Hi everybody. I'm Brent Stafford, and welcome to another segment of Reg watch on GFN TV. We spend a great deal of time on this broadcast discussing issues around harm reduction, specifically as it relates to tobacco use in what is now a decadelong struggle to convince public health regulators and the public that nicotine vaping products are a safer alternative to smoking. Advocates the world over have turned to tobacco harm reduction to help make the cakes. But is it working? Joining us today to tackle this question is one of the founders of the drug harm reduction movement, Dr. Alex Wodak. Dr. Wodak is a physician specialized in internal medicine and he's the former director of the Alcohol and Drug Service at St. Vincent's Hospital in Sydney, Australia, where he worked from 1982 to 2012. During his career, Dr. Wodak helped establish Australia's first needle syringe program and first supervised injecting facility when both were PreLegal. He also served as president of the International Harm Reduction Association. Dr. Woodach, thanks for coming on the show. Great pleasure, Brent. It's great to see you. Before we begin, a quick note to our viewers here on GFN News and it's a bit of a cross promotion. Part two of today's interview with Dr. Wodak is scheduled for release on our main region social media channels and on regulatorwatch.com in just a few days. So keep watch for that. Dr. Wodak, right off the top, tobacco harm reduction. Is it a valid application of the harm reduction principle? Yes, it's a very valid application. Look, harm reduction has been used for all the different kinds of drugs alcohol, tobacco, prescription drugs, illicit drugs. It's most well known for its application for illicit drugs but we use it widely in the drugstores and also in public health and generally in public policy, particularly in road safety where outside the drug it's generally harm reduction is not controversial, it's not difficult. So what are the core principles around harm reduction? The central focus is reducing the adverse consequences of a risk behavior. So we still try to reduce the extent of that risk behavior but generally those efforts aren't terribly affecting it. What is very effective is focusing in on the actual harm and trying to reduce that. So of course, in road safety we try to reduce the number of road crashes and the severity of road crashes. Those efforts continue, they have some success. But the real success in road safety is with harm reduction. So car seat belts, airbags motorcycle helmets, incredibly effective. And the same thing goes in the drugs field. Where the drugs field gets difficult with harm reduction is because there's a pleasure involved that people are a little uncomfortable with. And we see that with other pleasures where there's also some harm, particularly sex. A lot of people are comfortable about sex and drugs and people getting pleasure from that. And that's where introducing harm reduction often is quite difficult. And it certainly is difficult with drugs harm reduction. So then considering drugs harm reduction and the pleasure that's involved there, I guess from the user, how does that extend to tobacco harm reduction? Is it just about the nicotine then? Is that the issue that people have a problem with is the pleasure from using nicotine? Yes. There's a lot of opposition in the tobacco control and public health field to nicotine, to cigarettes, and especially to big tobacco. So anything that seems to be dealing with those without taking a morally judgmental stand against them is seen as very threatening. And harm reduction avoids moral judgments both about the consumers of psychoactive drugs and so the producers of psychoactive drugs. It puts that aside and focuses on reducing harm and it's very effective in doing that. We don't see the natural drug harm reduction advocate totally getting out the posters and the signs and marching on behalf of tobacco harm reduction. They seem to be some of the most opposing people around. Look, public health, including tobacco control, has been pretty supportive of drug harm reduction until it involved tobacco. There is quite a history of harm reduction and in the drugs field it really became very prominent when the HIV epidemic emerged in the early 1980s and people started to realize that there was a very serious risk of major health. Social and economic costs resulting from widespread HIV infection spreading among people who inject drugs and then spreading from them to the general community and in probably up to a dozen countries that actually happened and it was very. Very damaging. So harm production emerged arguably in Liverpool, merseyside in UK in 987 with the term was used directly and round about that time in the Netherlands and the UK there was roaming support, including support for setting up legal syringe programs. And we had around that time a hell of a battle in Australia to get needle syringe program accepted. My colleagues and I resorted to civil disobedience to get that started in time. So it was very difficult. And even before that we'd had difficulty getting methadone programs accepted, even though the evidence was already very compelling that methadone programs were very helpful to people who use drugs and their families and their communities. And indeed, every new drug harm reduction intervention has been fiercely resistant in almost every country. Generally they get accepted eventually and then the next stage is they get expanded roughly to the scale that's needed. The next stage is people say why the hell didn't they tell us that these are so effective and so safe and so cost effective. And that's been the history with many drug harm reduction interventions. And I'm sure this is what's going to happen with tobacco harm reduction, that eventually the resistance will be overcome and the tobacco harm reduction options will be expanded and will prove to be enormously beneficial, save many, many lives, saved many, many dollars, and I think that we can look forward to. But in the meantime, in my 40 years of experience in this area, every new drug harm reduction intervention gets resisted to the hilt, and eventually we get there. And I'm sure that will happen here. But like you mentioned, though, regarding Big Tobacco in the other applications around drugs, there isn't this invested kind of emotional and professional investment in fighting Big tobacco. I mean, is it just a matter like a Big Tobacco hasn't been so shameful? Do you think it would be a bit different or a Big Tobacco, say, wasn't involved in vaping in any manner? Would that make a big difference? Look, I think there was similar kind of resistance with the needle syringe programs, for example, that the people who were advocating entrenched advocates for drug prohibition felt very threatened when we started to introduce something that really did work and was enormously beneficial to the community. And so they resisted the needle syringe programs. I couldn't fully understand why there was so much resistance when we had at that stage, HIV was not treatable. There was no treatment for it. And so it seemed obvious we had to hand out clean needles and syringes and take back used needles and syringes. Yet there was ferocious resistance. And I think this is the same. Careers are threatened, empires are threatened, organizations and their funding are threatened. And people who build up comfortable, successful careers feel that everything is at risk now. Well, I don't really care about that. What I care about is reducing cancer, heart and lung disease from smoking. 8 million deaths here in my country, there are more deaths from smoking than there are from alcohol, plus prescription drugs, plus illicit drugs, plus road crashes, plus suicide, plus HIV. It's a very big public health problem, and I'm sure this is the same in almost all countries. Dr. Wodak, from your position in watching everything unfold, do you think that public health has been participating in misinformation with regard to nicotine vaping and the efficacy and reduced risk? Yes, of course. Public health and tobacco control not helping by so vigorously spreading information they must know is wrong is simply incorrect. It doesn't make it any easier. But frankly, this is what happened with all the other battles we've had in drug harm reduction. They've always resorted to smear and fear campaigns. So people like me, my cars in other countries have smeared, and they've run campaigns that the harm reduction interventions, despite the compelling evidence for them that they wouldn't work and that they would and the sky would fall in. And we heard this with methadone treatments, with needle syringe programs, with drug consumption rooms, with drug testing, you name it, they've run the same kind of campaigns. And really, the campaign of disinformation with tobacco against tobacco harm reduction is really no different from what's happened previously. We do have another factor, though, this time, and that is that the tobacco harm reduction options are also disruptive innovation and that's another reason why they're going to be accepted. We have powerful market forces now which will steamroll these tobacco harm reduction options get accepted. The tobacco industry is about 1% of global GDP. It's about trillion dollars close to that. And many people in the tobacco industry realize that combustible cigarettes are obsolete, just like the analog cameras were obsolete and were replaced by digital cameras, just like the landlines we used to use 34 years ago were replaced by Nokia and then by BlackBerry and then by smartphones. The same thing is going to happen in this area as well. So I'm supremely confident that we'll be on the side of history and our opponents will be drawn into the dust. So, Dr. Waldak, let me ask you then about tobacco companies and their efforts to go smoke free. Is this something that is credible? Like, should we actually take tobacco, big tobacco's promise to go smoke free? If we want to see consumers of nicotine go from deadly options to much lower risk options, then clearly the people who produce those products have to also go from highly dangerous products. And cigarettes are incredibly dangerous. We also have to see the producers go down the same risk gradient from high risk to low risk. And we have to remember that Fort Morris International, the largest traded tobacco company in the world, actually began this process in 2004 when they stopped spending money on research into cigarettes and started spending money on reduced risk options. And they have spent between 2004 and now, they've spent $9 billion on that research. And they started marketing their reduced risk options in 2015 when these options accounted for only zero 1% of PMI's income. And in the first quarter of this year, they accounted for 30% of their income. And by 2020 05:00 p.m., I believe that they will reach their target of 50%. And of course, they want to make that transition. And the share market rewards tobacco companies that are making a faster transition by having a higher price. And if your tobacco companies being very slow in that transition, the share market marks your share price down. So I think it's very clear how this is going to end. And it's going to end so that people who like nicotine, who don't want to stop using nicotine will have safer options and let's hope they'll keep on getting safer and safer. Sounds like to me that no matter what, their business is so big, they are selling the product that is harming people. So the most important place for tobacco harm reduction to happen is that the tobacco company tobacco control certainly has an issue in terms of taking philip Morris and the other tobacco companies pledges to go smoke free, certainly worsen a grain of salt. They actually pretty much don't believe it at all. Look, I'm not faced by that. International drug control fought harm reduction every step of the way 25 years ago. My colleagues and I went to the headquarters of the World Health Organization in Geneva and we requested a meeting with senior executives. Which was granted. And we complained to them that who was opposed to needle syringe programs. And they were the International Harm Reductions Association held its annual conference in Geneva deliberately to engage with who sent a memo to its staff to bidding their staff to attend a meeting in their own city. So we requested that meeting. They granted the meeting, and then a year later, who and another organization came to our conference and they said, I am with you individually and we are with you organisationally. And they drop their opposition to drug harm reduction. So this is a familiar battle for me. I've been in this battle for 40 years, and every time my colleagues and I have started off in a minority, a tiny minority, we've been votified and ostracized, and over time people said, Maybe you're right. And then later on they said, yes, you are right. And then they said, you're even more right than you let us believe. And I think we'll find the same pattern with tobacco harm reduction. And it's sad to me that our earthquake colleagues in public health have been so concentrated, but that's their problem. Dr wodak is it fair to say then, that the war on vaping could be an extension of the war on drugs? It's very clear that the war on drugs has metastasized to war on vaping. And it's ironic that around the world we are now in the process of legalizing cannabis, regulating it, recognizing that all the complaints that my colleagues and I in the harm reduction and drug law reform field, all the complaints we made about cannabis prohibition were correct. And so now cannabis is being regulated for the first time. But in the meantime, there is a de facto ban being imposed on vaping. It's not being prohibited outright, except in a few countries, but it's being regulated so strictly, it's so hard to get or so expensive, that it's a de facto prohibition and the result will be the same. Dr woodak the opponents of the tobacco control, many in public health, are they open to debate? The opponents of vaping avoid debate whenever they can. That's certainly true in my country, and I think it's true around the world. And I guess that they've been given instructions to avoid the debate and avoiding the debate as they did with drug prohibition. They're avoiding the debate because it's a debate. They can only lose the facts, the evidence. The arguments aren't on their side. The arguments are on our side. So they avoid the debate and they resort to smearing us and they resort to fear campaigns. And to be honest, those tactics work for a while. They do. It's hard to fight fear campaigns, it's hard to fight smear campaigns. But those campaigns don't last forever. And they're delaying the inevitable. But they can't prevent it. Now we hear all the time in this debate over nicotine vaping that the damage. The concern is all about the kids. In the end, they're throwing adult smokers and adult users of vaping products under the bus in order to prevent the next generation of nicotine users. Now that does seem a bit familiar from the drugs war. The arguments of the vaping opponents and the opponents of other forms of tobacco harm reduction don't withstand scrutiny. They're preposterous nonsense and we need to say that. We need to call it out and eventually people will start listening to us because at the end of the day, the people who will make the policy decisions won't be the health professionals and the academics. It will be professional politicians. And the politicians will hear from the vapors, the consumers, the people who struggle for decades to smoking and were only able to do that by switching to vaping or other harm reduction options don't hear from many of them. And the secret of this is energizing the vapors, energizing the consumers, the advocates. They're the ones who will end this epidemic prevailing upon the politicians to change their mind on this. And I think this is going to happen. It's happened in the UK. It's happened in New Zealand. And it's significant that the politician who made that decision in the UK, david Cameron, Prime Minister in 2010, was an ex smoker and he understood the arguments. He knew that this was nonsense. So I think we're going to see this with pressure coming from both sides, from the consumers and also the producers. They don't want to produce deadly products. They know the products are deadly. They know that their products that have been so profitable for so long are obsolete. And they are. So is this fight winnable? Yes, the fight is very winnable. We will win this debate eventually, as we did with methadone treatment, with needle syringe programs, with drug consumption rooms, with heroin assisted treatment, with drug testing. They're hard battles, but eventually they're one in almost all countries. There are a few countries today that still stand out against drug harm reduction. Russia, Saudi Arabia, Singapore, they do exist. But every year there are fewer of them and there are more countries that accept it. And it's significant that no congressman was more active in writing legislation for the war on drugs in the United States. Joe Biden and now Joe Biden is President and harm reduction is steaming ahead in the United States. It's still got a way to go. But it's clear that support in the United States for the war on drugs is shrinking and support for effective harm reduction is expanding. That will happen here as well. You.