Nicotine Pouches and Public Health

Dr Konstantinos Farsalinos is a Senior Researcher at the University of Patras, Greece, and was one of the first to explore the potential and risks of vaping. The webcast he hosted discussed the current situation and trends in international legislation concerning nicotine pouches, exploring pathways to find the balance between benefits of pouches and avoiding unintended harms from over-legislation.

Nicotine pouches are the newest oral, smokeless tobacco harm reduction product with a safety profile very similar to pharmaceutical nicotine formulations. Their availability in a variety of strengths and flavours represents a potentially important tool in the arsenal of the tobacco cigarette-alternative options that smokers, particularly those unable or unwilling to quit with currently approved methods, might need in order to partially or completely substitute for smoking. 

“However,” says SCoHRE, “as with all harm reduction products, appropriate regulation is key in determining whether pouches will become a valuable addition to the smoking control strategy or a wasted opportunity.”

Professor Fagerstrom began by highlighting Sweden's historical context with tobacco products and recent government support for harm reduction. He stressed that non-tobacco nicotine pouches are probably the least harmful of the nicotine containing consumer products. He went on to present data from the Nordic countries that use alternative tobacco products, such as snus, to support this. 

In Sweden, up until very recently, governments regarded all tobacco products equally harmful. It is the last government that endorsed harm reduction for nicotine products; as a consequence, the tax on snus was lowered by 20% while it was increased on the more dangerous cigarettes by 10%. Very recent statistics on use of nicotine and tobacco show that Sweden has reached endgame with at most 5% prevalence of smoking with the help of snus and nicotine pouches.

Professor Fagerstrom presented findings on tobacco attributable deaths among males in the European Union showing that all the countries that are using snus—Sweden, Norway and Iceland—are enjoying less tobacco attributable deaths. He commented that this is the result of the use of snus on the smoking prevalence that lowers the tobacco related harm. He presented details on the ingredients and composition of nicotine pouches and noted that the non-tobacco nicotine pouches need to be regulated e.g. according to legal age for buying, packaging, advertising and amount of nicotine in the pouches to ensure good quality products that can contribute to improved public health. Countries could learn from Sweden’s success, he concluded, for example by considering increasing taxes on cigarettes and lower them on less harmful products.

Tim Phillips, Managing Director of Tamarind Intelligence, highlighted the rapid growth of nicotine pouches and their current market value. Nicotine pouches estimated global worth is around $65 billion, he noted, with a significant portion concentrated in the U.S.

He pointed out that many governments are still unfamiliar with these products, resulting in a lack of specific regulations. That, together with concerns over youth use and the illicit vape market has led to defensive government reactions and bans in countries such as Russia, Germany, and the Netherlands. Mr Phillips commented that the next Tobacco Products Directive (TPD) in the European Union is going to be crucial for how novel nicotine products are treated, not just in Europe, but around the world.

David T. Sweanor J.D., Chair of the Advisory Board of the Centre for Health Law, Policy & Ethics at the University of Ottawa, provided insights into the regulatory landscape, arguing that the opposition to low-risk alternatives is often poorly reasoned and serves to protect high-risk products. He drew parallels to historical resistance against innovations, suggesting that societal fears can overshadow the dangers of established risks.

"Claims about the promise of a new technology are at times greeted with scepticism, vilification, or outright opposition, often dominated by slander, innuendo, scare tactics, conspiracy theories, and misinformation," he said.

Professor Sweanor emphasised the conflict between public health objectives and moralistic agendas, which can hinder efforts to reduce health risks. He stressed the importance of addressing nicotine use through a public health lens, advocating for the promotion of safer alternatives rather than attempting to eliminate nicotine entirely. He likened the situation to the consumption of coffee, suggesting that society should focus on reducing risks rather than imposing bans. Despite regulatory bans, he noted, there is a persistent consumer demand for these products, and paralleled the situation to past struggles for individual rights and access to contraception.

During the discussion, Dr Farsalinos stressed the importance of providing accurate health information, citing Moldova's restrictive policies on harm reduction products as a significant issue, as access to health-related information is a human right. He questioned the rationale behind focusing on nicotine dependence, which does not equate to the harms associated with substances like alcohol or opioids. 

“Is it a failure of public health to explain that dependence is not harm," Farsalinos said. "Dependence is a repetitive behaviour and if it's not associated with health harm, why should we care?”

SCOHRE is an International scientific Association of independent experts on Smoking Control & Harm Reduction, who seek an open and constructive dialogue to help come up with a new approach to smoking control policies.

Dave Cross

Journalist at POTV

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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous start-ups to develop content for their websites.