Regulatory imbalance between medicinal and non-medicinal nicotine.

Cigarettes are very efficient, but exceedingly 'dirty', nicotine delivery systems. Although nicotine creates dependency, it is the contaminated delivery system that causes tobacco-related harm. With an annual global tobacco market > USD$300 billion, and a large proportion of the > 1 billion tobacco users seeking to avoid the 50% risk of death, there should be a huge market for alternative nicotine delivery systems. A move towards risk reduction could significantly benefit public health, provide consumer choice and allow free market forces to combat the leading cause of preventable death. However, market forces are currently prevented from providing consumers with the risk-reducing products they want because of existing regulatory systems. Tobacco products have been exempted from consumer protection laws, but there are no such exemptions for other nicotine delivery products, e.g. NRT. This has resulted in an exceedingly uneven playing field for nicotine products, with the most harmful products subject to little regulation while the least hazardous products are stringently regulated. In effect the world is upside-down, and nicotine regulatory systems should be reformed in order to maximize the reduction in risk. In addition, regulatory bodies need to: develop nicotine- and tobacco-specific expertise, rapidly evaluate which products should be permitted and decide how these products should be marketed. Appropriate regulatory structures could harness the power of free enterprise in global efforts to control the tobacco epidemic. This can be done through the development of regulatory processes designed to ensure that all nicotine delivery products are considered in relative terms (regardless of source), and ensuring that all regulatory action strives for the greatest practical reductions in risk.