The health case for banning cigarettes is ironclad. As the then head of the World Health Organization, Gro Harlem Brundtland, put it in 2000, “a cigarette is the only consumer product which when used as directed kills its consumer”. Smoking is still the leading cause of preventable death worldwide. Many countries, including the UK, have taken strong measures to restrict and even ban cigarettes and other tobacco products. Over the past two decades, however, tobacco-free nicotine products such as vapes and nicotine pouches, which use a synthetic version of the addictive ingredient, have exploded in popularity.
Regulation has been slow. The nation of Palau has now tasked the WHO expert committee on drug dependence with reviewing nicotine, which will lead to a UN vote – likely to be in 2028 – on banning it worldwide. The case relies partly on deciding whether addiction and dependence themselves – in the absence of other major health consequences – are harmful. There is certainly an argument for that, and smoking taught us that it is often better to stamp out highly addictive habits if consequences may become obvious later. But there is also reason for caution.
Nicotine products have some benefits. There are still 1.2 billion smokers worldwide, and people who switch to vaping are twice as likely to quit smoking, according to a recent Cochrane review. Palau’s submission includes some data linking nicotine to cardiovascular disease and other health conditions. But a recent Royal College of Physicians report in the UK found that “current evidence suggests nicotine itself confers little risk to health”.
However, regulators cannot make decisions on the current science alone. Reading between the lines of Palau’s submission, there is obvious frustration with the way that the market for nicotine products sprang up rapidly in a regulatory grey area, and targeted children specifically. A WHO report found that children on average are nine times more likely than adults to vape. Some e-cigarettes contain harmful ingredients like heavy metals, and nicotine is proven to be harmful to adolescent brain development. This experience is common worldwide. The UK did not have vape-specific legislation until 2016: the previous law covered tobacco only. It is understandable that countries do not want to continue this game of regulatory Whac-A-Mole, separately evaluating every highly addictive new product only after it takes hold with the public. Banning nicotine would cut this problem off at the source.
There is a middle ground. The UK smoking ban coming into effect next year will also restrict e-cigarette displays and advertising, and leaves room to restrict child-friendly flavours. Ministers should go further. The Canadian province of Quebec has fully banned flavoured vapes and limits the sale of nicotine pouches to pharmacies. Those sorts of restrictions should apply to all forms of nicotine to head off novel forms that flout existing regulation, while still allowing suffering smokers and consenting adults limited access.
Synthetic nicotine – freed of the carcinogens in tobacco – is a fascinating case, seeming to offer addiction without other obvious harm. But there is no clear benefit to allowing nicotine to become widely available, the science on pure nicotine use is still limited and downstream products like vapes are not benign. Addictive substances are by definition difficult for individuals to control, which is why countries may need to manage them.
