Earlier this year, an op-ed published in the New York Times triggered a conversation among U.S. federal lawmakers about nicotine pouches, and whether an increase in their use is a threat to public health. Some were quick to argue that the pouches’ growing popularity – particularly on social media feeds – represents a danger to minors. Since then, a class action lawsuit has been filed in the U.S. District Court for the District of Southern Florida against Zyn’s maker, Philip Morris International, accusing the company of marketing to teens. And earlier this month, the U.S. Food and Drug Administration (FDA) sent out a flurry of warning letters to retailers it found to be selling pouches to individuals under 21.
It’s true that nicotine pouches like Zyn – like any product that contains nicotine – should not be accessible to minors. Companies and other entities that are found to be selling these products to children should face legal consequences and be prevented from doing so in the future.
And yet, the manifesting of public concern regarding Zyn reflects a larger, and far more complex problem with the way that the U.S. approaches nicotine and tobacco regulation.
Nicotine pouches are a reduced-risk nicotine product. Though they are not entirely safe, they are magnitudes less harmful than combustible cigarettes, which kill one out of two long-term users, and other non-combustible tobacco products like chewing tobacco.
In Sweden, smoking rates have plummeted to about 6 percent – significantly lower than the E.U. average of roughly 18 percent and the U.S. smoking rate of 11.5 percent. Sweden also boasts lower rates of lung cancer than these other countries. This is in part because of the country’s early adoption of smoke-free policies, and the popularity of snus, a nicotine pouch that is similar to Zyn. (Unlike Zyn, snus actually contains tobacco.) Swedish health authorities correctly identified that reduced-risk forms of nicotine like snus can protect users against the dozens of carcinogens and numerous other toxic chemicals in the smoke produced by burning tobacco, and therefore created a landscape that encourages nicotine users to make a less dangerous choice.
Like Sweden, the U.S. has also prohibited smoking in many public spaces. But when U.S. lawmakers sound the alarm about reduced-risk nicotine products with a focus on youth risk only, they jeopardize the appeal and availability of these products to adults who smoke and are otherwise unable or unwilling to quit.
In the U.S., there are about 30 million adults who continue to smoke. Most of them want to quit, but most have not succeeded in doing so with the nicotine-based and other cessation medicines approved by the FDA. As a result, these individuals continue to smoke, which is unquestionably the single deadliest way to consume nicotine. Discussions that demonize nicotine pouches risk the lives of millions of adults who continue to smoke.
In an ideal world, there would be more effective scientific solutions for people who smoke and want to quit nicotine use entirely. But in the meantime, we must acknowledge that in a world where more than a billion human beings today smoke tobacco with devastating consequences, public health must bring compassion and respect to people’s real-life needs.
In the U.S., there is an urgent need for the FDA to create a carefully regulated environment that makes reduced-risk nicotine products like Zyn available to smokers while keeping them out of reach of minors. These two critical goals can be carried out harmoniously. The imperative of protecting our youth from exposure to nicotine should not be at odds with supporting the urgent needs of adults who smoke and can benefit from much safer use of the same substance.
As the regulator of tobacco products in the U.S., the FDA must clear the air about the risks posed by different forms of nicotine. It must effectively emphasize that nicotine, while not risk-free, does not cause the massive illness and death resulting from cigarette smoking. By shifting the focus to the true dangers of smoking and emphasizing the potential benefits of reduced-risk, non-combustible nicotine products, we can and will save many more lives – together.
