The next front in tobacco control

New nicotine products are challenging traditional approaches to tobacco regulation

The Maldives became the first country in the world to enact tobacco-free generation legislation last year when it introduced a law, which prohibits anyone born on or after 1 January 2007 from being sold tobacco products. And the UK is planning to bring in similar laws from 2027.

The RCPI has now called for such a measure to be introduced here for what it calls a “tobacco endgame” strategy. In an article published in the Irish Medical Journal in May, the College argues that the Government in its role of protecting the public must change the focus from simply managing the harm caused by tobacco products to eliminating it completely.

More than 100 million packs of cigarettes are still sold annually in this country, while declines in smoking prevalence have stalled after decades of progress, with nearly one in five adults continuing to smoke. Tobacco remains the leading cause of preventable illness and death in Ireland, claiming more than 4,500 lives each year.

But even as the tobacco industry fights a determined rearguard action to maintain cigarette sales, large tobacco companies have developed a new wave of tobacco-derived products. The industry increasingly targets a younger generation of customers with new products such as nicotine pouches. The World Health Organisation (WHO) has recently called for stricter legislation of nicotine pouches.

In 2025, the global market for small pre-portioned nicotine pouches, which deliver nicotine by mouth, was almost €6 billion, according to the WHO. Nicotine pouches are not risk free. Addiction, increased risk of cardiovascular disease, and damage to the developing brain in younger people are just some of the potential hazards associated with the nicotine products.

Placed between the gum and upper lip, nicotine pouches contain either tobacco-derived or synthetic nicotine, as well as cellulose powder, flavourings, sweeteners, and alkaline agents to increase nicotine absorption. They can also contain trace contaminants from tobacco, such as aldehydes and nitrosamines, both of which are potentially carcinogenic.

Dr Vinayak Prasad, unit head of WHO’s Tobacco Free Initiative, said that the use of nicotine pouches was spreading rapidly, while regulation struggled to keep pace. Unsurprisingly, given the tobacco industry’s tactics for years with cigarettes, the WHO report warned that manufacturers were using “aggressive” marketing tactics designed “to hook a new generation of nicotine users”.

“The major manufacturers use diverse tactics to encourage and sustain use, and nicotine pouches are becoming increasingly popular, particularly among adolescents and young adults, given their strong youth appeal and high addiction potential, which raise urgent public health concern that demands coordinated, urgent, decisive action,” the report says.

Of particular concern is the “systematic” targeting of young people with the use of flavours, sleek packaging, digital marketing, social media promotion, sponsorships, and influencer marketing. These tactics position nicotine pouches as lifestyle products rather than addictive and harmful, according to the WHO.

The authors warn that “initiation during youth increases the likelihood of sustained addiction, dual or poly-product use and future transition to other tobacco and related products”.

“These strategies to normalise nicotine use, reduce the perception of risk and exploit regulatory gaps place a new generation at risk of lifelong addiction,” according to the report.

Dr Ranti Fayokun, a scientist with the Tobacco Free Initiative, told a WHO press conference that the pouches, with the use of candy-like flavours and packaging, were “clearly not designed to help smokers quit, but are designed to initiate and sustain nicotine addiction”.

According to a 2024 review, some 16 countries ban the sale of nicotine pouches. Another 32 countries otherwise regulate the pouches, including five that impose flavour restrictions to reduce appeal to youngsters, 26 that restrict sale to minors, and 21 that ban advertising, promotion, and sponsorship. However, 160 countries have no regulation of nicotine pouches in place. Canada is cited as an especially positive example of regulating nicotine pouches, where they can only be sold to adults as smoking cessation aids from behind the counter in pharmacies.

With the tobacco/nicotine industry, it’s always a case of plus ça change, plus c’est la même chose.

In response, public health regulation must address not only what nicotine pouches contain, but also how they are packaged, priced, and sold. And it may well be time for advocacy groups to give more prominence to the word nicotine in their campaigns than is currently the case. A nicotine-free initiative, anyone?