Home Society The Successful Strategy Making Sweden Smokefree Still Ignored by Some

Society

The Successful Strategy Making Sweden Smokefree Still Ignored by Some

A recent report presented to Sweden's Minister of Social Affairs and Public Health, is recommending setting restrictions on nicotine pouches in a way which would make them inaccessible also to adult users, not just teens.

Diane Caruana

August 19, 2024

In March, Swedish Justice of the Supreme Administrative Court Inga-Lill Askersjö submitted a report titled “A Safe Upbringing Without Nicotine, Alcohol, and Nitrous Oxide” to Sweden’s Minister of Social Affairs and Public Health, Jakob Forssmed. The report aimed to explore harm reduction in line with the ANTDS strategy, but instead focused on restricting nicotine use, particularly in nicotine pouches (NPs), without distinguishing the relative harms of different substances.

Askersjö’s report proposes capping nicotine content in pouches at 12 milligrams per gram. This reduction could make nicotine pouches less effective as smoking cessation tools, affecting the majority of consumers who rely on them to quit smoking.

Additionally, the report suggests measuring nicotine per gram instead of per pouch, which could lead to larger, less convenient pouches. It also advocates for nicotine-free schools, applying to both students and adult staff, a policy that may be counterproductive by making nicotine use more appealing to minors while unfairly restricting adult use.

Why advocate against a successful approach?

The report seems to ignore the fact that Sweden is about to become the first smoke-free country, 17 years ahead of the EU’s target.

More notably, these suggestions all seem to ignore the fact that Sweden is about to become the first smoke-free country, 17 years ahead of the EU’s target. Sadly, they also overlook the fact that this impressive feat was achieved by allowing adult smokers access to safer and non-combustible nicotine alternatives to cigarettes, most notably snus.

Additionally, one cannot ignore the fact that NPs are considered by many smokers a cleaner and safer alternative to snus, given the fact that they contain no tobacco. Moreover, local brand Stingfree AB invented a version of NPs that is gentler on gums, and therefore safer for oral health. In fact, in a 2024 trial involving 23 dentists using this innovative product, most reported significant improvements in their oral health and now recommend it to patients unable or unwilling to quit NPs.

Meanwhile, critics of Askersjö’s report argue that her proposals ignore the needs of adult users and could undermine the harm reduction potential of nicotine pouches. Public comments on the proposal are open until August 30th, with many planning to submit feedback opposing these restrictions.

Youngsters are avoiding dentist visits to avoid being told to quit snus/NPs

While a recent release by Stingfree AB revealed that many young people are avoiding much needed dentist visits to avoid being told to quit the products. In fact the use of nicotine pouches and snus among young adults in Sweden is leading to significant oral health issues, including gum inflammation and mucosal damage, a fact confirmed by several studies.

Once such study conducted in 2022 University of Gothenburg study, found that 70-90% of participants had snus lesions, and 54-57% had receding gums. While a 2023 Norwegian study similarly reported that 79.2% of young adults experienced mucosal changes after using snus for just three years.

The release shared the story of a Swedish young person named Åsa whose severe gum irritation and inflammation persisted for six years. In response to this, her dentist advised her to stop using snus, however, being unwilling to quit snus, Åsa just stopped visiting the dentist instead.

Sadly, this has become a trend, resulting in many young people avoiding regular dental visits, and therefore exacerbating their oral health problems. A recent Swedish dental care reform, set to lower the age for free dental care from 23 to 19 in 2025, may worsen the situation by making dental visits more expensive for young adults.

Concerns about nicotine pouches and snus were echoed by Swedish dental experts on “Vetenskapsradion,” who warned that young users might not fully understand the risks. An ongoing study by Folktandvården Stockholm aims to compare the oral health of young users of nicotine pouches, traditional snus, and non-users, with results expected later this year.

A balanced approach vs prohibition

Sweden’s successful smoking cessation strategy, which heavily promotes the use of safer nicotine alternatives such as snus and NPs as harm reduction tools, has been credited with achieving one of the lowest smoking rates in the world. Despite delivering results, at times this approach still faces criticism, namely from conservatives who insist on total nicotine abstinence. This conflict in opinions calls for ongoing debates over the best methods to achieve public health goals, while managing the risks of alternative nicotine products.