A recent article in the UW Medicine publication Right as Rain aims to shed some light on nicotine pouches. However, it doesn’t quite hit the mark on a number of points and, as it turns out, they’re just trying to sell you something anyway.
Let’s take a look.
The “expert” view
The article, titled Are Nicotine Pouches Bad for You?, draws heavily from a few sources that are connected to the UW Medicine campus. The first of which is Fred Hutchinson Cancer Center tobacco treatment specialist, Brandon Omernik.
Sometimes, refuting an argument is as simple as laying out a person's words. Check out this incongruity from Omernik.
“I used to view nicotine pouches and vaping as a harm reduction strategy…But using nicotine pouches in place of traditional tobacco is really not solving the issue.”
“I’m honest with patients that if somebody were to switch entirely from traditional cigarettes to a nicotine pouch, it’s probably going to be healthier for them,”
Now, unless Omernik is working off an interpretation of harm reduction that I’ve never encountered, it seems like he no longer believes that transitioning a patient to a less harmful product that reduces their exposure to harm is not harm reduction.
It begs the question, what constitutes harm reduction in Omernik’s world? Quitting nicotine altogether?
What does he mean by “solving the issue”? Well, as you might have guessed, it’s entirely in line with Tobacco Control’s newest goalpost shift: now it’s all about addiction!
Yes, in the past, tobacco control was interested in reducing death and illness from combustible tobacco. You know, tackling big issues like cancer and heart disease. That was THE issue.
However, with smoking rates plummeting, to a large extent due to safer products like vaping and nicotine pouches, they have been forced to stay relevant by attacking harm reduction and worrying about nicotine “addiction” instead.
The argument that the author of this piece tries to push forward is that pouches are not a long-term solution because they can “worsen nicotine dependence” — no citation provided, obviously — which, as they explain, means people are “more susceptible to going back to tobacco products.”
The bioavailability trap
Omernik’s argument focuses on the bioavailability of pouches vs nicotine. Long-standing research suggests about 10% of available nicotine is absorbed during cigarette smoking. On the other hand, pouches are far more efficient, with pouches sitting around 55-59%%20compared%20with%20the%20snus).
So, if the average cigarette has between 11.9– 14.5 mg of nicotine at 10%, that means 1.2mg to 1.4 mg of nicotine is absorbed.
The most popular pouch strengths sold by ZYN are 3mg and 6mg. If we round up bioavailability to 60%, then a 3mg pouch gives about 1.8mg, and 3.6mg.
I think we’re meant to look at the difference in nicotine absorbed through these distribution methods and be bowled over that it’s a greater amount. We're meant to ignore that by using pouches, you are cutting out the tar, carbon monoxide, arsenic, benzene, formaldehyde, or any of the other hundreds of harmful chemicals in cigarettes.
Worrying about the higher bioavailability of a relatively harmless chemical that has a host of benefits makes for a strange argument in the context of harm reduction.
What’s more, the author worries that “there are no barriers to prevent you from continuously consuming nicotine packets to keep up the rush,” as if there exists some special mechanism that stops chain-smoking, binge drinking, or excessive coffee consumption.
The grift within a grift
If you spend any time at all on the internet these days, you’ll be familiar with that sinking feeling when you realise someone is trying to sell you a course. Well, sure enough, one of the experts quoted in the article is pushing a CBT course with a call to action button at the bottom of the article.
Yes, instead of taking personal responsibility on your journey to quit smoking, you can pay someone money for an approach that is consistently proven less effective than vaping or nicotine pouches for smoking cessation.
The Right as Rain blog suggests that CBT combined with nicotine replacement is “perhaps the most effective tool”. However, without the evidence to support this claim, it’s hard to see this article as anything other than an advert for a service designed to finesse people who smoke.
Public health is full of grifters masquerading as people who care. If they could sell you a course, they would. Indeed, these people are happy if you quit cigarettes, but only as long as you pay them your tithe along the way.
