The excise duty on traditional cigarettes increases, decreases on smokeless inhalation tobacco. To be clear, we are talking about those cigarettes which, instead of being lit with a lighter, must be inserted in a special heater to be smoked. Among the most famous brands, we find Iqos, Glo e A plum: they are produced by the same multinationals that dominate the international tobacco market. But why the Meloni governmentin the 2023 Budget law, has provided for an increase in taxes for the classic “blondes” and, instead, has eased thetaxation about these alternative products? Intuitively, one would think that the type of cigarette with the higher excise tax causes more damage to health than the other. “There is currently no one direct comparison between the two cigarettes can scientifically evaluate the damage differences» explains a Open a renowned Italian pulmonologist who, however, asks to remain anonymous. «Studies have been carried out on traditional cigarettes which foresee a subject’s exposure of 20, 30 years to smoke. These heated tobacco ones, on the other hand, have been around for a couple of years».
The pulmonologist believes the lower presence of tar in the new type of cigarette without combustion is undoubted, «but other substances are present and chemical processes take place which can damage the lung in different ways. Before assuming that one does less harm than the other – he concludes -, it would be necessary to analyze an extended population of individuals with different characteristics and follow them for a long time, which cannot be reduced to a handful of years». In the maneuver approved by the Council of Ministers, the excise duty on traditional cigarettes, in 2023, will increase to 36 euros for a thousand cigarettes. It is estimated that, for the consumer, a pack of 20 cigarettes could cost up to 70 cents more. In the same article of the draft, number 28, in letter b of point 4 – the one concerning smokeless inhalation tobacco – we read: «In article 39-terdecies, in paragraph 3, the words: “and at 40% per cent from 1 January 2023”, are replaced by the following: “al 36,5% from 1 January 2023, to 38% from 1 January 2024, to 39,5% from 1 January 2025 and to 41% from 1 January 2026”».
Numbers that listed in this way say little, but going to recover article 39-terdecies, in force from 1 January 2021, “Provisions on inhalation tobacco without combustion”, we have the confirmation that the Meloni government has decided to lower the excise duty of 3.5 percentage points. We will have to wait for the 2026 so that the excise duty on smokeless cigarettes returns to the level established by the previous budget laws. «Today we consider it probable, but yet to be definitively proven, that these new cigarettes have a lower risk of causing neoplastic diseases. It is a fact, however, that smokeless cigarettes cause bronchioliti o organizational pneumonia». Talking is Luca Richeldi, pulmonologist at the Gemelli University and professor at the Catholic University, specialized in diseases of the respiratory system. He says he is concerned about the diffusion of inhaled tobacco because it is too recent a product to know all the negative effects on health. And he gives an example: «During the post-war period, doctors advertised to use the classic“ blondes ”, the risk of lung cancer was still not known. It took fifteen years to prove it. Even for these new types of cigarettes, today, we have to wait at least another ten years before being able to classify the long-term effects».
Richeldi: «These new cigarettes risk encouraging smoking rather than making people quit»
On short period, however, the damage to health has become apparent. «Every day I see patients who show health problems for these new cigarettes, especially among those who smoke more or among those with underlying diseases, such as asthmatics, who tend to perceive these cigarettes as less dangerous for their asthma. Before continuing the conversation, Richeldi is keen to recall that, around the world, there have already been deaths from inhaling smokeless tobacco, which is a type of smoking that causes lung and heart damage. It cannot be excluded that, over time, negative effects will also be discovered on other organs. “They cause the same, if not more, addiction than traditional cigarettes. This is proven and is due to nicotine: Nicotine addiction is a global pandemic that especially affects the youngest. These new cigarettes risk encouraging smoking rather than making people quit.” How? Being about technologies that facilitate smoking, you don’t need a lighter, you don’t need an ashtray, we tend to use heaters even in some closed environments. «Kids, for example, feel more relaxed towards their parents because these cigarettes don’t leave the classic smell of smoke on clothes. For some, heaters have become objects fashionlet us realize the enormous risk to which we are exposing young people».
Nicotine and oxidative stress on the airways
For Richeldi, a real «inducement to increase tobacco consumption». He says that several of his patients, who previously smoked less than ten traditional cigarettes a day, have come to smoke over 20 with heaters. The professor criticizes the government’s choice on excise duty: “If we then incentivize the use of heated tobacco by keeping the tax burden lower, the picture is completed: we are running towards a reckless increase in inhaled tobacco consumers”. There are two components that cause adverse health effects: nicotine exposure and oxidative stress on the airways. «In these new cigarettes there is a considerable mass of dangerous chemical compounds, and this has already emerged from hundreds of studies. They are not harmless, they are not a bridge to risk reduction, but they induce new risk factors.” Richeldi, with a periphrasis, defines the heaters «tools of delivery of nicotine, heavy metals and preservatives, which are absorbed through the epithelium of the respiratory system». And even if combustion in the traditional sense does not occur, the risks for the respiratory system are already evident, “while in the long term – he reiterates -, as we still don’t have any cases to study, we are groping in the dark”.
The sense of false security
The teacher complains that, instead of pursuing strategies to reduce or eliminate any type of smoking, the use of these new cigarettes is encouraged, also through swaggering forms of marketing and public spaces given in concession to producers. “There is a totally wrong perception: these new ways of smoking induce lung disease. Instead, consumers are conditioned by a sense of false security. The substances used to create the fragrances that disguise tobacco are also part of this commercial trap, as well as being harmful. Everything we inhale is dangerous – he concludes -, we worry about a waste-to-energy plant who want to build five kilometers away from home, using a very controlled technology, studied for decades, verified in its effects on health, and then we start inhaling, therefore bringing into our bodies, chemical substances that we know are harmful. It’s a complete paradox».
How many smokers are there in Italy?
In the report updated on smoking in Italy, disclosed by the Higher Institute of Health last May, the data on smoking are alarming. Almost one in four citizens, the 24,2%is a smoker: 12.4 million individuals. The highest prevalence of male smokers is recorded in the age group between 25 and 44 years (42,9%), while the highest prevalence among women is reported in the 45-64 age group (24,5%). The daily average of cigarettes smoked per person is equal to 11,5. Finally, the South is the geographical area where the prevalence of smokers is highest. From 2019 to 2022, the number of people who smoke heated tobacco cigarettes also tripled. It will be a coincidence, but the 36,6% of the sample chosen by the ISS consider these cigarettes less harmful than traditional ones: more than one in three people. “The new tobacco products and e-cigarettes have added to the consumption of traditional cigarettes and their users are in fact almost exclusively dual consumers – he says Roberta Pacifici, head of the National Addiction and Aftercare Center of the ISS -. The false perception of consuming products that are less or even harmless to health and the feeling authorized to use them everywhere, notwithstanding the Sirchia law, are certainly affecting the increase in their consumption».
Aggressive marketing
If the trend of tobacco heater users is growing, it is also due to aggressive marketing of multinationals. In the stations and in the most famous streets of the city centres, some have sprung up boutique where you can test these products for free, customize them with infinite combinations of colors and materials and sign up for loyalty programs. They define them «club» and, in fact, they are legitimate ways to circumvent the Italian legislation which prevents the advertising of smoking products. They offer «dedicated offers» and access to «community esclusive» with other consumers. The search for new customers, then, is particularly boosted when phone calls arrive to club members: «If you convince a friend to buy our product, you earn “x” points». Points that translate into discounts that are good for the pockets of those who are already consumers but which, in exchange, lead another person to consume inhaled tobacco. Without combustion, it is true, but not without health risks.
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