Spain is wasting a major opportunity to reduce smoking-related deaths by imposing restrictions on nicotine pouches – just as new evidence shows they are already helping people cut down or stop smoking altogether.
A new Smoke Free Sweden report, Power in a Pouch: Spain – The road to a healthier, smoke-free future, reveals that nicotine pouches are delivering measurable harm-reduction benefits among Spanish consumers, despite limited public awareness and no government support.
A nationwide survey found that among Spanish nicotine pouch users:
- 62% said they now smoke fewer cigarettes
- a further 6% said they had stopped smoking cigarettes altogether
- 77% said the ability to use pouches without disturbing others was an important reason for choosing them
- if pouches were no longer available, 28% said they would return to smoking or smoke more, while 30% said they would seek pouches from other sources.
The report argues that these findings provide crucial lessons for a country where tobacco use was responsible for an estimated 49,510 deaths in 2023 and where smoking prevalence remains approximately 25.8% overall.
It also finds that Spain stands apart in Europe on women’s lung cancer. While mortality is stabilising across most EU countries, deaths among Spanish women are projected to keep rising through 2026, by 2.4%, to around 10 per 100,000 women.
Co-author Dr Fernando Fernández Bueno, oncological surgeon at Hospital Central de la Defensa Gómez Ulla in Madrid and spokesperson for the Platform for Tobacco Harm Reduction, said:
“The survey tells us something policymakers cannot afford to ignore: people in Spain are already using nicotine pouches to move away from cigarettes. Some are smoking substantially less and some have stopped smoking altogether.
“That is a public health opportunity we should be trying to expand, not suppress.”
He added: “Spain continues to suffer an enormous burden of smoking-related disease, yet we are considering policies that could make one of the alternatives to cigarettes less accessible and less attractive. When almost three in 10 users say restrictions could push them back towards smoking or heavier smoking, that should be a serious warning.”
The report says Spain’s proposed regulatory approach, including a 4mg nicotine limit per pouch and restrictions on flavours, could substantially reduce the usefulness and appeal of the products for adults who smoke.
It notes that 63% of Spanish pouch users surveyed regard flavour variety as an important factor in their decision to use them.
Awareness also remains strikingly low. Among people who did not use nicotine pouches, more than one in three (37%) had never heard of them, while only 15% said they were very aware of what they were and how they were used. The report describes this as significant untapped harm-reduction potential.
Dr Bueno said:
“Spain does not have the luxury of ignoring evidence that could help save lives. The priority should be to give adults who smoke accurate information and access to alternatives that do not involve combustion.
“Regulation should protect consumers while encouraging people to move down the risk continuum, rather than protecting cigarettes from competition.”
The report highlights the experience of Sweden, where smoking prevalence has fallen to less than one-fifth of Spain’s rate alongside widespread availability of smoke-free nicotine alternatives.
It argues that Spain should adopt risk-proportionate regulation, improve communication about relative risk and preserve product characteristics that make switching attractive to adults who smoke.
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