Ontario's own public health agency expects smokers in the North to stay well above the national target in 2035 — while Ottawa keeps a considerably less toxic alternative behind the pharmacy counter.
In an October report, Public Health Ontario projected adult cigarette use would fall to 4.6% by 2035 if 2015 to 2021 trends persist. But it projected 6.8% in the Northeast, 6.5% in the Northwest, and 8.1% among adults without a high school diploma, with workers in the trades and transport also expected to stay above 5%.
The agency said smoking "is more prevalent in rural, small, and medium-sized population centres than in large urban centres." It also warned that vaping products and nicotine pouches "deliver addictive nicotine and may lead to dependence among people who do not currently use tobacco."
A scoping review published September 6 in Nicotine & Tobacco Research by researchers at Georgetown University, the University of Michigan, and other institutions found that pouches "are considerably less toxic than cigarettes." It said their long-term health impacts "remain understudied" and that short-term studies show pouches can reduce smoking, though usually alongside cigarettes rather than replacing them. Twelve of the 73 new studies it reviewed were industry-funded.
Health Canada's August 2024 order limits authorized pouches — Imperial Tobacco's Zonnic is the only brand — to mint and menthol, sold from behind the pharmacy counter. Convenience stores, which can sell cigarettes, cannot carry them.
In a May 2026 report, the Ontario College of Pharmacists said 65% of pharmacist respondents faced business pressures, and that many respondents indicated they have "no capacity to safely implement new scope of practice changes."
The Lung Health Foundation said smoking contributes to an estimated $7 billion in annual healthcare spending in Ontario.
The National Post reported in September that Ontario Health Minister Sylvia Jones raised the pouch rules with her federal counterpart, which a source called "very quiet diplomacy." On November 3, the Ontario Convenience Stores Association urged Queen's Park to join Alberta in pressing Ottawa.
Federal Health Minister Marjorie Michel said on September 22 of easing the rules, "That's not something I'm considering."