Kun kansanterveys unohtaa yleisön: Ukrainan nikotiinipussikeskustelu

Fifty doctors in Ukraine recently called on lawmakers to cap nicotine pouches at 16.6 mg per pouch, arguing that anything higher is “too dangerous” for consumers. At first glance, it sounds responsible. Doctors. White coats. Concern for health.

But look closer, and something important is missing. The people.

Nowhere in this appeal do the doctors acknowledge how nicotine pouches are actually used, or who uses higher-strength pouches in the first place. They do not reference former heavy smokers, people who once smoked a pack or more a day and now rely on stronger pouches to stay away from cigarettes. They do not mention transition, tolerance, or real-world behavior. Instead, they jump straight to limits.

Here’s the basic problem. Nicotine pouches do not burn. They do not produce smoke. They do not expose users to carbon monoxide, tar, or fine particulates, the substances that drive heart disease, stroke, and cancer as established by decades of cardiovascular research. The doctors’ proposal focuses narrowly on nicotine concentration while ignoring combustion entirely, even though combustion is what causes the overwhelming majority of smoking-related harm. That omission matters.

Because for many adult users, especially long-time smokers, lower-strength pouches simply do not work. If a 16.6 mg cap is imposed, these users do not “use less nicotine.” They use more pouches, or worse, they go back to smoking, where nicotine delivery is faster, less controlled, and paired with thousands of toxic by-products.

This is not speculation. Countries that have allowed adults to access smoke-free oral nicotine products across a range of strengths have seen smoking decline faster than countries that restrict them. Sweden’s experience, where oral nicotine products are widely available and affordable, has driven smoking rates down to among the lowest in Europe, while neighboring countries that rely on stricter limits continue to struggle.

The Ukrainian doctors also frame their proposal as a precautionary measure. But precaution without context is not safety. It is policy theater.

No evidence is presented showing that adult use of higher-strength nicotine pouches leads to measurable population-level harm. No data is cited linking pouch strength to cardiovascular events. And no explanation is offered for why a hard cap at 16.6 mg, a strangely precise number, represents a meaningful safety threshold.

What we are left with is a familiar pattern. Experts speaking noin consumers, not with them. Regulation designed for headlines, not real outcomes.

Harm reduction only works when it reflects reality. Real smokers. Real habits. Real transitions away from cigarettes.

If policymakers listen only to calls for tighter limits, while ignoring the people who actually use these products to quit smoking, they risk repeating the same mistake Europe has made over and over again. They regulate the alternative and protect the habit of smoking.

Public health should not be about controlling numbers on paper. It should be about helping people stop smoking in the real world. And that starts by listening to the people who actually did.