, Sharifa.
64:43 - 65:52
[Sharifa Ezat Wan Puteh]
Yeah, back to the issue of who should be in the room, I was thinking the media, I know that the media is here, some of the media is here, and we've already had a session on the media engagement just now, but just touching on how importance of data to the media, example, we've had some, there was some papers talking about COAD, COPD, occurring among vapors, and they code it as vapors COAD six times higher and things like that. But in the end, when we look at the paper, it was a relative risk paper. So meaning that if you compare this with non-vapors and you compare it with cigarette smokers, So back to the story is that when you engage with media, we always have to tell the media what is behind the scientific data. Sometimes they might misquote or misconstrue this. In the end, it becomes a hot topic somewhere, and quoting that, you know, smoking is less harmful than vaping, vaping is worse, and things like that. So I think the scientific community has a role not only to be here, but also provide good and informative information to the media as well.
65:53 - 66:40
[Martin Cawley]
Jess, again, so there are three very specific suggestions there that, you know, between law enforcement, community leaders, various, whether it's religious community leaders or otherwise, and how you frame the argument with the media based on strong foundation of evidence and data. I posed a bit of a question earlier on in thinking about you personally. Why are you in the room? Why are you here? That may be very self-evident. But the more interesting part of that was if you could have someone sitting next to you that you would like to try and influence. Was there anyone that gave that question a bit of thought? I'm reluctant to pick on people, but I'm tempted to, I have to say. Tony, I'm looking directly at you. So, yeah, microphone here.
66:43 - 68:50
[Tony Duffin]
That was totally predictable, Mark. So I'm Tony Duffin, and I've got a couple of roles. One of my roles is I'm the chair of the advisory committee for Correlation European Harm Reduction Network, and this is my first conference, so I'm well-versed in harm reduction generally for the last 30 years. I'm here to listen. As I said, I haven't been to one before. I'm here to meet you all and find out more. And if I had anybody else in the room, I know a couple of people from the leadership in terms of harm reduction across the world that I would have here with me or with us to listen. I do think that It's all been said already and it's completely obvious. It's to do with the industry's involvement or the perception, the reality and the perception of the industry's involvement that keeps people away. I do think that having worked with people who use drugs for 30 years, that tobacco is probably down here on the, it's up here in terms of harms, we know that, but in terms of priorities, it's down here somewhere with physicians and such. I think that harm reduction generally came about, and I'd make sort of general statements, but came about from a bottom-up approach in the 80s, and research and medics and all sorts of people came in sort of kind of after. Prisons were very much involved at the beginning in Dublin, Mount Troy and such, you know. Yeah, I'd look to get peers here. I think peer involvement is really, really important and co-production, co-design is essential. So more peers here. And just address the concerns around the industry really openly. and maybe just have more generic harm reduction involvement, just wrap it all up into... I'd worked around harm reduction in alcohol, but never around harm reduction in tobacco before in 30 years.
68:50 - 69:14
[Martin Cawley]
One of the things that I think people enjoy most about this conference is the strength of the consumer-led element to it. It's always been very strong in that respect and very welcoming. There are one or two people in the room from the tobacco industry themselves. I don't know if they would like to put forward a perspective. Again, I don't want to single anyone out, and I'm looking in the opposite direction now, but there, what about Cecilia again?
69:17 - 70:07
[Cecilia Kindstrand]
Thank you. I understand that we are a bit of a challenge to the wider cause, but I think we shouldn't underestimate the importance of the industry there, both when it comes to developing and marketing reduced-risk products. My company divested our cigarette business in 1999. Our main product has been banned from the European market. So it is... even if the industry has been trying, and we can see that with other big companies over the years and small companies, it is very difficult to get your voice heard. So we also feel a bit stigmatized, but we come from a fairly different perspective because we come from a well-off economics, but we can help, and I think we have helped, but we also understand that we are a bit of a kiss of death to have around.
70:08 - 70:38
[Martin Cawley]
I remember asking a question from British American Tobacco about the motivations for driving alternative products, you know, and the balance between the market demand for that and the morality that sits behind it. And clearly there is a market-driven motivation, you know, within the industry. And you see that in different parts of the world where the promotion of smoking products, tobacco products, is heavier and perhaps...
70:39 - 71:05
[Cecilia Kindstrand]
I think all products have to be produced by someone. It's the same with all products that you need in harm reduction. Opioid, I mean, in all the spaces, someone needs to produce it. And you can let the government produce it or you can let the private market produce it, but it will be produced by someone. And most often and more rational is to get enterprises to produce it.
71:05 - 71:11
[Martin Cawley]
The market could determine a lot. Yes, gentleman here in the middle.
71:11 - 73:12
[Mark Tyndall]
Great. My name is Mark Tyndall from Vancouver, Canada. I think we bought into this idea that this is being driven or the perception that this is being driven by industry. And we have to remember that industry is scrambling. This is a disruptive technology. Industry is quite happy with cigarettes. And In some ironic or bizarre fashion, when all these blocks are put to these alternative projects, I think that tobacco company executives are clapping their hands. I mean, they're quite happy with the profits they're getting from cigarettes, and the longer it takes to transition is in their favour. How we've got bought into this narrative that this is great for the tobacco companies, it's not. And they're worried and scrambling. And if we open this up to alternative products, they are alternative products. they leave themselves open to other companies and other challenges and things. And right now, the main tobacco companies have a monopoly on this. They're highly profitable. It's quite amazing that they can pay the American government $200 billion and not even blink an eye, basically. So they're quite happy with... us lagging and really losing the objective of getting people off cigarettes. So I think as a group here, we seem to have bought into this thing that, yeah, we're tarred and feathered with industry, but if we really look at the history of this disruptive technology, it wasn't industry's idea to come up with safer products. They've been driven into this, and the longer we let this slide, the happier they are.
73:14 - 73:19
[Martin Cawley]
Interesting points. Yes, Carolyn. Thank you, Mark.
73:27 - 74:19
[Carolyn Beaumont]
Thanks. Carolyn, clinician from Australia. Sorry, this is the little Australia area. A very important group for always advocating to have more health professionals in the room, but in particular, psychiatrists. So I've had a significant number of my customers, clients, patients, whatever you label them, been referred to me from their psychiatrist because the last thing the psychiatrist wants the chronically mentally unwell person to do is stop nicotine they want them to continue nicotine just not through smoking but they At least my experience in Australia is that they don't know where to start, they don't know what product to recommend, and especially they're needing the pharmacy access, they certainly don't know how to prescribe it. So I think psychiatrists get it, obviously, as anyone does in any form of addiction. So very important and a receptive group to involve.
74:21 - 74:32
[Martin Cawley]
Sharifa or Adriana, in terms of your work and engagement with other health professionals, including psychiatry, Is that heavily prevalent in the work that you're doing?
74:32 - 75:00
[Sharifa Ezat Wan Puteh]
I think from Malaysian experience, I think, Caroline, you're absolutely right. We have a huge group of addiction specialists. Most of them are psychiatry-based, and they are into addiction treatment and so forth. They are really into harm reduction, including tobacco harm reduction. They know the problem of addiction. They have a huge society as well, but sometimes they are quite reluctant to come forward, but they are one of our biggest supporters in Malaysia.
75:01 - 75:01
[Martin Cawley]
Adriana?
75:03 - 75:43
[Adriana Curado]
Yeah, I think it's absolutely crucial to involve mental health people. Because I think there is a huge link between nicotine use and mental health. And nicotine, and we talk more about the harms, but we should talk about the benefits of nicotine. And I think to bring psychiatrists and other mental health professionals, it's essential that they could advise and support people better in these transitions and to recognize the role of nicotine.
75:45 - 76:25
[Martin Cawley]
We are entering the last 10 minutes or so of this session. Now, let's just use that time if we'd need it all. Great. If not, we'll close a bit early. But the question of who else should be in the room, if there are any very focused suggestions or comments or observations that people like to make in addressing that core question. There have been three or four great suggestions so far, and I'm sure Jess and Paddy and Gerry will be thinking about how they can try and weave and target some people that might help, encourage and further debate. But any other questions or contributions that people want to add or make with the core question? Yeah, go on.
76:26 - 78:32
[Garrett McGovern]
Probably the most important room of all is the drug policy making room in parliament, whatever the title is. In my own country it's the Oireachtas. It's my kind of experience that the people who tend to be in that room tend to be people who are anti-vaping, anti-alternative nicotine products. There doesn't seem to be a balance. The user voice, the lived experience doesn't tend to be there. and people who would have a, I believe, a more enlightened view, and they would not call my view enlightened. There doesn't tend to be a balance in there. Politicians tend to bring in people that reinforce their own prejudices about these things. And this is a problem. It's been a problem in harm reduction. We've been brilliant in the wider sort of drug harm reduction world of challenging this and making sure we're in there. And that's the quality of the people. We talk about who. You can have all the professions and all the people you like, but it's also the quality of the people in there. Some people are just absolutely phenomenal at influencing people. I mean, Tony is here and we have our first injecting room. We've had a citizens assembly on drugs and we had a minister with the responsibility for drugs called Eoin O'Riordan who did what no other health minister with that responsibility did. And he went and decided that I'm no longer gonna look at the media narrative about this. I'm gonna actually educate myself. And he went around with Tony. They went around the streets. Tony showed him in reality what injecting drug use in the byways and the alleyways and the streets of Dublin and what it meant. And he educated himself and he's come out and he said, I had the same view most other people did. You know, drugs are bad, or injecting rooms, perpetuating addiction. I don't have that view anymore. And if we could have that type of approach with tobacco harm reduction, we might get places, we might be able to get politicians, change the hearts and the minds of politicians.
78:34 - 78:53
[Martin Cawley]
Before I ask my panel colleagues just to sum up maybe 30 seconds to a minute of their thoughts and observations on the core question and what message they'd like to leave the audience with, are there any other questions that anyone from the floor wants to ask? I think we probably will. We'll do Tony again.
78:53 - 79:27
[Tony Duffin]
It's not really a question, it's more of a statement, and I'll be quick. Fiona mentioned a moment ago about policing, and I think she's correct in many ways around the different forms of drugs, but in this one I think Mick is really important. in terms of what he's achieved in Scotland and we would do well to engage with the criminal justice side of the house particularly with prisons and see what more can be done because that is a phenomenal piece of work and I just want to commend him on that Thank you for that
79:27 - 80:30
[Martin Cawley]
I mean, I started this session talking about you guys being the movers and shakers and the thought leaders in tobacco harm reduction across the world. What other thought leaders and movers and shakers do we want to try and influence to express and progress your own motivations further? And that's a core question, I think, that this conference has tried to address in the number of years that I've been coming along and facilitating and assessing that. There's a saying that keeps, again, and I'll come to you first, Mike, but there's a saying that keeps going back into my head, and that's that if you tell me something, I'm more likely to forget it. If you show me something, I'll probably, or maybe remember it, but if you involve me in something, I'm going to really understand it more. So that notion of involving the right people with the right data and the right quality of narrative is crucial in winning the hearts and minds and the point you made, Garrett, of those people that still need that element of convincing. Michael, how would you like to close?
80:31 - 81:17
[Michael Stoney]
I just think the one that struck me was the gentleman's comment about religious leaders. And I don't know why you never thought of this before, but when we're looking to influence our local community, we tend to go to the natural leaders in that community. So I will seek out the boxing clubs and I'll speak to the guy that runs the boxing club because he's working probably with the most disadvantaged kids and the people who will probably come into prison and their parents. And we often ask their opinion on how they can influence people and what we need to do in terms of supporting that community. So I think more people who not get skin in the game, they've not got a vested interest, but they can be convinced and can become an advocate, would be really useful to be in the room. Thank you. Sharifa?
81:17 - 81:50
[Sharifa Ezat Wan Puteh]
Yeah, I think another person that should be in the room is the opportunity for funding, independent funders on tobacco harm reduction, because at this point in time, definitely not Bloomberg or something like that, but whoever is able to fund independent research and neutral research on the benefits of tobacco harm. At the moment, the data is so huge, most of these are being taken out of context. And some of the persons who quote this may not be able to screen whether this paper is of scientific sound material and so forth. So opportunity for funding is very important as well. Adriana?
81:52 - 82:17
[Adriana Curado]
I think we have already mentioned almost everyone. So I would say that we need more community representation, more diversity in this representation. I know that the consumer movement is here and it's important to be here, but more diversity would be important.
82:18 - 82:26
[Martin Cawley]
Garrett, I'll give you the last word. In terms of who we involve? Do you have any messages you'd like to leave the audience with?
82:27 - 84:37
[Garrett McGovern]
Yeah, I mean, it was a great point made earlier about why do, I suppose, the people with opposing views, who are generally very influential people, not come here. We have a tobacco control... conference in Dublin. I think it's next week. To my eternal shame, I wasn't really even aware of it. Maybe somebody might have mentioned it many months ago, but I think it was Clive Bates mentioned it. My understanding about that particular conference is that, surprise, surprise, they've kind of not permitted many groups to go in there. So I don't think there are going to be many who are singing to the choir as we are here in support of safer nicotine products, and I pretty much know what's going to be coming out of that. It's going to be very anti-vaping. The sad thing about tobacco control is they're very, very anti-vaping, and it's not... I don't know whether they realise this, but they try and blame vaping for... for in some ways stalling smoking reduction prevalence rates, which is absolutely absurd. You know, they've given no credit to safer nicotine products in the battle against smoking related harm. And I think we're gonna get an awful lot of that. I was very happy It wasn't my idea. I think it might have been Paddy's idea, but I was able to pre-empt what goes on next week. Brent, I don't think Brent Stafford's in here at the moment, regulator watch, but I was able to do a little kind of pre-emptive strike about next week. I'm hoping there's a bit of media coverage out of it so that there's balance because if there isn't, That worry we all have about this message getting across and involving the right people, that will be buried next week and even further. And in light of the disposables ban, it doesn't bear thinking about. And I don't want to be pessimistic about that, but it does worry me.
84:37 - 85:58
[Martin Cawley]
Let's try and finish now, a bit of a more positive note. I mean, my last role was, I worked for an organisation that was called the Beetson Cancer Charity. Now, the Beetson is the major cancer centre in Scotland, and it's synonymous with the quality of support that it offers people at those most challenging and intimate parts and moments in their lives. And I remember when you were speaking to fund audiences, we were trying to build fundraising opportunities and stuff, and I think hope is the underpinning message within that field, you know, the hope that tomorrow could be better today, that next week's going to be better than this week, and that next year's going to be far better than this year, and we're all living in a very volatile environment just now, so I think the messages for GFN is the hope that next year when the conference comes back, that some of these voices that people have identified today are contributing as vociferously as the voices that you hear, you've heard over the last few days. I told you earlier on that as a true Glaswegian Scot, I'm not very good at sticking to time. Well, for those of you that don't know, there's two huge monitors down here and there's a big clock that counts down and there is one minute and 56 seconds left. So I am very proud of myself. Ladies and gentlemen, would you please show your appreciation for your panel? Thank you very much indeed.