The Italian Society for Addiction Diseases (SIPaD) has published an official Position Statement on risk reduction in Tobacco Use Disorder (TUD), formally recognizing for the first time in Italy the clinical relevance of reduced-risk strategies for adult smokers who are unable to quit traditional cigarettes.
The document, titled “Risk Reduction in Tobacco Use Disorder (TUD): Critical Analysis of the Available Evidence”, reviews the scientific evidence surrounding smoke-free alternatives such as e-cigarettes and heated tobacco products (HTPs), considering them an intermediate option for cases in which complete abstinence is not immediately achievable.
Focus on smokers who cannot quit
According to SIPaD, smoking remains one of the leading preventable causes of disease and death, with particularly severe consequences among people with substance use disorders and patients with mental health conditions. In these populations, smoking cessation attempts often fail, while continued cigarette consumption significantly reduces life expectancy and worsens overall health outcomes.
In comments released to the press, SIPaD President Claudio Leonardi emphasized that harm reduction is already a well-established approach in addiction treatment and may also be applied to smoking when immediate cessation proves difficult.
“The final goal must always remain smoking cessation, but we cannot ignore patients who want to quit and are unable to do so,” he stated.
What the scientific evidence says
The document reviews a range of toxicological and clinical studies on smoke-free products. According to SIPaD, heated tobacco products work by heating tobacco without combustion, significantly reducing the generation of toxic substances found in cigarette smoke.
The society cites evidence showing that aerosol generated by HTPs contains 92–97% fewer toxic and potentially harmful substances compared to cigarette smoke, as well as a substantially lower number of chemical compounds overall.
Clinical studies referenced in the document show that smokers who completely switched to smoke-free alternatives experienced significant reductions in biomarkers associated with exposure to toxic substances, including carbon monoxide, nitrosamines, and volatile organic compounds. Improvements were also observed in markers linked to oxidative stress and inflammation.
SIPaD further highlights that several studies have shown improvements in respiratory and cardiovascular parameters among patients who fully replaced cigarettes with smoke-free products, including individuals with chronic obstructive pulmonary disease (COPD).
“Not risk-free” and not for young people
At the same time, the document clearly underlines that alternative nicotine products are not risk-free, are not medicines, and should not be promoted to non-smokers or young people.
SIPaD stresses that all public communication around these products must remain cautious, balanced, and free from promotional intent, avoiding any normalization of nicotine use.
The society also states that reduced-risk strategies should be considered temporary, carefully monitored, and integrated into a structured therapeutic pathway ultimately aimed at complete smoking cessation.
A debate gaining momentum across Europe
The publication of this Position Statement comes at a time when the debate around tobacco harm reduction is receiving growing attention across Europe and within the international public health community.
While health organizations continue to emphasize that the best option remains never starting smoking or quitting entirely, a growing number of experts argue that for adult smokers who are unable to quit cigarettes, reduced-risk strategies may represent a pragmatic option to lower harm and reduce exposure to toxic substances.
