Pharmacist Calls for Person-Centered Approach to Smoking Cessation in Canada
Nicotine pouches have gained significant international popularity and are now a permanent fixture in the market. No level of restriction will cause them to disappear entirely. Canadians now face two distinct policy choices regarding these products.
Defending Health Canada-Approved Nicotine Pouch
As a pharmacist and health professional, I read with interest recent opinion pieces about nicotine products in Canada. I was particularly struck by the decision of Cynthia Callard, Flory Doucas, and Les Hagen to attack the credibility of Canada's authorized nicotine pouch—Zonnic—in their response piece.
Limiting access to a Health Canada-approved smoking cessation aid appears to conflict with Callard's organization's stated goal: reducing tobacco-caused illness through decreased smoking and reduced exposure to second-hand smoke.
The Established Role of Nicotine Replacement Therapy
Smoking is a well-established cause of cancer, cardiovascular disease, and chronic obstructive pulmonary disease. Nicotine replacement therapy (NRT) has been available for decades, and its safety profile is thoroughly established. Canada's approved nicotine pouch is licensed as an NRT product.
As a pharmacist, I welcome any approved cessation therapy to support my patients. The criticisms raised by Callard and her colleagues appear to focus on three primary areas: the effectiveness of nicotine pouches, youth use concerns, and the fact that the authorized product is manufactured by a tobacco company.
Examining Effectiveness Claims
First, they cite data from the Canadian Community Health Survey indicating that the estimated proportion of failed quit attempts is highest among tobacco-free nicotine pouch users at 92 percent. What they don't highlight is that the failure rate for "all nicotine replacement products" is 87 percent and "any method" is 85 percent.
Well-designed controlled trials are necessary to allow meaningful comparisons between nicotine pouches and other therapies. Currently, there is no quality evidence demonstrating nicotine pouches are more or less effective than conventional NRTs. Singling them out on effectiveness grounds lacks scientific support.
Addressing Youth Use Concerns
Second, Callard and her colleagues express concern about youth use, citing the International Tobacco Control Youth Tobacco and Vaping Survey, which asked youth what brand of nicotine pouches they used most often.
The most commonly cited brands were Zyn (35 percent) and Lyft (9 percent). Both are illicit products unauthorized in Canada. The least mentioned brand was the authorized Zonnic (7 percent).
Illicit nicotine pouches operate without regulatory oversight of maximum nicotine content, without restrictions on youth-appealing flavors, and without effective age verification systems. Restricting regulated products does not eliminate demand—it simply shifts that demand to unregulated suppliers who operate outside established safety frameworks.
The Need for Individualized Approaches
What's needed is a person-centered approach to smoking cessation that recognizes different individuals respond to different cessation methods. Some patients find success with patches, others with gum, and still others with newer options like nicotine pouches. A one-size-fits-all approach fails to acknowledge the complex nature of nicotine addiction and the varied needs of those trying to quit.
Health Canada's approval process for smoking cessation aids involves rigorous evaluation of safety and efficacy. When we undermine approved products without substantial evidence, we potentially deny patients access to tools that might help them quit smoking successfully.
Balancing Regulation and Access
The debate around nicotine pouches highlights the ongoing tension between regulation and access in public health policy. While legitimate concerns about youth access must be addressed through proper age verification and marketing restrictions, we must also ensure that adult smokers have access to a range of approved cessation options.
As healthcare professionals, our primary concern should be reducing the harm caused by smoking. This requires a nuanced approach that considers both population-level data and individual patient needs. Dismissing approved cessation tools without robust evidence may inadvertently harm the very people we're trying to help.
