Press Release || Webinar “Nicotine pouches regulation: Questions, uncertainties, and ways to maximize public health benefit”

Wednesday, November 27th, 2024, 15:00-16:30 CET

“The importance of educating regulators about the benefits of vaping and nicotine pouches in smoking control”

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, 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.

Konstantinos Farsalinos, MD, MPH, Senior Researcher University of Patras, Greece; School of Public Health, University of West Attica, Greece; Data & Media Lab, University of Peloponnese, Greece, moderator to the webinar held on November 27^th, titled “Nicotine pouches regulation: Questions, uncertainties, and ways to maximize public health benefit,” introduced the speakers: Karl Fagerstrom, Tim Phillips, and David Sweanor, and presented the topics to be discussed: the current situation and trends in international legislation concerning nicotine pouches; exploring the appropriate pathway to find the balance between exploiting all intended benefits and avoiding unintended harms on an individual and population level.

Karl Fagerstrom, Professor Emeritus; President, Fagerstrom Consulting, Sweden, addressed an introductory presentation discussing the regulation of nicotine pouches, 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 presented 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, Tamarind Intelligence, UK, highlighted the rapid growth of nicotine pouches and their current market value. Total novel nicotine estimated global worth is around $65 billion, he noted, while nicotine pouches are a small fraction of that, less than $5bn, 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, Centre for Health Law, Policy & Ethics, University of Ottawa, Canada, provided insights into the regulatory landscape, arguing that the opposition to low-risk alternatives is often poorly reasoned and serves to protect high-rtan 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.

At the discussion that followed, K. 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 behavior and if it’s not associated with health harm, why should we care?” he added. Tim Phillips agreed, suggesting that public perception is heavily influenced by the association of nicotine with smoking-related deaths. Both speakers emphasized the need for a rational, evidence-based approach to nicotine regulation that acknowledges the historical persistence of stimulant use and promotes safer alternatives.

The discussion also touched on the dangers of limiting public choices without viable alternatives, which D. Sweanor believes erodes trust in authorities and he urged public health officials to reflect on their trustworthiness rather than questioning why the public does not trust them. K. Farsalinos highlighted the political dimensions of the issue, pointing out that censorship attempts by authorities fail to address the underlying reasons for public distrust.

Tim Phillips noted that politicians use the issue of nicotine dependence to garner public support, often overlooking the potential for increased illicit markets. The need for a better understanding of how regulation affects market dynamics was emphasized, and how attention should be paid on the effects that novel products like nicotine pouches can have in low- and middle-income countries, such as India, or countries of Southeast Asia.

The conversation concluded with a focus on the need for educating regulators about the public health implications of smoking and the potential benefits of alternatives like nicotine pouches, as well as the ethical questions surrounding government bans on such products.

“Smoking is the number one preventable risk factor for a number of disease conditions in several organ systems. And the public health impact, not only in terms of health, but also in terms of financial burden of smoking globally is tremendous. So, there are many benefits in accelerating the smoking decline”, K. Farsalinos concluded.

Issues raised during the webinar:

• The importance of educating regulators about the benefits of vaping and nicotine pouches.
• The shift in focus from safety issues to addiction as the primary argument for restricting vaping products.
• The moralistic versus evidence-based approach to nicotine regulation followed by legislators.

The webinar was organised by SCOHRE, the International Association on Smoking Control & Harm Reduction.

Το watch the video recording, please visit the webinar platform: WATCH