The U.S. Food and Drug Administration (FDA) has authorized the marketing of Zyn nicotine pouches as a reduced-risk alternative to traditional cigarettes, marking a significant step forward in tobacco harm reduction. These pouches, which deliver nicotine without the harmful effects of tobacco combustion, are being hailed as a game-changer for smokers looking to quit or are planning to switch to a better alternative of nicotine intake. But as the U.S. embraces this innovative approach, the question arises: Is Pakistan, a country with one of the highest smoking rates in the world, falling behind in adopting harm reduction strategies?
Pakistan is home to an estimated 25 million tobacco users, out of which smoking is the most harmful, making it one of the countries with the highest smoking rates in the world. According to the World Health Organization (WHO), tobacco use is responsible for over 160,000 deaths annually in Pakistan, placing a significant burden on the country’s healthcare system. The economic and social costs of smoking-related illnesses are staggering, with billions spent on treating diseases such as lung cancer, heart disease, and chronic obstructive pulmonary disease (COPD). In 2019, the total cost of all smoking-attributable diseases and deaths amounted to an estimated USD 3.85 billion.
Compounding this issue is the fact that stress levels in Pakistan are exceptionally high, driven by economic instability, political uncertainty, and social pressures. For many, nicotine has become a coping mechanism, a temporary escape from the relentless stressors of daily life.
In Pakistan, prominent nicotine pouches like Zyn and Velo are already available in the market, but they exist in a regulatory gray area. Unlike in the U.S., where the FDA ensures strict quality control and safety standards, these products in Pakistan are unregulated. The absence of a regulatory framework also means that public health authorities are unable to understand the product, and regulate it accordingly. This is a missed opportunity, especially in a country like Pakistan, where the prevalence of tobacco use remains alarmingly high. Regulating nicotine pouches could provide smokers with a better alternative, potentially reducing the health burden associated with traditional smoking.
Many European countries have demonstrated the impact of harm reduction in achieving ‘smoke-free’ status. In some cases, smoking rates among native-born adults have dropped as low as 4.5%—well below the 5% benchmark—reaching this milestone 16 years ahead of the EU’s target. This success has been driven by policies promoting safer alternatives like nicotine pouches, offering a model for countries like Pakistan to reduce smoking rates through regulation and harm reduction.
As Europe leads by example, the U.S. has also taken proactive steps to authorize and regulate such products. In contrast, Pakistan’s lack of formal regulation on nicotine pouches puts its population at risk of exposure to untested products. There is a pressing need for Pakistan to establish a regulatory framework that ensures these alternatives are safe, properly labeled, and accessible to those looking for a way to manage their nicotine addiction—ultimately reducing the healthcare burden and contributing to savings in the national health budget.
The FDA’s authorization of nicotine pouches highlights the potential of innovative alternatives to reduce the health impacts of smoking. For Pakistan, the question is not whether nicotine pouches should be available, but how they can be regulated to maximize public health benefits while minimizing risks.
This article is written by Danial Hashmi.
