For years, products containing nicotine have faced intense scrutiny and a complex public health narrative. As scientific research increasingly highlighted the health risks associated with certain forms of consumption, the need for clear regulation and harm reduction strategies became urgent.
This shift sparked a major transformation across the industry — one driven by science, innovation, and a growing commitment to safer alternatives.
Yet, in the past decade, a significant shift has taken place. Global tobacco companies, led by names like Philip Morris International, have redirected billions of dollars into research, innovation, and next-generation nicotine products. All under the ambitious banner of Tobacco Harm Reduction — and the pursuit of a smoke-free future.
To witness this transformation firsthand, we were invited by Philip Morris International, and embarked on a fact-finding journey to Stockholm, Sweden. Why Sweden? Because this Scandinavian nation has quietly become a poster child for smoke reduction, boasting some of the lowest smoking rates and smoking-related fatality figures in the developed world. It’s a public health success story built not on bans, but on science, pragmatism, and alternative solutions.
Read: Could oral nicotine pouches help cut smoking rates in the Middle East?
The Swedish experience: How a nation is quietly redefining Tobacco Harm Reduction
In the heart of Scandinavia, a quiet public health revolution is unfolding. Sweden, long celebrated for its innovation in welfare and healthcare policy, is on the cusp of becoming the first smoke-free country in the Western world — not through outright prohibition, but via pragmatic harm reduction strategies. At the center of this story lies an unlikely protagonist: The humble nicotine pouch.
A paradox in tobacco control
At first glance, Sweden appears unremarkable in its tobacco control policies. According to the Eurobarometer 506 report, the country sits close to the European average in implementing comprehensive tobacco control measures. Yet despite this, Sweden boasts the lowest smoking prevalence in the EU, and it continues to decline at a pace unmatched by its peers.
How is this possible? The answer lies in the nation’s embrace of smokeless alternatives — primarily snus and, more recently, modern nicotine pouches.
From snus to nicotine pouches: A cultural shift
Sweden’s historical relationship with snus, a moist, smokeless tobacco product, set the stage. Introduced in its modern portion form in 1973, snus rapidly gained popularity, especially among men. By 1999, the daily use of snus had surpassed cigarette smoking among Swedish males, a phenomenon unique in the Western world.
The next evolution came in 2016 with the commercial introduction of tobacco-free nicotine pouches. These white, discreet, and increasingly sophisticated products cater to modern consumers seeking nicotine without combustion, tobacco-specific nitrosamines, or teeth staining. Their uptake, particularly among women, a demographic traditionally less inclined toward snus, has fueled Sweden’s smoking decline even further.
Patrik Hildingsson of Swedish Match explains: “Sweden’s low smoking rate — around 5 percent — isn’t the result of bans or campaigns, but a cultural shift. Swedish men largely replaced cigarettes with snus, while modern pouches like ZYN made these alternatives more accessible and palatable, especially to new demographics.”
Behavioral science also plays a key role. According to Dr. Karl Fagerström, “Nicotine might account for 60 percent of the dependency — the other 40 percent is behavioral: The ritual, the hand-to-mouth action, the habits.”
This explains why products such as nicotine pouches, which lack the visual, tactile, and olfactory cues of smoking, may be less addictive than cigarettes.
The discreet, modern nature of nicotine pouches has also contributed to their appeal among women. “The nicotine pouches are cleaner, more attractive, and perceived as modern — this helped make it socially acceptable for women,” one observer notes. “People don’t want the taste of tobacco — they want to get away from it. Flavors help them quit smoking.”
The science behind the shift
The relationship between increased snus and nicotine pouch use, and declining cigarette sales is clear. In parallel, Sweden has also recorded a comparatively lower incidence of certain cancers, notably lip, oral, esophageal, and lung cancers among men, compared to the EU average.
“Studies — including one involving over 420,000 men — show no strong link between Swedish snus and oral cancer,” notes Hildingsson. “Snus isn’t risk-free, but it’s substantially less harmful than smoking.”
Comprehensive scientific reviews consistently find no significant risk association between snus use and oral cancer — a claim backed by decades of epidemiological data involving hundreds of thousands of participants. This evidence led the U.S. Food and Drug Administration (FDA) to grant Swedish Match’s general snus products the first-ever Modified Risk Tobacco Product (MRTP) designation in 2019, reaffirmed in 2024.
As Dr. Fagerström explains: “Nicotine is not the cause of cancer, vascular disease, or respiratory disease — it’s the thousands of other substances in cigarette smoke.”
This distinction, often misunderstood even within the medical community, underlines the importance of accurate public health messaging. “Even medical professionals are misinformed. Why should a smoker switch to a less harmful product if they’re told all nicotine is equally bad?”
Dr. Josef El-Achkar echoes a similar sentiment: “To say that [nicotine pouches are] unharmful is not correct — it is harmful, but to a lesser extent than cigarette smoking.”
Hildingsson also highlights the importance of quality: “Swedish Match introduced Gothiatek®, a quality standard that limits harmful substances in snus. Our products are pasteurized, stored chilled, and chemically stable — features that set them apart even among smokeless options.”
A new model for public health policy
Sweden’s differentiated excise taxation system further acknowledges the varying risk profiles of tobacco products. Recent government proposals advocate reducing taxes on snus while increasing levies on cigarettes — a policy designed to nudge smokers toward less harmful alternatives.
Legislation also ensures these alternatives are responsibly marketed: Age restrictions, health warnings, advertising limitations, and stringent product standards form the regulatory framework for nicotine pouches under Sweden’s 2019 Act on Tobacco and Similar Products.
The broader implications
What makes the Swedish experience so compelling is its scalable potential. By prioritizing individual risk reduction and providing accessible, regulated alternatives, Sweden offers a pragmatic pathway for countries grappling with the immense social and economic costs of smoking.
The implications for global health policy are profound. Dr. El-Ackhar stresses: “We can eliminate a lot of hospital visits and diseases just by switching from smoking to non-smoking alternatives.”
He continues: “As a doctor, my job is not only to cure but to reduce harm for people who don’t want to quit completely.”
Dr. Fagerström adds a sobering statistic: “If all EU countries had the same tobacco habits as Swedish men, we would have had 350,000 fewer deaths annually. There is no other area of public health that comes close to this.”
A note on messaging, regulation, and choice
Sweden’s success also offers a cautionary tale about the power — and peril — of public perception. “If you say this product is as harmful as a cigarette — one, you’re a liar. Two, you lose trust. Three, people believe you — and keep smoking,” warns a Swedish public health advocate. “Public health policy doesn’t always align with actual public health. Sometimes, it’s just about fear and perception.”
With some EU nations considering restrictions on nicotine pouches, experts warn of unintended consequences. “If 25 percent of users between 20 and 30 switch to smoking because of a ban, that would be devastating.”
Ultimately, the Swedish model reinforces one principle: Choice matters. As one expert succinctly put it: “To reduce smoking globally, you need as many options as possible available to smokers.”
Sweden’s approach is not perfect, but it is working. And in a world still battling the deadly toll of smoking, that is a story worth telling — and perhaps, replicating.
