Nicotine in the mouth: a strategic frontier for reshaping tobacco harm reduction

Core Insights:

Oral nicotine products, especially modern tobacco-free nicotine pouches that have evolved from traditional Swedish snus, are becoming a disruptive force in the field of tobacco harm reduction. Its growing scientific evidence and market acceptance pose a serious challenge to global tobacco regulatory frameworks based on historical biases rather than scientific evidence, indicating that public health policies are facing a critical transition point.

Drivers:

• The scientifically proven potential for reducing harm: The core driving force lies in a clear scientific consensus that eliminating combustion is the key to reducing tobacco harm. Both oral cigarettes and nicotine pouches fundamentally eliminate major pathogenic substances such as tar and carbon monoxide by avoiding the combustion process, and their relative safety is supported by a large amount of data.
• Consumer demand and product innovation: Modern consumers, especially adult smokers, are seeking cleaner, more convenient, and socially acceptable nicotine alternatives. The nicotine pouch, which is tobacco-free, odorless, and does not produce secondhand smoke, perfectly meets this demand, and its technological innovation (such as the evolution from tobacco-containing to tobacco-free) further expands its appeal.
• The demonstration effect of exemplary cases: The experiences of Sweden and Norway provide strong real-world evidence. These countries have achieved smoking rates and tobacco-related mortality rates far below the EU average by accepting oral smoking, providing a highly persuasive reference model for policymakers in other countries.
• The significant divergence in global regulatory policies: The fragmentation and contradictions of regulatory policies in various countries are key factors shaping the current market landscape. From the scientific review authorization of the US FDA, to the active recognition of public health in the UK, to the rigid ban of the EU (excluding Sweden), this regulatory difference itself highlights the tense relationship between traditional tobacco control thinking and emerging harm reduction science.

Key Evidence:

• The public health miracle of Sweden: The article clearly states that “the daily smoking rate among Swedish men is less than 5%, while the EU average is still above 20%”, and “Sweden’s tobacco-related mortality rate is about 40% lower than the European average”. This directly links the widespread use of oral tobacco to significant improvements in public health.
• Authoritative scientific evaluation of nicotine pouches: A 2025 Cochrane review concluded that smokers who switch to nicotine pouches have significantly reduced exposure to toxic and carcinogenic compounds. This provides a strong third-party scientific endorsement for the harm reduction potential of emerging nicotine pouch products.
• Recognition from US regulatory agencies: The US Food and Drug Administration (FDA) has not only granted certain oral tobacco brands “improved risk tobacco product” status, but also “authorized the sale of 20 Zyn nicotine pouch products” by 2025, believing that their listing “may benefit overall public health by helping smokers transition to low-risk alternatives”.
• The inherent contradiction of regulatory policies: Despite decades of data from Sweden showing strong public health benefits, the EU still prohibits the sale of oral tobacco products under the Tobacco Products Directive (excluding Sweden). This fact vividly reveals the lag and unscientific nature of regulatory policies.

Strategic Takeaways:

The evolution of nicotine-containing products from traditional to modern is not only a technological advancement, but also a fundamental challenge to the traditional smoking control mindset of “all or nothing”. It proves that providing more attractive low-risk alternatives for adult smokers under proper regulation is one of the most effective paths to accelerate the end of the smoking era. The key challenge for the future is not technology itself, but whether policymakers can go beyond outdated concepts and establish a modern framework for regulation based on scientific evidence and risk ratios. This framework should effectively prevent teenagers from using it, while maximizing the enormous potential of these innovative products in saving the lives of adult smokers.