Harm reduction – minimizing the health and social harms associated with the use of addictive substances – is becoming one of the key issues in today’s addiction and health policy. Experts stress that although the prevalence of smoking and substance use in the Czech Republic is slowly declining, it remains the leading preventable cause of premature death. Harm reduction offers solutions for those who cannot or do not want to quit completely, while also pointing the way to lower health and economic burdens. Success, however, depends on better awareness, systematic prevention, stable funding, and bold political decisions.
Smoking and Vulnerable Groups
According to Dr. Ladislav Csémy, harm reduction in the field of tobacco is particularly indicated for two groups: smokers who are not motivated to quit, and those who repeatedly fail in their attempts to stop smoking. Another vulnerable group are people with serious mental illnesses, such as schizophrenia or severe depression. These patients smoke more often and more intensively and face a higher risk of premature death – not because of their psychiatric illness itself, but primarily due to smoking-related diseases.
Harm reduction can also play a role when combined with modern psychological approaches and digital technologies. Narrative persuasion and the use of virtual reality to boost motivation are examples of promising tools. Equally essential is education of both health professionals and the public – an area in which the Czech Republic still significantly lags behind.
Regulation and Economic Settings
Although research shows that alternative nicotine products (such as e-cigarettes, nicotine pouches, or heated tobacco) carry lower health risks than traditional cigarettes, the Czech Republic does not provide any economic incentives to encourage their use. “A pack of nicotine pouches costs the same as a pack of cigarettes,” Csémy points out. This eliminates the motivational effect that could otherwise lead smokers toward less harmful alternatives.
Data from Studies: Declining Trend, Ongoing Problem
The annual National Addiction Study (NAUTA), conducted by the National Institute of Public Health on a representative sample of more than 1,800 respondents, shows that smoking prevalence has been slowly declining since 2012. Today, about 16.4% of the population are daily smokers – roughly 1.5 million people. The fastest decline is seen among adolescents, which mirrors international trends: young people drink less alcohol and smoke less than they did a decade ago.
At the same time, however, the use of alternative products – particularly e-cigarettes – is rising sharply, especially among people under 24. About a quarter of users say they vape as a way to quit smoking cigarettes, and another large group view vaping as a healthier alternative. Use of nicotine pouches and heated tobacco is also growing, albeit more slowly.
Health Risks: Comparing Products
Systematic reviews and international meta-analyses show that traditional cigarettes pose the highest health risks – from chronic obstructive pulmonary disease, through lung cancer, to heart attacks and strokes. E-cigarettes are associated with substantially lower risks; heated tobacco carries less risk than cigarettes but more than e-cigarettes or nicotine pouches. The lowest risk profile is linked to smokeless nicotine pouches.
It is important to note, however, that all of these products contain nicotine, a highly addictive substance. Protecting children and young people from exposure to nicotine products is therefore crucial. The main benefit of harm reduction is in offering existing smokers a less harmful alternative – not in creating new generations of users.
International Perspective: Still Above Average
According to Ladislav Kažméř, smoking prevalence in the Czech Republic remains slightly above the European average. Data from the Global Burden of Disease project confirm that tobacco use is still the leading modifiable risk factor for premature morbidity and mortality. On average, current smokers live about ten years less than non-smokers.
A positive trend is that thanks to declining prevalence and better health care, smoking-attributable mortality is falling, especially for cardiovascular diseases. Among men, lung cancer mortality is also decreasing, but this is not yet the case for women – reflecting the delayed onset of smoking in the female population.
Harm Reduction: Beyond Tobacco
As Jana Michailidu emphasized, the principle of harm reduction extends beyond tobacco and illegal drugs. In Brno, for example, a “wet center” provides supervised alcohol consumption. Similar approaches are applied in gambling prevention or even in addressing digital addictions.
International studies and data from European agencies clearly show that investments in prevention and harm reduction pay off economically – although with a delay, which reduces their political appeal. Funding remains a major obstacle: in the Czech Republic, only 0.06% of excise tax revenues are directed to prevention and harm reduction, while more than half goes to law enforcement.
An Opportunity Not to Miss
The Czech Republic now stands at a crossroads. Smoking may be slowly declining, but it still kills 16,000 people each year and generates hundreds of billions of crowns in health and social costs. Harm reduction provides a pathway for those unable to quit entirely to at least reduce their health risks. This requires:
- economic incentives for less harmful products,
- systematic education of professionals and the public,
- long-term and stable funding for prevention and services,
- protection of young people from nicotine addiction.
As experts remind us, prevention and harm reduction are not “soft” approaches – they are evidence-based strategies with clear health and economic benefits. What the Czech Republic lacks are bold political decisions to fully embrace this path.