A recent report from the Office parlementaire d’évaluation des choix scientifiques et technologiques (OPECST) on Novel Tobacco and Nicotine Products, only months after the French proposals for a ban, offers significant findings concerning nicotine pouches. These findings indicate that France is following the clear European trend of regulating nicotine pouches rather than pursuing the prohibitionist approach adopted by Belgium (that came into force on October 1st).

The OPECST, or the Parliamentary Office for the Evaluation of Scientific and Technological Choices in France, plays a crucial role in promoting evidence-based policymaking. Composed of members from both the National Assembly and the Senate, it bridges the gap between scientific experts and policymakers. Its purpose is to assist parliamentarians in making informed decisions based on the best available scientific knowledge and technological advancements.

The introductory sections of the report conclude that, while more research is needed, existing studies already suggest that exclusive consumption of “snus” could reduce health risks for smokers. This comment concerns the tobacco-based product, but the British Royal College of Physicians’ report linked to this paragraph, also states that “oral nicotine products have a good safety profile, with the most commonly reported adverse effects being related to mouth and throat irritation, and hiccups.” Furthermore, the OPECST mentions that the German Federal Institute for Risk Assessment estimates that “for smokers, switching to nicotine pouches could represent a reduction in health risks.

Gateway to smoking?
In the section on assessing if new nicotine products could serve as a potential gateway to smoking, US studies suggest that the use of oral forms of tobacco could lead to the consumption of traditional cigarettes, while Swedish data do not observe such a trend with “snus.”
The discussion on nicotine pouches is surprisingly more cautious which can be explained by that it refers to addiction caused by pouches with extremely high doses of nicotine (47.5 mg per pouch).
The report ends with a conclusion that there seems to be a consensus on the need for regulation for non-smoked tobacco products.

In the section suggesting legislative actions, there are several welcome proposals regarding new nicotine products and nicotine pouches such as:
• Launching independent nationwide research on the specific and relative harmfulness of these products and their effects on smoking.
• Request the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) to promptly publish its health risk assessment for these products and regularly update its findings.
• Base legislative and regulatory decisions on the best available scientific knowledge.
• Provide consumers with clear, complete, and objective information about these products.
• Consider the relevance of a scoring system or rating that assesses the level of harm or danger associated with different products to inform consumers about product harmfulness.
• Adopt a risk-reduction approach for smokers who cannot or do not wish to use traditional nicotine treatments, similar to the United Kingdom’s strategy.
• Ban marketing directed towards children, such as using sweet-inspired flavour names.
• Increase controls and sanctions for the sale of tobacco or nicotine products to minors.
• Quickly develop a regulatory framework for new oral nicotine products, especially pouches.

Our comments
Pouchforum welcomes this more balanced approach presented by the OPECST and would support a regulation that provides a clear framework for the market while allowing smokers to choose a low-risk product as an alternative to smoking cigarettes. Key points of the scientific note align with the NNPA position, including no sales or marketing to minors and proper labelling for consumers. Pouchforum acknowledges concerns about nicotine pouches with very high nicotine levels and advocates for a scientifically relevant cap on nicotine content. However, it is important to note that such extreme products represent only a miniscule part of the market. 47,5mg is more than twice the nicotine content usually considered extra strong and no major manufacturer produces anything even close to these extreme fringe market products.

The relative risk compared to cigarette smoking is a key figure and we are convinced that research on the subject confirming the relevant facts would be extremely valuable for legislators, as well as for the market and nicotine consumers.
Ultimately, Pouchforum would welcome a tobacco control strategy that recognizes the harm reduction concept and includes nicotine pouches as one of the policy tools. There are approximately 13 million smokers in France and it is highly unlikely that all of them will choose to quit and statistics suggest far from everyone will manage even if they would try. It would be irresponsible to not take a broader perspective on relative risk, in particular considering that it is likely that nicotine pouches are the least harmful nicotine product on the market.

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