Heat-not-burn products (heated tobacco or HnB) are electronic devices which heat processed tobacco without burning it (combustion).
Heating creates a tobacco-flavoured vapour containing nicotine which is inhaled by the user.
Typically, heated tobacco devices are rechargeable and consist of a holder and tobacco sticks, plugs or capsules. The tobacco is heated with an electronically controlled heating element. All these products are made by tobacco companies.
Most of the harm from smoking is due to the toxic chemicals formed during the burning of tobacco. HnB devices operate at much lower temperatures and form an aerosol with far fewer harmful chemicals than are found in smoke.
Are they safer than smoking?
The aim should always be to stop all tobacco products entirely as this will produce the greatest benefit to health. However, research so far suggests that HnB products release lower levels of toxins and are likely to be less harmful than smoking but not as low-risk as vaping.
In the most recent review, the US Food and Drug Administration in July 2020 has concluded:
- The IQOS system (PMI brand) heats tobacco but does not burn it
- This significantly reduces the production of harmful and potentially harmful chemicals
- Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals
A report by the UK Committee on Toxicity on HnB products concluded:
- They are probably less harmful than smoking
- There would likely be a reduction in risk for smokers who switch
- Exposure to compounds of concern is reduced compared to smoking
- A reduction in risk would also be experienced by bystanders compared to smoking
- In pregnancy, the risk to the unborn baby is likely to be reduced if using these products instead of smoking
Another independent systematic review in 2018 of the 31 studies to date found that ‘HnB delivered reduced levels of harmful and potentially harmful toxicants by at least 62% and particulate matter by at least 75%’ and ‘reductions of human exposure to toxicants varied between 42 to 96%’.
Most of the research on HnB products has been carried out by tobacco companies. Considering the past history of the tobacco industry, it is reasonable to be cautious and it is important for independent studies to be done on these products. However, the review above found that results were ‘largely similar for independent and industry-funded studies’.
Studies by Philip Morris International of their HnB product (here and here) both reported a reduction of more than 90% in a wide range of toxins compared to cigarette smoke. A British American Tobacco (BAT) study reported that the toxicant levels in the aerosol of their HnB product are about 90% less than in smoke. Another study by BAT found that the levels of toxins in the bodies of users were substantially reduced after switching from smoking to HnB products.
One independent analysis recently compared the harmful chemicals in the aerosol of a HnB product (aldehydes and volatile organic compounds) to cigarette smoke. The levels in the HnB aerosol were between 80-99% less than from smoking. Another independent study found a reduction for most toxins of 90% or more compared to cigarette smoke.
A further study found that a heated tobacco product emitted substantially lower carbonyl emissions compared to cigarettes. Carbonyls (such as formaldehyde, acetaldehyde and acrolein) are among the most toxic compounds emitted in tobacco cigarette smoke and have been linked to respiratory disease, cardiovascular disease and cancer formation.
According to a review by Public Health England, HnB products deliver similar levels of nicotine to the user compared to smoking and reduce urges to smoke. HnB products also retain much of the ritual and experience of smoking.
HnB products appear to be helping many smokers to quit smoking in countries where they are available. For example, in Japan and Korea, there have been substantial reductions in smoking rates from substitution by HnB products.
Are they legal?
Heat-not-burn products are not currently legal in Australia.