World No Tobacco Day puts spotlight on Canada’s limited access to safer nicotine products

It is World No Tobacco Day and Canada is falling behind countries where nicotine pouches are freely sold.

Imperial Tobacco points out that 11% of Canadian adults still smoke, a figure that has barely changed in recent years. 

By contrast, Sweden, which allows a wide range of smoke-free nicotine products, including pouches and traditional snus, has driven its smoking rate among Swedish-born adults down to 4.5%, officially earning “smoke-free” status. 

Officials there credit easy access to safer nicotine products such as nicotine pouches for the historic drop and being the first “smoke-free” country.

The United Kingdom is seeing similar gains. 

A peer-reviewed study published this year in JAMA Network Open found quit attempts that used nicotine pouches had an unadjusted success rate of 30%, the best performance among all stop-smoking aids.  

Japan, meanwhile, reports cigarette sales now falling nearly 10% a year after the arrival of heated and oral nicotine products. 

Japanese government health surveys show exclusive cigarette smoking dropped from 19.6% of adults in 2014 to 10.6 % in 2022 as consumers switched to smoke-free options, that’s a 9% drop in only eight years.

"For years, nicotine has been misunderstood, largely because its use was predominantly through the act of cigarette smoking," said Frank Silva, President and CEO of Imperial. 

"We need people to understand that nicotine, while addictive, does not cause cancer and is not the cause of smoking related diseases. By offering adult smokers access to less harmful alternatives that deliver nicotine without combustion, we can, in fact, significantly reduce the health impact on the Canadian Society.” 

After a three year review, Imperial launched Zonnic last year, the first Health Canada approved nicotine replacement pouch legal for sale in Canada.

Within weeks, former Liberal Health minister Mark Holland issued a ministerial order that pulled Zonnic from behind the counter at convenience stores and restricted sales to pharmacies and limited flavours to mint and menthol. 

Silva says the move undermines harm reduction goals and burdens pharmacists as Zonnic is only available behind the counter at pharmacies, which takes up a pharmacist’s time. 

“The evidence shows that if you want to help smokers quit, make cessation alternatives available where cigarettes are sold,” said Silva, warning the restrictions have already fuelled an illegal online market for unregulated nicotine pouches.

Public health officials counter that pharmacy only sales are needed to keep high nicotine products away from teens. 

Advocacy groups pushing for looser rules in Canada point to Sweden’s dramatic drop in tobacco related cancers and the United Kingdom’s plan to legalize stronger pouch strengths later this year. 

They argue that, with smoking still killing nearly 48,000 Canadians annually, Ottawa cannot afford to ignore tools that appear to work elsewhere.

Imperial says it shares Health Canada’s target of reducing smoking to below 5% by 2035 but insists that will only happen if adult smokers are allowed to buy approved products like Zonnic where they buy cigarettes today.

For now, a Canadian visiting London, Stockholm, or Tokyo can purchase nicotine pouches at ordinary retail outlets. 

Back home, the same product sits behind the pharmacy counter, a reminder that federal policy has not yet caught up with global evidence on harm reduction.