In this episode of GFN News, Joanna Junak speaks with Will Godfrey of Filter about Germany’s proposed regulation to ban flavoured e-liquids containing cooling agents.
The draft measure would prohibit menthol and other “iced” vape products that rely on cooling additives. Supporters of the proposal, including Germany’s Federal Institute for Risk Assessment, argue that cooling effects may make vaping easier to inhale and potentially increase nicotine intake - particularly among young and inexperienced users.
Transcription:
00:00 - 01:06
[Joanna Junak]
Hello and welcome. I'm Joanna Junak and this is GFN News on GFN.tv. Nicotine pouches are gaining popularity as a potentially less harmful alternative to cigarettes. Research shows that they contain significantly fewer toxic substances than tobacco products. However, more research is needed to understand their long-term impact on health. Joining us today is Konstantinos Farsalinos, a physician and public health researcher, who in his review highlights nicotine pouches as a promising carb reduction option for smokers. Hello Konstantinos. In your review you suggest that nicotine pouches might be the safest option for smokers looking to quit.
01:07 - 04:49
[Konstantinos Farsalinos]
The safest of all the alternative consumer nicotine containing products. We need to be very accurate because the safest option that someone may have to quit smoking is to quit by himself or herself. Not using any medications, not using any alternative products, just decide on one day or whatever date and simply get rid of cigarettes completely. I mean, not smoke even one cigarette per day. This is the safest option. At the same time, it is the most frequently used option. and the least effective. The success rate has been calculated at around 4% to 5% annually. But many smokers eventually quit with this method because they use it many, many times. Then we have the pharmaceutical options, which are nicotine replacement therapies and oral smoking cessation medications. The latest one is, which is an old medication, of course, is CITICIN or CITICICLIN. There are many different names. And then we have the harm reduction products, which are available as consumer products. for someone to choose and basically make a lifestyle change. So not treating smoking as using a therapeutic option, but changing the lifestyle and instead of using tobacco cigarettes to use some alternative products. And as you know, we have three main options. Snooze, not really in Europe because it has been banned. The sales have been banned everywhere besides Sweden. Electronic cigarettes, I'll give it in chronological order when they appeared in the market. Electronic cigarettes, heated tobacco products and recently nicotine pouches. So of all these products, nicotine pouches is the least harmful of all options. And the level of risk I mentioned in the article is very close, if not identical, to nicotine replacement therapies. And there is a very simple reason for that. It contains pure pharmaceutical-grade nicotine and, of course, some other compounds like pH modifiers, some other excipients anyway, and flavors. It does not undergo any thermal degradation, so there is no heating of the product at whatever temperature, which even in low temperatures there is some thermal degradation. The product does not contain tobacco, which has some impurities by itself, cured tobacco leaves. And of course, you also avoid the agricultural impurities that may remain in the tobacco once you process it to make a tobacco product. So in reality, And you don't inhale anything. I forgot about that. You get it through the oral route. So it's even much easier to choose ingredients because there is a large list of compounds that have been proven to be safe for oral use, so for ingestion. So in reality, it is much more predictable, the outcome of the compounds that you're using into the nicotine pouch. In that respect, I'm very confident that they are the least harmful of all harm reduction nicotine containing products.
04:51 - 05:01
[Joanna Junak]
And you mentioned Swedish snus, which looks similar to nicotine pouches. But can we really compare the two products or could that be misleading?
05:02 - 07:06
[Konstantinos Farsalinos]
Well, there is great value comparing them and using the paradigm of snus For two reasons. First of all, the products are used in a very similar way and nicotine pouches are expected and common sense suggests that they are less harmful than snus itself. simply because of avoiding the tobacco plan. At the same time, SNUS has a long history of strong epidemiological evidence concerning health outcomes, comparing SNUS users versus non-users of any nicotine product. So that's very important. Basically, the most evidence that we have about the effects of nicotine per se is coming from snus, while in reality snus is not a pure nicotine product and is not even a product containing pharmaceutical grade nicotine. It contains nicotine because it contains tobacco. So And that is why I decided to use the SNUS example to apply what we call a bridging principle, meaning use the evidence, the clinical evidence, of snus, which is very strong and very convincing, and apply it to nicotine pouches, considering that nicotine pouches are a very recent product, was very recently available in the market. And as you understand, there is no time to provide long-term epidemiological evidence. I think it's a very valid argument to use this bridging principle because of the resemblance in the patterns of use of the product. And because, as I said, we expect nicotine patterns to be even less harmful than snus itself. So until we get some product-specific evidence, which will take time, we know that, I think it's great value to use the snus data.
07:08 - 07:21
[Joanna Junak]
In your paper you mentioned that nicotine pouches are still relatively new, so long-term data are not yet available. How should people understand their safety compared to other nicotine alternatives?
07:21 - 09:20
[Konstantinos Farsalinos]
The statement that I used in my article is that nicotine pouches are expected to be of similar harm profile as nicotine replacement therapies. So the word expected is exactly what you mentioned. is a very reasonable expectation. And it is still an expectation because we don't have the evidence, as you said. And we cannot have the evidence, even if we wanted to, and even if we were trying desperately to look for that. It's still too early. But as I said, this is exactly the reason why I use SNUS data. SNUS has been used historically for decades, particularly in Scandinavia. There is a lot of very high quality evidence from long term a follow up of large cohorts of people. I'll give you an example that a large study, a pooled analysis on the effect of snus on stroke followed up a total of 130,000 participants. So you understand a very big sample, a very big sample size. And that's why I said that considering how close these products are and the fact that pouches are a more purer form of oral nicotine product because of not containing tobacco, it is very reasonable to use the SNUS data. It is very reasonable to expect that if not better than SNUS, It will carry the same risks to health, which we know that for snus are extremely low, very low, and there is no even comparison with tobacco cigarettes and any combustible products.
09:22 - 09:36
[Joanna Junak]
Based on what you just said and with recent bans on potentially safer products like e-cigarettes and nicotine pouches, why is snus still available as a smoking alternative with no discussion of banning it?
09:37 - 13:20
[Konstantinos Farsalinos]
Well, first of all, since you mentioned it, it is quite ironic and paradoxical that the strongest, the harshest, the most restrictive regulation in Europe, I'm not even talking about countries outside Europe, is now being implemented for nicotine pouches, for the product that we expect to be the least harmful of all alternative nicotine harm reduction products. For example, Belgium has banned pouches, the Netherlands, France is following Germany for some technical reasons. You're not allowed to sell it. It doesn't make sense at all. Seriously, it doesn't make any sense. Now concerning snus. Yeah, I understand very well why there is no discussion about snus because it's one of the biggest public health scandals in the history of the European Union. It is there is no explanation, but the product with such long term evidence, a product, the only tobacco and nicotine-containing products that have received from the U.S. FDA a reduced risk claim, a reduced risk claim, which means risk refers to clinical health outcomes, not to exposure to toxins. You know, the reduced risk claim has only been given to snus products by the U.S. FDA. Well, the E.U., has banned these products. You know, a product which has the stamp of the FDA that it is less harmful to health than cigarettes is being banned by the whole European Union besides Sweden, which of course Sweden asked for an exemption. And that was one of the main arguments in order to join the EU. So that shows how bad how awful the current situation in the EU is concerning snus. And as I said, I considered it a public health scandal, literally. It makes zero sense. Even looking at the outcome of Sweden, the only country that has eliminated smoking. You know, the EU has set a goal to become smoke-free, so a smoking rate of less than 5% in 2040. well, Sweden has done it in 2025 and no one talks about it or they mention some totally invalid argument that no, it's not snows that had this effect in Sweden. It's the other tobacco control measures, while Sweden, if you look at the official figures and scoring systems, they are not even scoring Sweden very high in the tobacco control measures. So maybe this is also an argument to suggest that The tobacco control measures and the scoring system does not really have any relevance to the smoking rates and how these are being reduced by countries. How can you not allow the sales of snus in countries where tobacco cigarette sales are perfectly legal and tobacco cigarettes are available everywhere? In fact, within walking distance, wherever you are in any country in the European Union. It makes no sense at all.
13:22 - 13:41
[Joanna Junak]
Thank you, Konstantinos. That's all for today. Tune in next time here on GFN TV or on our podcast. And make sure to check out our social media pages for the latest updates on this year's Global Forum on Nicotine conference. Thanks for watching or listening. See you next time.