For years, health professionals have debated “harm reduction” vs. “abstinence-only” when it comes to smoking and tobacco use. Groups like the Campaign for Tobacco-Free Kids have pushed for a Prohibition-style “just say no” approach.

Many public health professionals have dismissed this strategy as wishful thinking, noting that it didn’t work for alcohol and it’s unlikely to work for tobacco. Instead, they support a public policy that moves smokers from “combustible tobacco products” (cigarettes) to lower-risk alternatives like e-cigarettes, vaping and pouches.

During the Biden administration, the Food and Drug Administration avoided approving tobacco-alternative products, and it appeared to be tilting toward the prohibitionist stance. However, the January 16 approval of the Zyn nicotine pouch products and the Trump administration’s talk of reforming the agency could be a sign that the more realistic “harm reduction” strategy is on the rise.

According to the FDA, the “science-based decision” affirms that Zyn nicotine pouches are “a better alternative for adults” who either use tobacco products or are trying to kick the habit.

Michael Siegel at Tufts University School of Medicine thinks this is a positive sign and a definite change of approach by the FDA.

“In the spectrum of risk, this is probably at the lowest end,” Siegel said. “As you go from nicotine patches to electronic cigarettes to smokeless tobacco towards heated tobacco and then towards real cigarettes, you get a drastic increase in risk, and these are probably the safest because not only is there no tobacco, there is no combustion, but there’s not even heating like you have with a cigarette, so there isn’t much of a chance to get harmful chemicals into them.”

Zyn nicotine pouches are tobacco-free and smoke-free. A customer places a pouch between his or her upper lip and gum. The pouches contain various ingredients, including powdered nicotine, sweeteners, flavorings and food-grade additives. Some prohibition advocates argue that tobacco use is culturally unpopular and, in the most brutal sense, will die out. Therefore, no new tobacco or nicotine products should be approved.

Harm-reduction advocates respond that while smoking is far less common than a generation ago, nearly 30 million Americans still smoke cigarettes. Smoking remains the leading cause of preventable disease and death in the United States, according to the Centers for Disease Control. 

“Cigarette smoking kills more than 480,000 Americans each year,” the CDC reports, and it cost the United States more than $600 billion in 2018.

Given this, “The FDA’s decision recognizes the role that Zyn can play in the protection of the public health by helping people switch from cigarettes and other traditional tobacco products,” said Tom Hayes, the president of Swedish Match North America.

Prohibition advocates aren’t backing down. The American Lung Association expressed its concern that “pouches contain high levels of nicotine, which is incredibly addictive and harmful to young people in any form.”

While few public health professionals are fans of nicotine, harm-reduction advocates note that nicotine is not a health-risk problem. It’s the toxic chemicals released from the burning of cigarettes. Siegel said that every smoker who switches to alternatives is a public health win.

“It’s mind-boggling to me how organizations like American Lung Association are against this idea of helping smokers to get off the most deadly product and get onto much safer ones,” Siegel said.

Meanwhile, Philip Morris International, which acquired Swedish Match in 2022, touts that it is expanding U.S. production, creating jobs and revenue for states such as Kentucky and Colorado.

However, Jeff Stier at Consumer Choice Center says there is another economic aspect to the FDA’s authorization of Zyn — and perhaps, other alternatives to smoking.

“The biggest economic benefit is that it will reduce healthcare costs by getting people off cigarettes,” Stier said. “Whether the nanny state likes it or not, there will always be people who choose to use nicotine, and from a public health perspective, we need to make sure that people are given the option of lower risk satisfying nicotine products other than the cigarette, and there is a lot more work for the FDA to do in authorizing lower-risk products across a range of product classes.”