What do you think about nicotine pouches in general? Are they a fine harm reduction tool compared to e-cigarettes and heated tobacco products? Are there any “cons” about nicotine pouches (maybe too high nicotine concentration in some products)?

Nicotine pouches represent the best harm reduction product we currently have in terms of its minimal (if any) risk. They are made of pharmaceutical-grade nicotine only, impregnated into inert fibres, and do not involve any heating. Thus they are expected to be safer than snus, a tobacco pouch that has an established safety profile (no increased risk for cardiovascular disease or cancer compared to non-smoking and not using any nicotine product). The design characteristics of nicotine pouches make them a perfect harm-reduction product. The only drawback that I can find is that they may not be a product that satisfies the needs of all smokers, since smoking involves a different behaviour as well as an inhalational habit. These characteristics do not exist with pouches. The issue of nicotine content in pouches can easily be addressed through regulation. However, we should not fall into the trap of issuing regulations for very low content because they will only make the products less appealing and even useless for smokers. Smokers need nicotine, some need more than others, and nicotine pouches should contain enough nicotine to satisfy the needs of every smoker.

What do you think about strict tax policies for harm-reduction tools in general?

I find the whole regulatory environment on harm-reduction products rather bizarre. It seems that regulators consider harm reduction more of a problem rather than a solution to smoking. In fact, in some cases, they appear as if they think of harm reduction products as being more harmful than smoking, which makes no sense from a common sense and scientific perspective. Harm reduction products have a substantial positive public health prospect. Therefore, not only should they not be taxed, but they should be treated as any other solution to the smoking problem: by creating incentives for smokers to switch to the use of harm-reduction products. That means, no taxation, lower VAT and increased availability and variability of products. All these will deliver a clear message to smokers that these products are less harmful to smokers, and will motivate them to try and make the switch.

Nicotine pouches are becoming more and more popular in Europe. What effect could a tax hike have on manufacturing, criminal activity, and harm reduction?

Nicotine pouches are substitutes for smoking. Therefore, any restrictions, whether in terms of punitive taxes or a reduction in availability and variability mean fewer smokers having the chance to quit smoking. There are studies in the US with e-cigarettes, which found that restrictions lead to more smoking. And that makes perfect sense. Unfortunately, the same is expected to happen with nicotine pouches. Of course, restrictions or increased taxation will inevitably result in the creation of a black market with all the problems associated with such criminal activity, such as lack of quality standards, unknown product origin, unknown or mislabelled nicotine content, and uncontrolled marketing and promotion to non-intended population subgroups, such as youth and non-smokers.

What should the European Commission do instead of raising the taxes on nicotine products to help more and more people without exposing new generations to these products?

In the case of harm-reduction nicotine products, things are pretty simple. We do not need to reinvent the wheel. Harm reduction is a principle we use daily in our lives, from the use of helmets and seat belts, just looking right and left before crossing the streets, to even medicine itself which is a harm reduction science. Harm reduction works by delivering proper education and communication to society, providing incentives and motivation for people to follow the harm-reduction approach and making it easier for people to have access to harm-reduction products. By following these steps, we can create balanced and evidence-based policies and regulations that will maximize the potential public health benefit and minimize any unintended harm. Price incentives, availability, variability and accessibility to harm-reduction products are key points of any regulatory attempt in order to fight smoking. Let's not forget that smoking is the enemy, not harm reduction. And I think it is finally time to study and use the example of Sweden, the only smoke-free country in Europe. Sweden would have never become a smoke-free country without the help of tobacco harm reduction. Let's use this success story everywhere in Europe.

Opening picture: Konstantinos E Farsalinos (Source: The Global Tobacco and Nicotine Forum [GTNF])