Introduction

Landmark new evidence shows that nicotine pouches could be the game-changer to combat Spain’s smoking crisis and accelerate progress towards a smoke-free future.

Smoking continues to impose a heavy and avoidable health, social and economic burden on Spanish society. Despite decades of conventional tobacco control measures, adult smoking prevalence remains among the highest in Europe.

Against this backdrop, the experience of former smokers, together with international population-level evidence, points to nicotine pouches as the most practical and effective quit-smoking tool aligned with modern lifestyles.

Sweden has already demonstrated how nicotine pouches can dramatically accelerate quitting, particularly among women, who are historically one of the hardest groups to reach with traditional cessation tools.

Survey data shows nicotine pouches outperform all other quit aids, with both men and women ranking nicotine pouches as the most effective method due to their socially considerate, clean and stigma-free format.

Taken together, this evidence confirms nicotine pouches as key to winning the war on smoking at a critical moment for Spanish tobacco policy.

Pouches hold particular potential for Spanish women, whose lung cancer mortality is rising even as rates stabilise elsewhere in the European Union.

Spain’s Smoking Crisis

Spain’s smoking epidemic continues to exact a severe human toll. In 2023 alone, an estimated 49,510 deaths were attributed to tobacco use, reflecting the persistent dominance of combustible cigarettes as a cause of preventable disease and premature mortality.

Despite decades of tobacco control policies, Spain retains one of the highest smoking rates in Europe. Between 2007 and 2015, daily smoking prevalence rose to 30.8%, before gradually declining following the emergence of safer nicotine alternatives. Even today, smoking prevalence remains unacceptably high at approximately 25.8% overall, with 28.9% among men and 22.6% among women.

This plateau highlights the limits of traditional tobacco control measures when they are not complemented by widely accepted safer alternatives.

The public health consequences are particularly visible in cancer outcomes. While lung cancer mortality among women is stabilising across most EU countries, Spain stands apart.

Projections show lung cancer deaths among Spanish women continuing to rise through 2026, increasing by 2.4%, to around 10 deaths per 100,000 women.

These trends underscore a pressing reality: Spain requires new tools to make meaningful progress in reducing smoking-related harm, especially among women.

Projections show lung cancer deaths among Spanish women continuing to rise. Spain needs new tools, especially for women.

NICOTINE POUCHES: A PROVEN SAFER ALTERNATIVE

Nicotine pouches are smoke-free and tobacco-free products placed under the lip, delivering pharmaceutical-grade nicotine without combustion. By eliminating smoke, tar and carbon monoxide, they remove the primary drivers of smoking-related disease.

The table on the right, from the Oral Nicotine Commission’s 2020 Report, visualises the relative harm of all nicotine products available for purchase in Sweden. Nicotine pouches present risks comparable to established nicotine replacement therapies such as gum and lozenges, which are on the World Health Organization’s list of essential medicines.

Survey data in Smoke Free Sweden’s Power in a Pouch report11 shows nicotine pouches outperform all other quit aids, with both men and women ranking nicotine pouches as the most effective method due to their socially considerate, clean and stigma-free format.

WHY NICOTINE POUCHES MATTER FOR WOMEN

Sweden’s experience demonstrates that nicotine pouches have been particularly transformative for women.

Historically, Swedish women have had lower quit rates and fewer appealing alternatives to smoking. Before the introduction of pouches, the country’s impressive reduction in smoking rates was driven largely by snus, a product that primarily appealed to men. The arrival of nicotine pouches in 2016 reshaped this dynamic.

Since then:

• female smoking prevalence in Sweden has fallen by 49%
• women’s quit-smoking rates have increased by 200%
• the gender gap in smoking cessation has narrowed substantially

SWEDISH CASE STUDY IN SMOKE-FREE SUCCESS

Sweden is on track to become the world’s first officially smoke-free country. It has cut its smoking rate by more than half since 2012, has the lowest smoking rate in the European Union at 5.3% and now records some of the lowest rates of tobacco-related disease.

SPAIN’S DE FACTO BAN ON SAFER ALTERNATIVES

Despite mounting international evidence, Spain has advanced legislative proposals that would severely restrict smoke-free nicotine alternatives.

The primary instrument is a draft Royal Decree amending Royal Decree 579/2017, notified to the European Commission in January 2025 as part of Spain’s Comprehensive Plan for the Prevention and Control of Smoking 2024–2027.

For nicotine pouches, the proposals include a maximum nicotine limit of 4mg per pouch. However, the most authoritative scientific evidence, a 2022 study by the German Federal Institute for Risk Assessment (BfR), has recommended a 16.6 mg nicotine limit per pouch as a viable alternative to cigarettes.

Proposals also include a ban on all flavours except tobacco. However, international evidence
shows that a variety of flavours in safer alternatives is key to adult smokers quitting cigarettes for good. In the Swedish survey, 60% of female and 55% of male pouch users identified the variety of flavours as either their top or second most important reason for choosing nicotine pouches over tobacco snus. In the Spanish survey, 63% of pouch users identified flavour variety as a key motivator for choosing them.

EVIDENCE FROM SPANISH CONSUMERS

A poll of Spanish consumers conducted by Prodege between January 30 and February 9, 2026 provides critical insight into awareness, usage patterns and perceptions of nicotine pouches. These findings follow polling results released last year, which found overwhelming opposition among Spanish consumers to the proposed de facto ban and warned of likely unintended consequences, including relapse to smoking and cross-border purchasing.

The results show that nicotine pouches are seen as a considerably lower-risk alternative to cigarettes. They are also viewed as the nicotine product that is most considerate to others and pose the lowest environmental risk, even though a general lack of awareness means they hold untapped potential as a quit-smoking tool.

SAFER AND MORE CONSIDERATE

Consideration, convenience, health and flavour variety drive interest in oral nicotine pouches. For pouch users, the key motivators are the ability to enjoy them without disturbing others, their compact design and their reduced risk compared to cigarettes. 63% of users rate flavours as extremely important or very important. When asked to rate products for their social consideration, all respondents ranked nicotine pouches as the most considerate-to-others option.

Q: How important was each of these features in your decision to use oral nicotine pouches? (graph shows pouch users who selected extremely important / very important on a 5pt scale)

UNTAPPED POTENTIAL

More than a third of respondents not using pouches had never even heard of the product, and only 15% describe themselves as “very aware” of the product. The harm-reduction potential of these products is being left almost entirely untapped.

Q: Before today, how aware of nicotine pouches were you?

Pouch non-users’ answer:

INEFFECTIVE REGULATION

The consequences of the Spanish Government’s proposed restrictions are illustrated by the same data. If pouches were banned or rendered ineffective through severe nicotine caps, only 8% of current users say they would quit nicotine products entirely.

The evidence points clearly towards an education-first approach by expanding awareness of lower-risk alternatives, supporting informed consumer choice, and allowing a product that is already reducing smoking rates to reach the millions of Spanish smokers who do not yet know it exists. Prohibition, by contrast, would remove a tool that is working, punish the users who have benefited from it, and produce precisely the public health outcomes the Government claims to be trying to prevent.

GREEN CREDENTIALS

Beyond health outcomes, the data also highlights the environmental credentials of oral nicotine pouches. When asked which nicotine product is most environmentally friendly, 32% of all respondents selected pouches, twice the rating for e-cigarettes and more than three times that of traditional cigarettes.