The Global Case for Nicotine Pouches [Position Paper]

We are pleased to share our latest position paper examining how nicotine pouches represent a unique convergence of public health, environmental, and social benefits in the pursuit of smoke-free societies.

Drawing on Sweden’s remarkable success—on track to become the first smoke-free nation in the EU—this comprehensive analysis explores why nicotine pouches have emerged as a critical harm reduction tool, particularly for women who previously struggled to quit smoking.

Key Findings:

The Lowest Risk Profile

• On the risk spectrum of nicotine products, cigarettes score 100 while nicotine pouches score just 0.1
• Leading European agencies including Germany’s Federal Risk Assessment Institute (BfR), the U.S. FDA, and UK Committee on Toxicity confirm substantially reduced health risks compared to cigarettes
• Several pouch products contain no detectable tobacco-specific nitrosamines (TSNAs), demonstrating these dangerous carcinogens can be eliminated entirely

The Swedish Success Story

• Sweden’s smoking prevalence has fallen below 5%, positioning it to become the EU’s first smoke-free nation
• If other EU countries adopted Sweden’s patterns, 355,000 lives could be saved annually
• After nicotine pouches arrived in 2016, women’s smoking rates declined 46% (2015-2021) vs. just 16% in the prior period (2009-2015)
• Sweden’s approach proves accessible alternatives and traditional tobacco control work synergistically, not in opposition

Environmental Leadership

• Addresses the cigarette butt crisis: filters take 2-3 years to decompose, leaching toxins and creating microplastics
• Zero electronic waste: no batteries, circuits, or charging infrastructure required
• Recyclable tins include compartments for respectful disposal of used pouches
• Environmental assessments show nicotine pouches do not exceed de minimis ecological impact thresholds under any disposal scenario

Social Consideration & Gender Equity

• Produce no smoke, vapor, or odor
• No secondhand exposure to bystanders
• Emerged as truly gender-neutral products, helping close the persistent gender gap in smoking cessation
• Discreet design avoids social friction

EU Policy Opportunity

• Aligns with WHO Framework Convention on Tobacco Control’s explicit endorsement of harm reduction strategies
• Sweden’s experience demonstrates smoke-free status is achievable within EU regulatory frameworks
• BfR recommends quality control and regulation rather than prohibition
• Current EU smoking rate stagnation at 24% calls for evidence-based innovation

Transforming LMICs

• Infrastructure-independent design requires no electricity, specialized storage, or complex distribution
• Can be distributed by community health workers as easily as urban retailers
• Offers direct substitution for dangerous traditional smokeless products (gutkha, khaini, nasvay) that contain high carcinogen levels
• Represents economic prevention vs. crisis treatment approach for resource-constrained health systems
• LMICs can leapfrog directly to progressive regulatory frameworks, avoiding policy missteps of high-income countries

Expert Contributors:

• Dr. Karl Fagerström – PhD in nicotine dependence and smoking cessation (1981), inventor of the Fagerström Test for Cigarette Dependence, founding member of the Society for Research on Nicotine and Tobacco (SRNT), deputy editor of Nicotine & Tobacco Research, WHO medal recipient (1999)
• Carissa Düring – Director of Considerate Pouchers Sweden, a consumer advocacy group promoting smoke-free alternatives and consumers’ rights; clinical psychology student at Uppsala University
• Federico N. Fernández – CEO of We Are Innovation, a global network of 50+ think tanks and NGOs; featured in The Economist, El País, Folha de São Paulo, and Newsweek; has delivered speeches across three continents and co-edited several books on economics
• José Alberto León – Project Director at We Are Innovation and Fundación Internacional Bases; Senior Fellow at CEDICE Libertad and Fundación Ciudadano Austral; co-author of “Después del Socialismo, Libertad”; studied Law at Universidad Central de Venezuela
• Beatriz Santos – Chief Communications Officer at We Are Innovation based in Lisbon; published in Portuguese outlets NOVO and Observador; international communications experience with ATREVIA agency and the European Parliament; two published books; key figure in Students For Liberty Portugal
• Tetiana Rak – Chief Operations Officer at We Are Innovation; journalist and freedom activist with 8 years’ experience at CNN, TechCrunch, Fox News, HackerNoon, BBC, and Radio Free Europe; champions technological advancement and digital transformation as tools for liberty

Published by We Are Innovation and Path to Smoke-Free, this paper offers evidence-based guidance for policymakers worldwide seeking to accelerate progress toward smoke-free targets.

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