By Ian Irvine
If I told you I was enthralled by a movie I saw last week in London in which six Swedes talked incessantly about nicotine, would you believe me? Probably not. There was no Tom Cruise fighting evil, no torrid sex scene, no Beautiful People at all. Instead, the movie analyzed how Sweden has already reached the zero-smoking goal set by numerous national and international health bodies, including Health Canada. In this context, “zero” actually means a five per cent smoking rate. Call me a nerd, but this is the stuff of wonder.
In Canada we are fretting about reaching zero by 2035. Meanwhile the Norwegians and Icelanders are mushing hard, chasing down Sweden, which, to go along with its effectively zero smoking rate, has the lowest rate of lung cancer and tobacco-related disease in the developed world. The European average death rate attributable to tobacco is 373 per 100,000 population. In Sweden it’s 40 per cent of that: just 152.
I was in London for the annual e-cigarette summit, held in the home of the Royal College of Physicians. About a dozen other Canadians were there to listen to academics and public servants talk about harm reduction as it pertains to tobacco use. London being the price it is, we all had our way paid by various interest groups. My tab was covered by a Canadian nicotine product producer sympathetic to my writings on reduced-harm nicotine products.
After two days of hearing about the successes of harm reduction, I arrived home in Montreal to find many health groups still up in arms about Zonnic, a new nicotine product produced by British-American Tobacco (BAT), the parent of Canada’s Imperial Tobacco. Zonnic is like a small white tea bag containing nicotine and vegetable material. Put it in your mouth for a while and it satisfies your urge for nicotine.
Like other lower-risk nicotine products, such as e-cigarettes and heated tobacco products, it avoids combustion, which is what creates the tar and toxins that do such damage to smokers when they inhale. BAT says Zonnic, which has been approved by Health Canada after rigorous screening, has only one per cent of the toxins of cigarettes.
Swedes, who have done such a good job reducing smoking rates, have a nicotine use rate well above Canada’s. About 20 per cent of the population uses nicotine, though most of it in the form of Snus, which is like snuff, and “modern oral” products like Zonnic. Despite their high use, Swedes’ avoidance of combusted products keeps their death rate low. Nobody claims Snus and modern oral products are zero-risk, just that their toxin content is a hundred times lower than cigarettes.
You might think there’s a lesson here for Canada: let’s tolerate low-risk use, get smokers to switch, restrict access by kids and reduce our death rates. But you would be wrong. Health groups have instead vilified the product, the manufacturer and the regulators that approved Zonnic.
When in London I collared a BAT rep and asked what they were doing about this. He responded that BAT had foreseen the ruckus, that new products (think AI) frequently force regulators to play catch-up and that BAT, as part of its contract with retailers, requires age checks on purchasers — even though, being low in nicotine, Zonnic is regulated as a herbal product, not a tobacco product, and can legally be sold to those under 18. Translated: if you sell to teens, your retail contract with Imperial is voided. In this instance, industry stepped into the regulatory hole.
But putting a product that has only one per cent of the toxins of cigarettes in corner stores was not good enough for health promoters in Quebec, who persuaded the government that Zonnic should only be sold in pharmacies. So as things stand it’s OK to continue selling cigarettes that are 100 times more toxic; it’s OK to have flavoured alcohol all over corner stores at kiddie-eye level; it’s OK to have Lotto Quebec’s lottery terminal just above the kiddie candy at check out. But it’s not OK to provide smokers with the opportunity to buy a product that could give them several extra years of higher-quality life.
Big Pharma must be relieved it will not face excessive competition, at least in Quebec, from an effective new entrant to the market. The medical profession recommends only pharmaceutical products (nicotine gum, sprays, patches and varenicline) as quit smoking aids. Coincidentally, Big Pharma is a major source of grants for medical researchers.
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In its low-risk form, nicotine serves a therapeutic as well as a hedonistic/utilitarian purpose. It provides solace to those suffering from anxiety and hyperactivity. It is consumed most heavily by identifiable minorities, including the impoverished, who often face special stresses. It has numerous cognitive benefits, including slowing the impact of Parkinson’s and Alzheimer’s diseases. And it may even help people lose weight without the side-effects of semaglutide-based drugs. Sensible policy would balance these benefits against the costs of possible induced dependence and overuse by minors. In Canada we are groping too slowly toward such balanced management.
Ian Irvine, a professor of economics at Concordia University, has worked on alcohol and tobacco policy for the federal government. Some of his recent research has been funded by the Foundation for a Smoke Free World.