With liver disease and health in general, my motto is to make the healthiest choices I can. I embrace the harm reduction model. The harm reduction movement began by dedicated activists and health care workers seeking social and health justice for people who use drugs. Strictly speaking, harm reduction was designed to serve drug users. However, the notion of harm reduction is so practical, I apply it more generally.

Harm reduction accepts that humans do the things they do, but offers support for reducing the potential harm they may incur as a result. Providing needle, syringe and other distribution services to reduce risk of infection is an example of harm reduction. Another example is offering substitution therapies that substitute illegal heroin with legal, non-injection methadone or other prescribed opioids. Equipping our communities with naloxone that provides an antidote to opioids to reverse an overdose is a third example.

I try to be cautions when applying the term ‘harm reduction’ to other health issues, mostly because I don’t want the strength of the term to ever be diluted. The health consequences of drug use are dire in the United States and drug use needs to be kept in the spotlight until the problem is sufficiently addressed. Keep this in mind, as I talk about another drug, one that injures the body more slowly…nicotine.

Research has long shown the potential harm that smoking has on the liver. Smoking causes cancer and is especially harmful to the lungs, cardiovascular system, brain and other body parts. Smokers with hepatitis C have a higher rate of liver cancer than nonsmokers. So when electronic nicotine delivery systems better known as e-cigarettes came out, I immediately thought of harm reduction. Surely vaping was safer than smoking, especially regarding liver disease. However, I was wrong; very wrong.

In the June 2019 issue of Hepatology (E‐cigarettes and Western Diet: Important Metabolic Risk Factors for Hepatic Diseases), Kamrul M. Hasan and colleagues reported results of a 12-week study using mice who were fed a western diet and exposed to nicotine aerosol versus those exposed to saline aerosol. Mice who were exposed to the nicotine aerosol experienced many alterations in liver function. The researchers concluded that the results demonstrated profound adverse effects on the liver from the nicotine delivery system.

Quitting nicotine is hard, very hard. If you want to quit using nicotine, get some help. Talk to your medical provider about this. Some pharmacists are also trained to help. The Centers for Disease Control and Prevention is a great resource for tips and information on how to quit.