Separating Nicotine from Tobacco: A Public Health Story for India’s Amrit Kaal

Over a million Indians die prematurely due to tobacco use. How do you address this public health crisis?

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(Photo: istock/Altered by FIT)

Under India’s historic presidency, the G20 Summit held in early September received well-deserved acclaim, both domestically and internationally. India is increasingly being considered a major global player – politically, economically, and industrially. 

India’s thorough preparation was evident in the 200 pre-summit meetings held across 50 cities, addressing wide-ranging issues from climate change to education.

Notably absent, though, was a robust discussion on the state of global public health and how India could assume a leadership role, as it did during the COVID-19 vaccine rollout. 

While leaders have turned their attention to health emergency preparations and exploring the use of digital technology, sadly, there is a lack of real focus on non-communicable diseases (NCDs) and health issues stemming from an interplay of unhealthy behaviors, genetics, and environmental factors.

Considering the World Health Organization's data that NCDs such as cancers, cardiovascular disease, lung disease, obesity, diabetes, and mental illness are responsible for 74 percent of global deaths, such oversight should be deeply troubling.

Importantly, poor mental health contributes to all non-communicable diseases in varied measures and has a substantial impact in diminishing the societal gross happiness index.

That data alone is a stark reminder that the NCD crisis in public health should be on everyone’s minds.

And while there is undeniable value in the renewed focus on pandemic planning and navigating the complexities of artificial intelligence in relation to health, it shouldn’t be at the expense of the ongoing erosion of the population’s physical and mental health.

Tobacco and Public Health: A Crisis at Hand?

Consider the growing tobacco-related disease and death burden as a case in point.

A problem that the “developed” world has wrestled with for the past five decades now threatens to plague countries such as India, China, Bangladesh, and Indonesia for the remainder of this century.

These two figures can help you understand that the magnitude of the problem is undeniable.

• 80 percent of the world’s 1.3 billion tobacco users live in low-to middle-income countries.

• India alone is home to nearly 300 million users of smoked and smokeless forms of tobacco.

This data is especially concerning when coupled with the fact that all of these individuals are putting themselves at significant risk of cancer, heart disease, and other chronic illnesses.

Over a million Indians die prematurely due to tobacco use. Where do you even begin addressing a public health crisis of this scale?

An Alarming Knowledge Gap at Play

Logically, it should start with doctors prescribing evidence-based medicinal nicotine products such as gums and patches to patients who want to quit their tobacco habit. 

A recent survey funded by the Foundation for a Smoke-Free World revealed that a startling 90 percent of doctors in India mistakenly believe that nicotine in tobacco products causes lung cancer.

This misconception not only hinders efforts to help smokers quit, but it also casts doubt over the medical community’s ability to offer accurate cessation counsel to their patients.

The same survey highlighted that while 94 percent of Indian doctors agreed that helping patients quit smoking is a priority, nearly half stated that they lack the appropriate training to do so effectively.

This knowledge gap is alarming, especially considering the high stakes involved in combating tobacco-related NCDs.

This becomes particularly important among clinicians who see smoker patients with severe mental illnesses. Smoking worsens mental health issues and reduces the efficacy of medications.

However, most mental health professionals de-prioritise smoking cessation over treating the presenting complaint.

Their lack of confidence in prescribing medicinal nicotine to smoker patients results in poorer mental health and physical health outcomes among their patients.

If our clinicians aren’t equipped with the right education and knowledge on preventing NCDs caused by tobacco use, what chance does the general public have?

If it was easy to quit by simply being told to do so, there wouldn’t be any smokers on this planet.

Behavioural counselling and nicotine replacement therapy are a cornerstone of tobacco cessation treatment.

It is imperative that doctors receive proper training to dispel these prevailing myths about nicotine among themselves and then among patients. 

Nicotine & Tobacco Cessation Model is The Future

India’s relationship with nicotine has evolved over 75 years of independence.

As a major tobacco growing nation and exporter, the nicotine in tobacco plants has brought wealth and security to hundreds of thousands of farmer households.

Millions of women earn a livelihood from bidi rolling. But they also suffer from transgenerational health issues due to their tobacco exposure.

Coming into the final quarter of a century as an independent nation, Indian entrepreneurs are successfully churning this sea, separating the poisons from the tobacco and extracting clean pharmaceutical grade nicotine for tobacco cessation, largely for the export market.

Nicotine’s consumption for pleasure and its protective role in neurodegenerative disorders and cognitive behavioral benefits are still uncharted areas needing much more research.

Clean medicinal nicotine’s role in tobacco cessation is not in doubt though.

Neither is nicotine’s dependence-causing potential, therefore, needing strict regulation and sales only to current adult users of tobacco.

If this nicotine is understood properly by doctors for its role in quitting tobacco and made available and affordable in India in well-regulated safer forms for tobacco cessation, a massive health dividend will be reaped by the country for generations.

This nicotine and the accompanying cessation model can then be exported worldwide – in line with 'One Earth, One Family, One Future', especially to the developing nations, bringing prosperity in health and wealth for all.

If that is not Amrit Kaal, then what is?

(Dr Sudhanshu Patwardhan is a UK-based medical practitioner and a nicotine expert. This is an opinion article and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)