Media: Altinget – Time to smoke out nicotine’s bad reputation

Op-ed from Professor Karl Fagerström.

[Read the full article here]

Sweden’s experience of using alternative nicotine products to reduce smoking has shown an eye-opening paradox: despite similar levels of nicotine use as in the rest of Europe, we have markedly fewer tobacco-related health problems when it comes to men.

This is no accident.

In the report I have co-authored with respected international health experts, we seek to highlight the data and science showing that it is the method of consumption that matters when it comes to nicotine, not the consumption of nicotine itself.

Embraced safe forms

To put it another way, we can say that while smoking results in a myriad of health problems, using snuff or nicotine pouches does not have the same effect. Here in Sweden, we have simply chosen a less risky way to consume nicotine, which has led to significantly better health outcomes.

We have 38 percent fewer deaths from tobacco-related causes than the European average and a 41 percent lower incidence of lung cancer.

At the same time, approximately 1 in 4 people consumes nicotine in Sweden, which is roughly the same as in our neighboring countries. We Swedes have not avoided nicotine: we have simply embraced its safer forms. Historically, the public health narrative has been clear – nicotine is the enemy. Yet here we are, a nation clinging to our nicotine, albeit via snus, nicotine pouches, vapes and other smokeless alternatives.

How did we do it? The solution was a changed view of nicotine. By adjusting public understanding and the regulations governing nicotine use, we can mitigate health risks without having to resort to total bans on a substance that has long been a socially accepted habit.

Like caffeine, nicotine has been a constant companion for many, a vice for some and a comfort for others. But our approach shows that the focus should be on how we use nicotine. By offering and regulating safer alternatives, we can address health issues without stigmatizing nicotine use itself.

Help smokers who want to quit

Persistent fallacies about nicotine have clouded global judgment. The widespread belief that nicotine is a significant cause of cancer is as scientifically incorrect as it is dangerous – and ignores what we actually know. No one believes that nicotine gum or nicotine patches cause cancer – why should it be any different for tobacco-free nicotine pouches or snuff? But if we fail to make this distinction and provide clear information, we risk harming the people we need to help: smokers who want to quit.

While the rest of the world continues to struggle with smoking, we offer a model that cleans the air, literally and figuratively. The report “No smoke, less harm” is an invitation to the world to reconsider the war on nicotine. It is a call for a global shift to harm reduction strategies that could save millions of lives. It is a call to policy makers, health practitioners and society at large to abandon the demonization of nicotine and to recognize the real enemy – the smoke, not the substance.

Sweden stands as proof of what is possible when addiction is not confused with illness. It is time for the global community to follow the evidence from Sweden and use it as a blueprint for a healthier world.