Sweden has one of the lowest proportions of smokers in Europe. However, opinions are divided on what conclusions policymakers should draw from this. In an opinion piece in Altinget, doctor Gustav Eriksson warns that the EU should not regulate smoke-free nicotine products without taking differences in risk into account. At the same time, Doctors Against Tobacco argues that all nicotine products should be subject to stricter regulation and treated in the same way as cigarettes.
Gustav Eriksson, a specialist in general practice, points out that around five per cent of the adult Swedish population smokes daily. At the same time, significantly more Swedes use snus and, in recent years, nicotine pouches as well.
According to Gustav Eriksson, it cannot be concluded that access to smoke-free nicotine products is the reason for the low smoking rates. However, he believes that this possibility should be taken into account when Sweden and the EU discuss future regulation.
”We should try to understand why we have been so successful in this regard before we impose stricter regulations or restrictions on factors that may have contributed to that success,” he writes in Altinget.
Wants regulation based on risk
Gustav Eriksson argues that the risks associated with nicotine must be distinguished from those associated with cigarette smoking. He notes that nicotine is addictive and not without risk, but it is, above all, the combustion and exposure to tobacco smoke that make cigarettes particularly harmful.
Among other things, he refers to the Cochrane reviews of research on e-cigarettes and smoking cessation. These reviews conclude that e-cigarettes containing nicotine help more people to give up smoking than traditional nicotine replacement therapies.
Eriksson also highlights the US Food and Drug Administration (FDA), which, following product-specific reviews, has authorised certain smoke-free nicotine products to be marketed with information about a lower risk of disease when they completely replace cigarettes.
”This does not mean that the FDA considers them to be risk-free. The agency’s position is instead based on something fairly uncontroversial, namely that different products carry different risks,” writes Gustav Eriksson.
He wants the same principle to be applied when Sweden and the EU draw up regulations for various nicotine products.
Doctors Against Tobacco want more uniform regulation
In a previous opinion piece in Altinget, Magnus Lundbäck of Doctors Against Tobacco, together with representatives from organisations including the Heart and Lung Foundation and the Cancer Foundation, argued in favour of a different approach.
The commentators point in particular to the rise in the use of white snus amongst young people. According to the figures they cite, the proportion of girls in upper secondary school who use snus has risen from four to 26 per cent in ten years.
Among other things, they want different nicotine and tobacco products to be regulated more consistently.
”The Public Health Agency of Sweden recommends that all nicotine products should be subject to equally strict regulation,” the commentators write.
Their eight proposals also include higher taxes on white snus, a ban on certain flavourings, regulated nicotine levels, a ban on single-use vejpar and stricter restrictions on marketing.
Mixed messages regarding the regulation
Doctors Against Tobacco justify the proposals by citing the rise in nicotine use amongst children and young people.
”A risky experiment is currently being carried out on children and young people. Unless we reverse this trend, an entire generation will pay the price in the form of illness and premature death,” write Magnus Lundbäck and the other contributors.
Gustav Eriksson argues the opposite when it comes to the differences between the products. In his view, regulation should be based on their respective risks, whilst also taking into account what happens to smokers if alternatives to cigarettes are restricted.
”For those who do not give up smoking, a less harmful alternative is better than continuing to smoke cigarettes. What happens if we make the less harmful alternatives less accessible and more difficult to choose?” writes Gustav Eriksson in Alltinget.
