Over the last two decades, vaping, nicotine pouches and a range of other less harmful products have completely transformed the nicotine space. Oral Nicotine Delivery Systems, or ONDS, represent the next generation in smokeless, tobacco-free nicotine products.

Scientific evidence surrounding the benefits of nicotine pouches and snus has been mounting. A recent study from the Karolinska Institute in Sweden, which involved 400,000 participants and covered 9-million-person years, has shown that there is no association between snus use and oral cancer. A separate study conducted by the physician and epidemiologist, Dr. Cother Hajat shows that we should not classify all oral tobacco or nicotine products in the same risk camp, and that snus confers no excess risks for oral and many other cancers, cardiovascular disease, and chronic lung diseases. When taking the scientific evidence into consideration, it comes as no surprise that the US Food and Drugs Administration (FDA) has authorised Swedish Match's snus as being appropriate for the protection of public health under its modified risk tobacco product (MRTP) guidance.

Regulators and international organisations continue to group oral nicotine products with combustible tobacco products, ignoring the evidence of their positive impacts. The WHO's latest report on oral health fails to distinguish between snus and toxic smokeless tobacco products and raises unscientific concerns about the potential negative effect of nicotine from vaping on oral cancer.

Sweden assumes the Presidency of the Council of the European Union in January 2023, so right now is the perfect time to look at the role snus has played in allowing them to become the European leader in smoking cessation.

Sweden has the lowest smoking rate in the EU at 6%, compared to the EU average of 23%. As a result of this, Sweden has the lowest tobacco mortality rate in Europe. Snus has been at the centre of the reduction measures, but in recent years, nicotine pouches and e-cigarettes have proven to be useful additional tools for Swedish smokers aiming to quit. The progressive, pro harm-reduction Swedish model is clearly distinct from the tobacco control policies proposed by other EU Member States. Ensuring that less harmful alternatives to smoking, such as nicotine pouches and vapes, are accessible will be paramount to ensure that other countries can replicate Sweden's success.

At Tobaccoharmreduction.net and the Oral Nicotine Commission, we have developed an advocacy instrument, which addresses public misconceptions surrounding tobacco harm reduction.