Author: Ian Irvine, C2C Journal and former Professor of Economics at Concordia University
Recent news that the federal government may be contemplating changes to its rules on the sale of oral nicotine pouches offers hope that Canada’s anti-smoking policy is about to veer in the direction of common sense and medical evidence. If so, it will be a welcome change.
Current regulations established by the Trudeau Liberals in 2024 require that oral nicotine pouches — useful as a stop-smoking aid — can only be purchased in pharmacies, and that they must be kept behind the counter. There are further restrictions on allowable flavours and marketing campaigns. As a result, it is easier today to buy a standard cancer-causing cigarette than a lower-risk oral pouch.
While not widely appreciated, nicotine pouches entail about 1 percent of the risk of cigarettes. It’s the combustion of tobacco that causes the bulk of the health issues. Pouches also deliver nicotine to users but spare them the cloud of carcinogen toxins caused by lighting a cigarette.
The same holds for other smoking alternatives. Vapes (aka e-cigarettes) are about 95 percent less risky than regular cigarettes. Heated tobacco products are slightly riskier than vapes or pouches, but still much less risky than smokes. A sensible health policy would see a government try to get smokers to switch to such products.
Yet Ottawa’s existing oral pouch policy gets it completely backwards. Alberta Premier Danielle Smith made this point in a letter to current federal health minister Marjorie Michel earlier this year.
“Restricting access to nicotine pouches creates barriers for adults who are actively trying to reduce or quit their nicotine consumption,” Smith stated. “When a regulated alternative is more difficult to access than cigarettes, it sends the wrong signal and complicates efforts by adults working to lessen their dependence.”
The recent suggestion by an unnamed federal source to the National Post that Ottawa is thinking about loosening its rules on nicotine pouches can be considered a nod in the direction of Smith’s logic. And while we wait for common sense to prevail in federal tobacco policy (Michel later walked back the idea), it’s worth considering how we ended up in this situation in the first place.
The answer is that the previous Trudeau government was very much under the sway of narrow-minded, puritanical lobby groups that want to put a stop to virtually all nicotine use in Canada.
Case in point is the influential Ontario Tobacco Research Unit (OTRU), based at the University of Toronto’s Dalla Lana School of Public Health.
The OTRU was a major player behind the federal government’s present anti-tobacco strategy that calls for the smoking rate to fall to less than 5 percent by 2035, down from the current adult smoking rate of around 11 percent.
Last year, the OTRU released a report titled “Canada’s Tobacco Endgame” purporting to offer the federal government advice on how to meet its 2035 objective. In doing so, however, the OTRU adopts the position that Ottawa must stamp out all forms of nicotine use, including less-risky alternatives such as pouches, vapes and heated tobacco products.
“An effective endgame strategy must… maintain surveillance and regulatory oversight of the entire spectrum of tobacco products to prevent substitution,” the OTRU report states. [Emphasis added.] Preventing substitution away from cigarettes makes no sense from a public health perspective.
A goal of zero cigarette smoking is one that all health advocates should adopt. But it is not realistic to support zero nicotine use because it denies individuals the right to consume lower-risk products and effectively throws away a valuable option for individuals who wish to quit smoking slowly over time.
It also ignores another little-known fact: nicotine provides important cognitive and calming benefits for many users, particularly those with anxiety and other mental health challenges.
Numerous other countries have considered the existing medical evidence on new alternative products and chosen an entirely different policy direction.
New Zealand, for example, recently dropped plans to outlaw all cigarette sales to residents born after 2008 and pivoted instead to a strategy called “Vape to Quit Strong” that sees public health agencies offer free vapes to smokers to get them to switch.
The UK is doing the same thing with its “Swap to Stop” campaign.
New Zealand’s experience is particularly relevant to Canada as it has had great success in getting Indigenous Maori smokers to switch to vapes. Indigenous Canadians have the highest smoking rate in the country.
In Sweden and Norway, the growing use of oral pouches and snus has led a dramatic drop in smoking rates and an improvement in health outcomes. Yet overall nicotine usage has risen. Such a shift is worthy of celebration. Yet by the blinkered standards of the OTRU, using nicotine in any form — even if it is orders of magnitude less risky than cigarettes — is considered a failure.
To be clear, nicotine is dependence-forming. But it is not a substantial cancer risk.
There are real health gains to be had in convincing smokers to switch to lower-risk nicotine products such as pouches, vapes or heated tobacco products.
If Ottawa follows through on improving access for pouches, it will be a step in the right direction. The OTRU’s advice points the exact other way.
Ian Irvine is a retired professor of Economics at Concordia University who has worked as a consultant in alcohol and tobacco policy. Some of his research has been supported by the Global Action to End Smoking foundation, and he has accepted conference costs from nicotine producers. The longer and original version of this story first appeared at C2CJournal.ca.
It's too early to say whether oral nicotine pouches are linked to oral cancer. Nicotine reduces saliva production, and there have been other carcinogens found in the pouches (like heavy metals and formaldehyde). Take a quick search on PubMed.
My concern with them is that they are not primarily used as a tobacco cessation product. But when they first came out on the market, they had bright marketing and advertising with all kinds of child-friendly flavours. They're clearly marketing to teens, with big tobacco pivoting, hoping to create new lifelong users of their products. If you have teenagers - or just eyes- this is very clear to see.
"ONPs have qualities (e.g., flavors, marketing claims of "tobacco free") that could increase appeal among youth and young adults, and these products can deliver nicotine at levels sufficient to cause dependence; widespread adoption of ONPs among otherwise nicotine-naive individuals may reduce their net public health benefit." https://pubmed.ncbi.nlm.nih.gov/39621395/
I'm far from a Liberal supporter, but as a mother of teenagers, I think it's ok to put in some regulations to prevent these companies from being able to market and hook our kids. Increasing avaiaiblity -ok. But the marketing and flavours are too far.
As with almost everything else that spews out of Ottawa's ever widening maw, this has nothing to do with its stated goals. Bill C9 has nothing to do with Children's Safety. The Tanker Ban has nothing to do with ecology. The abortion laws (or lack thereof) and MAiD have NOTHING to do with healthcare. And their tobacco/nicotine policies have nothing to do with people's well being. All of these things are about one thing and one thing only. The exercising of authority. Once a bureaucrat or, worse, a politician gets a little taste of what authority can do to stroke one's ego there is nothing to stop that Leviathan from growing out of control. The OTRU and the U of T have gotten a small taste of how they can slurp at the trough of authority and they are milking it for all it's worth whether it is good for Public Health or not is irrelevant to them. They get to clutch their pearls and purse their lips and inflict a little bit of discomfort on people and, oh, that feels SO GOOD.