3 August 2023

What the UK can learn from Sweden about a smoke-free future

By Richard Crosby

It’s not often the UK places highly in Europe.

Our men’s national football team has never won a European tournament, we regularly jostle for the bottom spot at the Eurovision Song Contest and according to the World Economic Forum, even Moldova has better roads.

Yet there is one issue at which the UK – much to the apparent displeasure of the World Health Organisation – has proven to be adept. And that is slashing smoking rates.

We have one of the lowest cigarette consumption levels in Europe, helped in no small part by our decision to implement some of the methods used in Sweden, where a harm reduction programme has seen the smoking rate slashed by 55% in the last decade alone.

Smoking prevalence there will fall below 5% this year, making Sweden the first smoke-free country in Europe, 17 years ahead of the target set by the EU. Yet, the important point is they still enjoy and consume nicotine. 

The reduction in smoking here has taken time. Around 45% of British adults smoked in 1974. By 2020, this figure had decreased to around 15%. In 2021 it was 13.3%, according to the Office for National Statistics, and the rates are expected to fall again after a government push for vaping.

Health Minister Neil O’Brien recently announced the world’s first ‘Swap to Stop’ scheme, handing out vaping starter kits to one-in-five smokers in a move that will attempt to echo Sweden’s success in getting people to switch from combustible tobacco to e-cigarettes.

But Cancer Research UK says England will still miss Westminster’s 2030 smoke-free target by 16 years and without urgent action, it will never claw back this ground.

So how did Sweden – where just 5.6% of the population light up – put itself on track to be the first smoke-free country, while we still lag behind? And what can be done?

A significant part of the answer lies in Sweden’s use of oral nicotine in the form of Swedish snus and nicotine pouches. The latter of which doesn’t contain tobacco, they both discretely release nicotine behind the top lip without using combustion, or emitting any odour. 

There are no significant health risks to using nicotine pouches, aside from those associated with any type of nicotine consumption which carries a similar risk profile to caffeine, they can be used anywhere and are much cheaper than smoking. Users report that different strengths and sensory pleasure they offer helped them wean themselves off cigarettes more effectively than Nicotine Replacement Therapy.

Commercially launched in 2016 as an alternative to snus – pouches that contain tobacco – nicotine pouches quickly became popular for flavours and the reduction in harm they offered. And according to Swedish research, as their use increased, smoking levels declined.

Sweden’s push for the use of pouches and snus – which frustratingly remain banned in the UK – as a means of harm reduction has had an undeniable impact.

As well as more than halving smoking prevalence in ten years, the Public Health Agency of Sweden now reports smoking-related deaths are also 22% lower in the country than the EU average, while cancer incidence is 41% lower, with 38% less total cancer deaths.

Harm reduction methods work.

So why is the UK not embracing nicotine pouches in the same way it has vaping?

It seems the main reason is a lack of awareness – in a 2022 survey of 13,000 people by ASH, less than half (45%) of 18 to 24-year-olds had even heard of nicotine pouches, let alone been made aware they were an effective way to stop smoking.

Fears surrounding nicotine addiction in young people have also likely caused government reluctance to promote them in the same way it has vaping because pouches are not regulated like e-cigarettes. But such scare-mongering – which has been leapt on by anti-harm-reduction bodies like the World Health Organisation – can easily be remedied by banning the sale of pouches to minors. Trading Standards can then aggressively enforce this legislation, as it does with alcohol and other age-restricted products.

Anti-vaping campaigns have also demonised nicotine, linking the drug to heart attacks and strokes, when evidence suggests it is no more dangerous than caffeine. Combustible tobacco kills, nicotine does not. In fact, there is significant research indicating an increase in anaerobic performance, alertness and even hearing in those using nicotine. And if we accept the evidence nicotine is not the evil drug many would have us believe, we should be open to using it as a means to solving the smoking problem.

Cancer Research UK, using the data available up to 2021, has now stated England will not reach smoke-free status until 2039 – doubling its 2018 projection.

The problem is as clear as the solution. Another effective smoking cessation tool is needed to accelerate smoking decline, and we may have the answer in nicotine pouches.

Government must not only educate the public but also encourage health care professionals to recommend nicotine pouches as being safer than cigarettes, alongside vaping, but also push back against the anti-harm reduction narrative we so often see when it comes to smoking alternatives.

It is time we fully supported the tools we know to be the safest to reduce smoking rates across the whole of the UK as quickly as possible if we stand a hope of reaching our 2030 target.

Sweden has shown harm reduction – in particular nicotine pouches and vaping – is the trodden path to eradicating cigarettes.

It’s the road the UK must take if it is serious about a smoke-free future.

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Richard Crosby is co-founder of consumer advocacy group Considerate Pouchers.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.