Tuesday 20 December 2022

Knives out for nicotine pouches

In 1991, the Lancet published an editorial titled 'Nicotine use after the year 2000'. It makes for very interesting reading. Click to enlarge.

The gist of it is that if 'purified nicotine products' were available, they would have the potential to 'eventually replace tobacco on the open market'. 

Thus it seems logical to offer either a cleaner product or, better still, an acceptable source of more pure, less contaminated nicotine.

The editorial then mentions 'a highly innovative type of cigarette that heats rather than burns tobacco' which is 'a near-perfect low-tar cigarette'. This was the direct ancestor of IQOS but it never took off in the USA, partly because - as the Lancet notes - public health groups spoke out against it. 

It concludes:

There is no good reason why a switch from tobacco products to less harmful nicotine delivery systems should not be encouraged. Smoking-related deaths after the year 2000 would fall steadily and substantially of this can be achieved. There is no compelling objection to the recreational and even addictive use of nicotine provided it is not shown to be physically, psychologically, or socially harmful to the user or to others.

Three decades later and several 'purified nicotine products' exist which go beyond the wildest dreams of the editorial's author. Vaping is vastly safer than smoking and has proven itself in the marketplace. Nicotine pouches are even safer and have tremendous potential. Heated tobacco products like IQOS have proven themselves in several countries, most notably Japan.

Are public health groups jumping for joy? For the most part, they are not. For the most part, they are trying to get them banned.
The latest target is nicotine pouches. They are snus without the tobacco. Cellulose plus nicotine. They are about as 'pure' as you can get. It is virtually inconceivable that they pose a non-negligible threat to health, and yet a growing number of governments are trying to nip them in the bud. 

Since they don't contain any tobacco, nicotine pouches are unregulated in many countries. Their legal status in Germany is unclear. In Norway, they are banned unless they contain tobacco!

The Netherlands has been ruled by an unusually puritanical government for the last few years and is now trying to ban nicotine pouches outright. There is already a de facto ban but this is legally dubious since the government has been regulating them as food, which they clearly are not.

And so it wants to ban them under the Tobacco and Tobacco Products Act for good measure. The government's rationale is just terrible: anti-scientific and deeply illiberal.

Nicotine is in itself very harmful

No it isn't.

The RIVM has determined that nicotine pouches contain harmful amounts of nicotine.

No they don't. Define 'harmful'.
Nicotine is an acutely toxic substance that is rapidly absorbed by the body, whether administered through the skin, by mouth or when inhaled. Use of a large amount of nicotine can lead to acute nicotine poisoning, sometimes fatal. 

A large amount of a lot of things could prove fatal, but commercial nicotine products do not contain anywhere near enough nicotine for that to happen. If you're worried about the strength of nicotine pouches, feel free to regulate the level of nicotine.

The only regulation needed of these novel products is (a) age restrictions on sale, (b) limits on nicotine strength, and (c) normal product regulation of ingredients. Banning them outright (while leaving cigarettes on the market, of course) is totally unjustifiable on any public health or ethical grounds. 

The public health of young people in particular is at stake. The government believes that more children should grow up in a smoke and tobacco-free environment. In such an environment, young people are protected against tobacco smoke, nicotine addiction and the temptation to start smoking. This also means that they do not come into contact with nicotine products without tobacco.

This doesn't make any sense, even on its own terms. At best, it is shameless mission creep. The last line is tacked on out of nowhere. Of course nicotine pouches are consistent with a 'smoke and tobacco-free environment', just like nicotine patches are. This is just lazy 'think of the children' drivel that would create a society fit only for children if it was followed through to its logical conclusion.
Not only does the government want to ban the sale of these pouches. It wants to ban the use of them. I didn't know this until today, but apparently snus is already included in the Dutch smoking ban!

The use of snus is prohibited in places where smoking is prohibited. It is difficult for those who have to ensure that the smoking ban is observed to determine whether someone is using snus or a nicotine pouch. This also applies to the Dutch Food and Consumer Product Safety Authority (hereinafter: NVWA)  who must ensure that the smoking ban is enforced by the manager of that location. Bringing nicotine pouches under the smoking ban also improves the enforceability of the smoking ban on this point. Furthermore, it is not in line with the aim of a smoke-free generation that there are products on the market (that are not a smoking cessation medicine) that can be used to maintain a nicotine addiction in places where smoking is not allowed. This would defeat one of the purposes of introducing a smoking ban, which is to encourage smokers to stop smoking.

It is difficult to know where to begin with the stupidity of this paragraph. It is unsurprising that a ban on the use of a product that is kept under the top lip is almost impossible to enforce, but it is not obvious why banning another product that can be concealed just as easily will make the ban any easier to enforce. A more logical response would be to remove snus from the ban.

We all know that smoking bans were designed to make smokers' lives harder, but it's rare to hear a government say the quiet part out as loudly as it does here. The ostensible aim of 'smoke-free laws was to 'protect' staff from secondhand smoke. Similarly, the aim of a 'smoke-free generation' policy was to have a generation of people who don't smoke, not to have an entire nation of obedient citizens who don't use nicotine in any form. The goalposts are now overtly shifting. It's almost as if prohibitionists will take a mile if you give them an inch.

Moreover, from a practical health perspective, having safer nicotine products will advance the goal of having fewer people smoking, not hinder it. The government completely ignores this. None of its documents mention the potential for adult smokers to switch to pouches.

It is sheer puritanism and it will spread around the world unless this senseless authoritarian juggernaut is brought to a halt. The Dutch government is consulting on these proposals until 16 January. The consultation webpage is here in Dutch and here in English. I'll be giving them some comments. I hope you will too.

No comments: