Uzbekistan’s regulatory stance on smoke-free products has shifted away from earlier openness and now reflects a significantly more prohibitive approach. For vapes, current scores are low across all dimensions: Accessibility stands at just 8.16, Acceptability is nonexistent (0), and Affordability is modest at 33.33. In contrast, heated tobacco products (HTPs) remain accessible (80.85) and fully accepted (100), though Affordability is again limited (33.33). Snus and nicotine pouches are both nearly inaccessible, scoring just 4.35 and 4.17 in Accessibility, respectively, and zero in both Acceptability and Affordability. Despite the country’s initial regulation of vapes and HTPs in early 2024, newly proposed legislation threatens to reverse this progress by seeking a full ban on both categories—adding to existing prohibitions on snus and pouches. This backslide into restrictive policy ignores the potential public health benefits of harm reduction, particularly for the country’s smoking and naswar-using population. There is a critical opportunity for Uzbekistan to revise its stance—especially regarding nicotine pouches—and align with global best practices. According to recent expert estimates, embracing a harm reduction strategy could save as many as 464,000 lives in Uzbekistan.