Imagine, for a moment, that you are a 50-year-old who has smoked a pack of cigarettes a day since you were a teenager. You tried to quit a few times, but after a few days, you craved a smoke, like a starving person hungers for food. Within a couple of weeks, you were back to a pack a day.

One morning, when you wander into your local convenience store for a pack of cigarettes, you notice something new on the sales counter. A circular container that says it is a nicotine replacement. You remember from a stop smoking course that nicotine is the substance that makes cigarettes addictive and that without nicotine, smokers develop withdrawal symptoms. But nicotine, by itself, is fairly harmless. That is why doctors and pharmacists recommend nicotine replacement therapy patches, gums and lozenges.

You remember your last check-up when your doctor was concerned about your cough and ordered a chest X-ray. She was also increased your blood pressure medication. It seems that three decades of smoking might be catching up with you. It is time to try a new way to quit.

You buy a pack of cigarettes, but you also buy the container and twist it open. You take out one of the dime-sized miniature white teabags and put it between your upper teeth and your gum. Before you even leave the store, you notice a tingling sensation in your mouth and a little bit of a “buzz” from the nicotine. You had been desperate for a smoke, but that has passed; you could leave opening the cigarette package for later. About an hour later the teabag had lost its flavour, so you remove it and put it in a little compartment in the lid of the container. Mid-morning, you are ready for that cigarette, but you are in a meeting and cannot smoke, so you open the container and use another teabag. At lunchtime, you go outside with your cigarettes and the container. You look at them both and decide that this time, maybe you really can quit smoking.

Six months later, you are feeling better. The chest X-ray is normal, your breathing tests have improved, and you can halve your blood pressure medication. If you keep this up gradually. Over months and years, your risk of tobacco-related cancer and other diseases will decrease and eventually disappear.

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The little white teabag in the round container is called a “nicotine pouch.” In Canada, the only brand available is called “Zonnic.” In other countries, nicotine pouches are sold as “Zyn” “On,” and “Velo”. Swedish snus is a similar product that contains real tobacco, while nicotine pouches are 100% tobacco-free.  Nicotine pouches provide people who smoke with the nicotine that they crave but without the risks of tobacco, without burning anything, and without inhaling any smoke or vapour. They are over 100 times safer than smoking and considerably safer than vaping or using heat-not-burn devices.

In Canada, health charities are calling on Health Canada to ban “Zonnic” and prohibit the sale of all other nicotine pouches. Six national health groups, including the Canadian Cancer Society, the Canadian Lung Association, Heart & Stroke and Physicians for a Smoke-Free Canada, say that the sale of this product should be suspended and that there should be a moratorium on any approval of any new nicotine products.

Their main concern is that non-smoking youth might buy these products, become addicted to nicotine, suffer brain damage and end up smoking cigarettes. The regulations about the sale of nicotine products only allow tobacco-free nicotine pouches to be sold in one category, as a natural health product, like nicotine lozenges and gum. In this category, there are no age limits and few advertising restrictions. A 12-year-old can legally buy nicotine gum off the shelf in a pharmacy.

Although nicotine is the major chemical that makes cigarettes addictive, other nicotine products, such as gum and lozenges, do not lead to addiction. In the US, half of the youth who were vaping nicotine in 2019 had quit by 2021, and youth vaping has resulted in a decrease in youth smoking. The evidence that nicotine causes brain damage comes from rat studies. In the 1960s, almost everyone smoked, including pregnant women, parents in cars and diners in restaurants, but there is no evidence that this damaged people’s brains.

Imperial Tobacco worked with Health Canada for almost two years to go through the process of being allowed to put Zonnic on the market in the natural health product category. Health Canada knew that they were authorizing this product in a category with no statutory age limit, but they went ahead anyway.

Why do these organizations think that Imperial Tobacco, the parent company for “Zonnic,” is targeting youth? You only have to glance at the official Zonnic Canada Instagram page to understand their concerns. While some of the postings mention that this is a substitute for tobacco smoking, most of them centre on the idea that this is something you can use with anyone, anywhere, at any time. Videos portrayed young people eating out together, packing for vacation, working out in the gym, or staying in to watch the big game and a young couple shoulder-to-shoulder in a car, all with a container of Zonnic at hand. None of the actors seem to be under 18, but they are all in their late 20s or early 30s, and they portray a lifestyle that a 15 to 17-year-old could reasonably aspire to; they look like role models for teenagers.

UPDATE: By Dec 2nd, 2023, many of the videos had been removed from the Zonnic Canada Instagram Site. It seems that all the images of faces have been removed, but young hands and animations with jazzy music remain, such as https://www.instagram.com/p/Cyv7lF1JV10/ . The original videos are still available on the Zonnic website (https://www.zonnic.ca/ca/en) to anyone who claims to be over 18.

These images were removed from the official Zonnic Instagram page at https://www.instagram.com/zonniccanada/

The people who most need to quit are the 1.8 million Canadian smokers over 50. Over one million of them will eventually die from smoking-related diseases if they do not find a way to quit.

If Zonnic is being sold to adult smokers, why does it even have an Instagram account when less than 10% of Instagram users are over 45?

Imperial Tobacco says that they are not targeting youth, but looking at their official Instagram page, it seems that they are either stupid or lying and tobacco companies have a long record of lying.

Advertisements for arthritis treatments and other medications show grey-haired people playing golf and going on cruises. They should be a model for Zonnic adverts.

What needs to be done

Health Canada

Health Canada should stay the course. Zonnic has been through the existing legal process and has been found to be a safe product. It should be sold in convenience stores, in gas stations, in supermarkets, and wherever else cigarettes are on sale. It should also be on sale in pharmacies, along with nicotine gum.

Nicotine pouches should be sold in flavours that make them pleasant to use, just as Nicorette gum comes in Fresh Fruit, Extreme Chill, Cinnamon and Extra Fresh Mint flavours.

Nicotine pouches should not be sold or advertised to people under 18. The existing agreement is that they should not be sold to under 18s, and Imperial Tobacco says that they are instructing their retailers to ask for age verification, but at present it is not actually illegal to sell this product to minors. This needs to be changed, and the rules about advertising the product need to be strengthened and enforced. In the meanwhile, Health Canada should monitor the situation very closely and work with Imperial Tobacco to limit sales to youth.

When tobacco companies get into the business of selling safer nicotine products, such as vape and nicotine pouches, they create an internal conflict of interest. Selling these products to people who smoke cuts into their existing and highly profitable cigarette market, but swelling them to people who do not smoke increases overall profits. Health Canada should encourage non-tobacco companies to enter the safer nicotine product marketplace and support them, just as governments financially support the transition to electric cars and greener energy.

Health Canada has a goal of reducing the prevalence of cigarette smoking to 5% by 2035. It seems unlikely that they will achieve this goal unless they can persuade adults who smoke to switch to less harmful nicotine products.

The Health Organizations

These groups need to remember that the number one threat to public health is cigarette smoking. The Canadian Cancer Society, for example, should remember that one-third of all cancer is caused by smoking. The risk of cancer from vaping has been calculated at 0.4% of the risk from smoking, and nicotine pouches are probably even safer than that.

They need to remember, and to remind physicians, that nicotine is NOT the cause of the cancer, lung disease and heart disease caused by inhaling burnt tobacco leaves. The problems are tobacco, combustion and inhalation. Products that avoid all three of these are very safe.

For people who smoke, continuing to use nicotine, but in a safer form, reduces the risk by 95 to 99%.

Even for teenagers, the use of safer nicotine products such as vaping has been associated with a more rapid decrease in smoking rates. These organizations need to stop worrying that nicotine use will lead to smoking and recognize that access to alternative forms of nicotine actually results in a decrease in smoking.

They also need to look at how Sweden has achieved the lowest smoking rates in Europe, along with the lowest rates of smoking-related cancer and other smoking-related diseases.

Imperial Tobacco

In an ideal world, Imperial Tobacco would sell off Zonnic as an independent company that would not carry the baggage and taint of being associated with “Big Tobacco”. This new company could compete with the tobacco industry for the adult nicotine user market, without concerns that by persuading adult smokers to switch the company’s tobacco branch would suffer.

But Imperial Tobacco probably wants to keep the Zonnic brand for diversification of its portfolio and to “greenwash” the company by being able to showcase its attempt at transformation away from combustible tobacco.

The company needs to look as if it is serious about selling Zonnic to adult smokers, not to non-smoking teens. It should therefore:

1. Immediately close down its inappropriate Zonnic Canda Instagram account. This should gain it significant goodwill with Health Canada, and perhaps even with some health organizations.
2. Rebrand the product. Hire experts on selling medical products to 50-year-olds. Choose colours, designs, fonts and flavours that appeal to older people. Advertise on cruise ships and in publications aimed at boomers. Make the container easier for people with arthritis to open.
3. Get pharmacists on board, and get the product into pharmacies across Canada.
4. Educate physicians and stop-smoking professionals (e.g. at the Ottawa Model Conference on Smoking Cessation)
5. Provide educational material for medical nursing and pharmacy students as well as qualified health care professionals. Many doctors are very ill-informed about nicotine and incorrectly think that it causes cancer.
6. Market directly to smokers. Put adverts for Zonnic in cigarette packages, along with a discount coupon. Use any marketing tools currently employed to engage with smokers to tell them about the new alternative.

People who smoke and their friends and family

The most important part of this current situation is that it presents adult smokers with a new lifeline, a new alternative way to quit smoking.

I urge all smokers to go to their nearest convenience store and buy a container of Zonnic or whatever nicotine pouch is available locally. In Canada, you can buy a small container with ten pouches for about $6 or a larger container with 24 for about $13.At that price point, you have absolutely nothing to lose. It may not work for you, but if it does, it could literally save your life.

Zonnic pouches would make an excellent  “stocking-stuffer” for anyone you know who smokes.

Conclusion

Zonnic and other brands of nicotine pouches are a new way to quit smoking. They provide a very safe alternative source of nicotine for smokers who have difficulty quitting smoking. Properly regulated and marketed, they could save over a million lives in Canada alone.

Imperial Tobcco, Health Canada, and the health care organizations need to work together to maximize this opportunity.

UPDATE: AUGUST 27th 2024. New federal restrictions on Zonnic

In a press release on Aug 22nd, 2024, Health Canada announced, “Health Canada introduces new measures to help prevent harms to youth from nicotine replacement therapies.” In addition to further regulations on packaging and advertising, the new legislation would:

Require NRTs in new and emerging formats, such as nicotine pouches, to be sold only by a pharmacist or an individual working under the supervision of a pharmacist and kept behind the pharmacy counter. (This would eliminate online sales as well as sales in convenience stores, gas stations and other places where cigarettes are commonly sold)

Prohibit NRTs in new and emerging formats, such as nicotine pouches, from being sold with flavours other than mint or menthol. (This means that Zonnic’s Berry Frost and Tropic Breeze flavours will be recalled. Medical NRT will remain available in various flavours, including fruit and cinnamon.)

The Honourable Mark Holland, Minister of Health, said: “Stronger measures are needed to protect youth from the harmful effects of nicotine and stop dependency before it starts. The action our government is taking will keep these products available for adults who need them to quit smoking while making sure they don’t get into the hands of youth for recreational use.”

In support of this statement, Health Canada released the following “Quick Facts.”

Excessive amounts of nicotine can cause overdose or acute poisoning, which can lead to respiratory failure and death. (However, I am not aware of any deaths caused by nicotine pouches. A small child could be killed by drinking liquid nicotine preparations that were negligently stored. Still, adolescents who foolishly try to carm their mouths with nicotine pouches for social media posts inevitably end up throwing up before serious harm results.)

In the U.S., the 2023 National Youth Tobacco Survey found that nicotine pouches were a popular nicotine product among middle school and high school students, and such products were the most used behind e-cigarettes, cigarettes, and cigars. The growing popularity of nicotine pouches within the U.S. may also have a significant impact on the awareness of and interest in using these products among youth in Canada. (No actual data about the number of Canadian minors using nicotine pouches was released by Health Canada. The Canadian Tobacco and Nicotine Survey, which provided rapid statistics on youth and adult use, was cancelled last year. David Hammond, a public health researcher at the University of Waterloo who studies nicotine use in Canada and other countries, said, “To some extent, we are flying blind.“)

Imperial has argued that Zonnic isn’t intended for minors and says it instructs convenience store clerks to check for identification before selling it. The company also has said that having Zonnic visible and available in stores could encourage smokers to quit. Imperial has lobbied hard against the federal restrictions. Eric Gagnon, vice-president, corporate and regulatory affairs at Imperial Tobacco Canada, said he believes Holland has a “personal vendetta” against the company, which went through a two-year approval process to legally sell nicotine pouches. “Apparently because we’re a tobacco company, we’re treated differently than anybody else,” he told CBC News.

Independent convenience store owners also oppose the change. Kenny Shim, owner of Busy Bee Mart in Toronto, appealed to the minister to find a way to ensure youth are protected without moving the products to pharmacies. “We know our customers by name, we know what they buy, and we talk to them about less-harmful alternatives,” Shim said in a press release on behalf of the United Korean Canadian Industry Alliance and the Ontario Korean Business Association. “We are ideally positioned to encourage smokers to purchase a cessation product instead of cigarettes. We cannot understand why Minister Holland does not recognize this.” “People say they like it more and more,” Ottawa convenience store owner John Zyadh told CBC News. “People say its more safe for their health and they save a lot of money compared to cigarettes.”

So, based on no actual data, the Health Minister has removed nicotine pouches from the places where cigarettes are sold. They will only be sold in stores that do not sell cigarettes.

As they are now only available behind the counters in pharmacies, why should there also be a flavour ban? Nicotine gum is sold in Spearmint, Extreme Chill Mint, Ultra Fresh Mint, Cinnamon, and Fresh Fruit flavors. There is clear evidence that many adult smokers prefer fruit and dessert-flavoured nicotine options, so why ban fruit flavoured Zonnic ?

Why ban online sales? Surely, there must be a solution that would include requiring ID to register for a website, requiring a credit card, and using the same secure delivery systems used for online alcohol and cannabis sales so thatonline sales to adult smokers could be allowed.

“The biggest losers right now are the adult smokers that have been using Zonnic.”