I am an anthropologist and non-formal educator—and also a Central American woman who uses drugs. For approximately three years, I've been involved in peer-based harm reduction, working to create supportive spaces and strategies for us people who use drugs, advocating for dignity, rights, and harm reduction education.

Tobacco remains a leading cause of preventable death in Costa Rica, surpassing other drugs. Despite efforts to reduce consumption, public policies have focused solely on abstinence and prohibition, which contribute little to public health. This approach neglects harm reduction (HR) strategies, which are essential components in any regulation of substances. This presentation underscores the need to expand policies toward HR in tobacco, considering its significant impact on public health.

According to the Global Adult Tobacco Survey (GATS, 2022), the prevalence of tobacco use remained nearly unchanged from 9.1% in 2015 to 8.7% in 2022 (IAFA, 2022). 48.8% of smokers attempted to quit in the last year, showing a desire for change that current policies do not adequately support.
In 2020, tobacco caused 628 deaths, up from 431 in 2015 (Ministry of Health, 2020), mainly due to respiratory and cardiac diseases. This increase highlights the need to strengthen public health strategies. Costa Rica has 34 cessation clinics, mostly in the Metropolitan Area, with limited access in regions other regions. (IAFA, 2022). There are 20 HR programs for other substances but none for tobacco (IAFA, 2022), and these programs also show deficiencies in addressing the specific needs of People Who Use Drugs (PUD), often failing to provide tailored support and resources that reflect the diverse realities of these populations.

Current policies focus on cessation without considering those unable or unwilling to quit, perpetuating risks. The absence of HR programs for tobacco reinforces a prohibitive approach that limits support options. Costa Rica must incorporate HR into its public health policies, allowing access to less harmful products like and developing educational programs for informed decision-making. Expanding HR diversifies support and aligns with evidence-based, humanistic approaches that could improve public health and reduce tobacco-related deaths.