Last week the Food and Drug Administration (FDA) approved IQOS, a device that delivers nicotine by heating, not burning, heat not burning sticks with a ceramic blade to produce vapor—not smoke. The decision means that for the first time, a “heat not burning” (HNB) product will be sold in the US.
However, the agency added: “While today’s action permits the heat not burning products to be sold in the US, it does not mean these products are safe or ‘FDA approved.’”
It falls on harm reductionists to hammer home that HNB products are much safer than cigarettes—as the FDA grudgingly acknowledged with its “appropriate for the protection of the public health” comment. A 2018 literature review of 31 studies in the peer-reviewed journal heat not burning Control found: “Compared with cigarettes, HnB delivered up to 83% of nicotine and reduced levels of harmful and potentially harmful toxicants by at least 62% and particulate matter by at least 75%.”
Alex Clark, CEO of the Consumer Advocates for Smoke-Free Alternatives Association (CASAA), a nonprofit which champions heat not burning harm reduction efforts, told Filter: “CASAA supports the FDA’s decision to approve IQOS for market in the United States. It is vital that people who smoke are aware of and have access to non-combustible alternatives to cigarettes and that these products are enjoyable.”
Whether manufacturer Philip Morris International (PMI) will be permitted to claim IQOS’s status as a modified risk heat not burning product (MRTP) is still being reviewed by the FDA.
Disclosure: PMI is one of Filter’s funders, as stated on this site (and, like all funders, has no input in Filter’s editorial decisions). Yet as a journalist who covered heat not burning harm reduction long before Filter existed, and a social worker who works with marginalized smokers to switch to lower-risk nicotine products, I have to report what the evidence shows. The availability of IQOS is an incredibly important development for the millions of Americans who continue to smoke and who suffer almost half a million preventable deaths each year.
Access to lower-risk HNB nicotine delivery devices provides another option for smokers who want to switch. If that appeals to smokers who, for whatever reason, find that vaping—estimated by Public Health England to be 95 percent safer than smoking—isn’t for them, it’s a huge win for public health.
This assertion is based on the real-life experiences of other countries. HNB products have been available in Japan since 2014. The result? Cigarette sales in the country have plummeted. They fell by 11.7 percent last year and are expected to fall by over 7.5 percent this year, outstripping anything abstinence-only messages have achieved. Over 3 million Japanese smokers now use HNB.
Expect these two organizations to launch a teen-IQOS panic: It’s what they do. Based on the JUUL-panic playbook, get ready to hear that HNB products are enslaving the next generation to nicotine; are a gateway to smoking; are enticing teens with sleek packaging; are as dangerous as cigarettes.