Abstract
A new generation of tobacco harm reduction products is stirring controversy and confusion among healthcare providers. These products, known as "potential reduction exposure products" (PREPs), can be described in terms of reported scientific evidence, as "the good, the bad, and the ugly." On the good side, there is sufficient scientific evidence to support the use of Commit(TM), a new over-the-counter nicotine lozenge PREP, approved for smoking cessation. On the bad side, there is no scientific evidence to support the use of Ariva(TM), another over-the-counter nicotine lozenge PREP, marketed as an alternative to cigarettes when smoking is restricted. On the ugly side, both of these PREPs are nicotine delivery systems with "candy-like" appearances; however, one (Commit(TM)) has the Food and Drug Administration (FDA) approval and the other (Ariva(TM)) does not. This article provides an overview of PREPs and strategies to help clinical nurse specialists (CNSs) address tobacco harm reduction issues.
A new generation of tobacco harm reduction products, known as "potential reduction exposure products" (PREPs), 1 is stirring controversy and confusion among healthcare providers. Clinical nurse specialists (CNSs) recognize the toxic health effects of tobacco everyday, whether listening to adventitious breath sounds or interpreting abnormal chest x-rays or facilitating smoking cessation clinics. In addition, CNSs have a history of advocacy initiatives 2 and leadership roles that impact patient and organizational outcomes. The commitment to promote the health and well-being of individuals, families, groups, and communities is core to the mission of the National Association of Clinical Nurse Specialist (NACNS). 3 Because of their direct influence with patients, families, and staff, CNSs may soon be submerged in "the good, the bad, and the ugly" issues with the newer PREPs being introduced by the tobacco and pharmaceutical industries. This article provides an overview of the significant problem of tobacco dependence in the United States, advances with approved and non-FDA approved PREPs, and CNS strategies for effective tobacco harm reduction advocacy.