TOBACCO CONTROL

Stub out misinformation to save lives

Get rid of the burning, reduce the harm.

In Summary

• A sensible start would be to put an end to the well-intentioned but misguided “quit or die” approach to tobacco control. 

• Like so many others, I have used nicotine pouches to quit smoking entirely. I want to be blunt about this. 

Evidence shows that innovative alternative nicotine products, such as tobacco-free pouches and e-cigarettes, can deliver nicotine with drastically reduced risk compared to traditional “combustible” cigarettes.
Evidence shows that innovative alternative nicotine products, such as tobacco-free pouches and e-cigarettes, can deliver nicotine with drastically reduced risk compared to traditional “combustible” cigarettes.
Image: COURTESY

One in every three Kenyan smokers has tried to quit. Yet, only a tiny fraction succeed.

Just how do we help them kick this deadly habit? And how do we persuade other smokers that it is a good idea to follow suit?

A sensible start would be to put an end to the well-intentioned but misguided “quit or die” approach to tobacco control.

 
 

For thousands of adult smokers for whom quitting nicotine entirely seems like an impossible dream and for others who want to continue consuming nicotine, it is no longer a binary choice.

Thankfully, there are other viable options.

Evidence shows that innovative alternative nicotine products, such as tobacco-free pouches and e-cigarettes, can deliver nicotine with drastically reduced risk compared to traditional “combustible” cigarettes.

Like so many others, I have used nicotine pouches to quit smoking entirely. I want to be blunt about this.

These pouches saved my life. And that is why I became a Tobacco Harm Reduction advocate.

Tobacco Harm Reduction is all about one thing: getting serious about saving lives by acknowledging that the majority of harm caused by cigarettes is from the burning of tobacco, which releases dangerous toxicants.

Get rid of the burning, reduce the harm.

 
 

The evidence from countries like Sweden suggests that if smokers can get their nicotine without burning tobacco, we should be able to dramatically reduce the 30,000 tobacco-related deaths seen in Kenya every year.

A tobacco-free nicotine pouch, which is placed between the lip and the gum, would appear to be a particularly relevant alternative for smokers in Kenya, and the wider East Africa region, where there is a long tradition of using oral stimulants.

Containing zero tobacco, the composition of oral nicotine pouches suggests that they should have amongst the lowest risk profile of available alternative nicotine products, close to that of medically-licensed nicotine replacement therapies (NRT).

Recently, oral nicotine pouches have been mistakenly conflated with snus and kuber.

However, such comparisons are dangerously misguided.

Unlike snus and kuber, oral nicotine pouches do not contain any tobacco at all, meaning that they do not contain the tobacco-specific nitrosamines (TSNAs) in kuber and some types of snus that have been linked with an increased incidence of certain cancers.

Significantly, research also shows that some alternative nicotine products can be more than twice as effective as NRTs when helping smokers to quit.

There are a number of theories as to why this might be, but it is likely due to the fact that, in the countries where these studies were conducted, there is (a) widespread public awareness about the relative risks of such products; (b) alternative nicotine products can typically be sold anywhere cigarettes are available; and (c) there is no stigmatisation involved with using such products.

Take Sweden, for example. Swedes have the highest consumption of oral pouches and the lowest smoking rates in Europe. The Swedish rate of tobacco-induced cancers for men is less than half the EU average.

Or look at the UK, where the government has adopted a progressive approach to alternative nicotine products, backed by international anti-smoking advocacy groups such as Action on Smoking and Health.

In just one year, e-cigarettes helped over 50,000 people in England quit smoking, while there are more than six million ex‐smokers in Europe who report that vaping helped them to end their smoking habit.

This is what makes calls for the Kenyan government to regulate tobacco-free nicotine pouches as if they were the same as cigarettes so alarming and regressive.

Other than the obvious point that these pouches are tobacco-free, and therefore an ill-fit for legislation targeted at tobacco, the real issue is that this outdated approach could actually end up costing lives.

Tobacco harm reduction prevents tobacco-related disease and premature death. This is the stated aim of the WHO’s Framework Convention on Tobacco Control.

If Kenyans are told that nicotine is the same as tobacco and that nicotine pouches are the same as cigarettes, there is a serious danger they will be deterred from making the switch to less risky products.

It is imperative that regulations are based on sound science, not swayed by ideological movements. I call on our government to consider existing evidence (e.g. the Swedish Snus experience) and commission more research on tobacco-free nicotine pouches.

In Sweden, this delivery system for nicotine has conclusively shown to prevent tobacco-related disease and premature death, it is incumbent on them to safeguard Kenyan lives in the same way.

If a ban was pursued without scientific underpinning, it would be a huge setback for the Tobacco Harm Reduction movement in Kenya, where we are already making slow progress in the fight against smoking.

Another problem is that it has been recently suggested that alternative nicotine products pose a special danger to young people as a slippery slope towards cigarette use.

These claims wilfully ignore international data which consistently shows that regular use of alternative nicotine products amongst young people who have never smoked is extremely rare (typically less than 0.1%) and that the majority of alternative nicotine product users are current or ex-smokers.

While nicotine pouches should never be sold or marketed to under-18s, it makes perfect sense to promote them as an alternative to adult smokers by making them available wherever cigarettes are sold and subject to the same supervision.

Get rid of the burning, reduce the harm, save lives. It is as simple as that.

Not only are alternative nicotine products effective, but they are also cost-effective for the government.

The state pays nothing when an adult smoker switches to alternative nicotine products.

Compare this with costly state-run programs. Meanwhile, by helping smokers quit, nicotine alternative products help ease the disease burden of smoking and the associated costs to the state.

It is therefore essential that Kenya adopts a balanced approach to such products.

If we fail in this, we will all count the cost.