Nicotine Pouches: The Next Frontier In Harm Reduction
Nicotine Pouches: The Next Frontier In Harm Reduction
Sweden’s experience with snus serves as a valuable case study for Tobacco Harm Reduction. Snus is a traditional smokeless tobacco product that is placed between the lip and gums and held in the, during which it gradually releases nicotine, which absorbed through the oral mucosa. In Sweden, snus users typically keep a snus portion in their mouth for 30 to 60 minutes on average. Some users may keep it in for longer, while others might remove it after a shorter period, depending on personal preference. It has been available in Sweden since the 17th century, although its composition has evolved, and manufacturing methods have seen significant improvements.
Since the 1970s, many people in Sweden have switched from smoking to using snus. More recently, other smokeless products – heated, vapour, and oral nicotine pouches have been introduced. Although tobacco usage per capita in Sweden is similar to the EU average, the country has the lowest prevalence of smoking in the EU at 5.4%. It also has the lowest lung, trachea, bronchus, and oral cavity cancer mortality rates in the EU.[i]
The main ingredient in oral nicotine pouches is made from a plant fibre known as cellulose. These fibres produce a soft, absorbent material that contains the added nicotine and flavours, allowing for release of nicotine when placed between the gum and the upper lip.
The simplicity of the products results in generally lower risk profile for nicotine pouches when compared to other smokeless tobacco and nicotine products. Oral nicotine pouches contain less than 1% of the levels of the harmful chemicals found in cigarette smoke. Furthermore, they possess a toxicant profile similar to pharmaceutical Nicotine Replacement Therapies – medically licensed nicotine gum and lozenges that assist with smoking cessation.
Laboratory studies have also demonstrated that nicotine pouches produce lower levels of toxicants than snus, which, based on long-term data, can be viewed as a reduced-risk profile alternative to smoking. The U.S. Federal Drug Administration has recognised certain snus products as a modified risk tobacco product, putting those who switch completely from smoking at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.
Remarkably, the European Union has banned snus outside Sweden, despite compelling long-term scientific evidence demonstrating its impact in harm reduction.
In Asia and Africa, there is also a history of traditional oral tobacco products. They are, however, very different from snus. Instead of being factory-manufactured and adhering to industry standards with high levels of product stewardship, oral tobacco products are often produced in a cottage industry.
Traditional oral nicotine products such as Paan, Naswar, and Gutka typically carry high levels of carcinogens, leading to increased rates of lip and oral cavity cancer. Given the differing risk profiles between tobacco-free nicotine pouches and these high-toxicant traditional oral products, we believe there is a significant harm reduction opportunity for regulators, particularly in developing countries.
Well-considered, progressive regulation is essential to maximise this opportunity. Nicotine pouches should be regulated based on their lower-risk profile in comparison to cigarettes. Adult smokers should have access to accurate information regarding their risk in comparison to smoking, enabling them to make an informed decision about switching; with measures in place to ensure high product standards, prevent underage access, combat illicit trade, and deliver robust enforcement and penalties for those who break the rules.
It is in everyone’s interest to reduce the health impacts associated with smoking cigarettes. Tackling such a significant societal issue can only be achieved through open dialogue, sharing scientific research, and collaboration.
This is why BAT recently launched Omni™, a platform to share the science on Tobacco Harm Reduction and bring together researchers and policymakers to share insights and examine evidence-based solutions. I encourage readers to visit www.asmokelessworld.com, review the evidence, and join the conversation.