Sweden’s smoke-free success is often credited to snus, but that’s only half the story. While snus appealed to many men looking to quit smoking, for women the smell, taste, and feel left something to be desired. For years, women were left without a viable alternative. That changed with nicotine pouches. Tobacco-free, discreet, and socially acceptable, they became the missing solution. In this GFN Interviews, Carissa Düring explains why nicotine pouches didn’t just complement the Sweden Model, they completed it, delivering the silver bullet public health refuses to acknowledge.
Featuring:
CARISSA DÜRING
Director, Considerate Pouchers Sweden
Consumer Advocate
consideratepouchers.org
@carissaduring
Transcription:
00:02 - 00:58
[Brent Stafford]
Thank you. Hi, I'm Brent Stafford, and welcome to another edition of RegWatch on GFN.tv. Sweden is the proof of concept tobacco control doesn't want to talk about. Embrace safer nicotine products like snus, protect access and choice, and watch smoking rates plummet. That's the Sweden model. But it wasn't a universal fix. For decades, snus skewed mail. Then came the product that changed everything, especially for women, the nicotine pouch. Joining us today to talk about the Sweden model is Carissa Döring, the director of Considerate Poucher Sweden, a consumer advocacy group dedicated to promoting nicotine pouches as a safer alternative to smoking and consumer choice in safer nicotine products. Carissa, thanks for coming on the show.
00:59 - 01:00
[Carissa Düring]
Really glad to be here.
01:01 - 01:16
[Brent Stafford]
Now, we spoke briefly during our live coverage of Good Cop 2.0, the counter-conference to the WHO's FCTC Cop 11 in Geneva last November. Stepping back now, what impressions did you come away with from that event?
01:16 - 01:49
[Carissa Düring]
Well, it always gets to me how public policy and a lot of the WHO's work is not really science-based rather ideology-based and it makes me sometimes feel very discouraged working in this field but at the same time it was a conference filled with people that really care to make a difference and that wants to help people quit smoking for real so that still left me with that with a good feeling
01:49 - 01:57
[Brent Stafford]
Now, did you get a clearer sense of just how entrenched or obstinate the WHO remains when it comes to safer nicotine products?
01:58 - 02:17
[Carissa Düring]
Honestly, it's really frustrating how they don't want to communicate with us and hear our perspective, but we're very willing to listen to them and have a conversation to them. So it really shows how entrenched they are in their own ways of thinking and their own version of reality.
02:18 - 02:28
[Brent Stafford]
For viewers who may not be familiar with your work, tell us about Considerate Poucher Sweden. What is its mission and why does consumer advocacy matter in this fight?
02:29 - 02:57
[Carissa Düring]
So it is a global consumer advocacy group. We exist all over the world trying to mobilize consumers of nicotine pouches and help them defend their safer choice in order to quit smoking. So our ultimate mission is to eliminate smoking. And the way to do that is through safer nicotine alternatives. And for our consumer group, that is nicotine pouches.
02:57 - 03:01
[Brent Stafford]
So what does Sweden's smoking picture actually look like today?
03:02 - 03:42
[Carissa Düring]
It's quite remarkable. Sweden is one of the first countries in the world becoming smoke-free. Our daily smoking rates are around 5% and we are on our way to go below that and become declared smoke-free. So that is really incredible and it's been a big consumer-driven change and it has really increased in its speed since nicotine pouches was launched back in 2016. So it's really an example of how alternative nicotine products can work in helping people to switch away from smoking.
03:43 - 03:46
[Brent Stafford]
So compare that then to the rest of Europe for us.
03:48 - 04:43
[Carissa Düring]
Yeah, well, the average smoking rates in the European Union is at 18%. So it's far above what Sweden is doing. And even the other countries that have the lowest smoking rates in the European Union are still above around 10%. So none of them are really even getting close to what Sweden has. And to understand that, you also need to understand that Sweden has an exemption on the rule of oral tobacco. So we've had snus for a very long time. And the rest of the European countries, snus is illegal there. with the exception for nicotine pouches because they don't contain tobacco. So nicotine pouches are allowed in the other countries in the European Union. So that's one of the reasons why it's become such a natural experiment, sort of, because the rest of the European Union couldn't have what we had. And it stands out.
04:44 - 04:51
[Brent Stafford]
Now, is it not true that Sweden actually made that exemption condition on them joining the EU? No.
04:52 - 05:09
[Carissa Düring]
Yes, it was. It was quite evident for Swedish politicians that the Swedes would not vote to join the European Union if that would mean that we would lose our snus. It's a cultural heritage. We've had it for many hundred years. So the Swedes wanted their snus.
05:10 - 05:16
[Brent Stafford]
So we hear often about the Sweden model. In your mind, what are the core elements that make it work?
05:18 - 05:56
[Carissa Düring]
The core elements that makes it work, I would say, is a combination of having these safer alternatives available, easy to get a hold of, to buy. They're affordable and they are acceptable by the society. It is normalized in our culture. But I think that is also something that goes very much hand in hand with more traditional tobacco control measures, like restricting smoking in public spaces. Because when you put those kinds of restrictions, it also creates incentives for people to switch. But if people have nothing to switch to, it won't matter so much.
05:57 - 06:02
[Brent Stafford]
The traditional tobacco control incentives, you know, some of them really do work, don't they?
06:03 - 06:24
[Carissa Düring]
They do, especially if people have a way to switch. still get their nicotine or find better ways to get it. So I think tobacco control in itself, it only gets so far. That's what we see with Sweden and the rest of the European Union. They're also implementing traditional tobacco control measures, but they're not seeing the results we've seen in Sweden.
06:25 - 06:37
[Brent Stafford]
So Sweden is always praised by tobacco harm reduction advocates as the example to follow. But when it comes to global public health, it appears Sweden's success is outright ignored.
06:37 - 07:34
[Carissa Düring]
I know. And it's insane to me that people are turning the other way and just pretending more or less that it doesn't exist at all. And it's super frustrating because we have a real life example. I understand if people are worried how this would work. on a large scale in a country. But in Sweden, we can see that it works. And we also have examples of regulation that works and helps with the issues that might be regarding safety and such. So it is crazy to me, honestly. Also, if you create an environment as the WHO are doing, and they're creating an environment where they won't let consumers in as long as they're not completely anti-nicotine, well, then it's easy to get a very skewed world view because you don't want to talk to people. You don't want to see what the reality actually is and what the reality actually looks like for consumers.
07:35 - 07:43
[Brent Stafford]
Carissa, take a moment to talk about how you became a smoker. When did you start and how popular was it with people your age?
07:44 - 08:20
[Carissa Düring]
I was in this in-between threshold before nicotine pouches really became popularized. So I'm a part of the generation that picked up smoking, just as all the generations before us. Mainly for me, it was, I was traveling a lot around Europe as well. So I was meeting a lot of, uh, youth from other countries that were smoking and that became the way you socialized, right? And parties, everybody was party smoking. The party was outside, not inside the venue because that's where everybody was hanging out. So that's how I got into, into smoking.
08:21 - 08:32
[Brent Stafford]
Party smoking, that seems to sum up how, well, maybe me and many other people started smoking. What surprised me, though, is how recent this was around 2018 or so.
08:34 - 09:12
[Carissa Düring]
Yeah. The change you've seen going on in Sweden, it is quite recent, especially for us women, more or less. And I'm not alone with a story that I started smoking and then just a year or two later, when nicotine pouches really became popularized, I switched. And most, a lot of young women my age have the same kind of story. I find it very fascinating because if you look just a few years later, um, Those young women usually never picked up smoking in the first place because nicotine pouches has replaced smoking in that manner as well.
09:13 - 09:29
[Brent Stafford]
Yeah. I mean, it's I guess it's one troubling and maybe the other one expected that, you know, women in their late teens, early 20s are still prone to picking up smoking. And boy, is tobacco control. Do they have a grasp on that?
09:33 - 10:21
[Carissa Düring]
I find that they really don't. Sometimes, I mean, we have a smoke-free generation in Sweden. We have, in my generation, only 2.3% smoke. That's age 16 to 29. It's almost no one. And when I talk to people that are more prohibitionist in Sweden, they usually say like, oh, but these are people that wouldn't have smoked at all. They wouldn't have used nicotine at all. And I'm just like, well, they're doing it in every other country. And we did that just eight years ago. That's what we did. Like teens want to try out a lot of things and they want to explore and experience. You see that with alcohol, you see it with smoking. And of course, you will see it with nicotine pouches as well.
10:22 - 10:30
[Brent Stafford]
So Carissa, am I to assume then that there are some perceived benefits, whether it's smoking or nicotine in general, that's attractive?
10:30 - 11:05
[Carissa Düring]
If there were not parts of nicotine that people, humans found pleasant, then we would not have a problem with smoking. Like that's obvious. People do it because of social reasons, enjoyment or cognitive benefits. And that's the reason why we're having such difficulties getting rid of smoking, right? So we need to find a way. where people can let go of the harmful parts of consuming nicotine because no country in the world has ever ended the use of nicotine. And I think that's really important to remember.
11:06 - 11:16
[Brent Stafford]
Is that a realistic goal? Because it seems tobacco control has embraced that as the end game. It's no longer about tobacco or smoking. It's about ending nicotine itself.
11:18 - 11:47
[Carissa Düring]
it seems to me super unrealistic because if it was possible then we would have done it by now because smoking has brought with it so many bad health effects for people you feel it quite instantly with your breath getting bad your throat being sore like all of those sides of fact you smell bad but still people keep doing it i don't i really don't think that's realistic at all honestly it's a bit of it's a bit delusional if i'm being honest
11:48 - 11:55
[Brent Stafford]
Carissa, Sweden already had snus, yet smoking persisted, especially among women. Why didn't snus solve the whole problem?
11:56 - 13:09
[Carissa Düring]
So the problem with snus is that it has a super heavy tobacco flavor and that tastes really bad and it gives you a bad breath and it looks bad as well. So a lot of women were not appealed by this. It was not a product that really was suitable for that group at all. So what really happened was that when nicotine pouches came, women started switching as well. Before that, the smoking rates for women were higher, a lot higher than for men because they used snus to a much higher extent. But when nicotine pouches were introduced in 2016, until now, the smoking rates for women decreased with 40%. So it just really dropped. And you can see that for young adults as well seem also to be more appealed by nicotine pouches. As I said, we have a smoke free generation now. And that was led by a drop of 70% in daily smoking rates since 2016. Like that's insane. And I think unprecedented.
13:10 - 13:12
[Brent Stafford]
How hard was it to quit smoking?
13:13 - 13:51
[Carissa Düring]
For me, it wasn't hard at all because I switched to nicotine pouches. And as I just stated, smoking is not a very nice thing. It is inconvenient. You smell bad. It feels bad. And nicotine pouches provide an alternative that seems... It fits your everyday life seamlessly, more or less. And you have a pleasant smell. It tastes good. And it's not harmful for you in the same way that cigarettes are. So it wasn't difficult for me at all, honestly.
13:52 - 13:57
[Brent Stafford]
So if you're concerned about women's health, nicotine pouches could be the silver bullet.
13:58 - 14:35
[Carissa Düring]
Definitely. I think it is really a question also about women and our health and our rights to safer alternatives as well. I think it's a very important perspective. And I mean, as a consumer advocate, I think nicotine pouches works really well for this group. But you can think of a lot of other groups that have other challenges that also deserve their type of preferred safer nicotine alternative. So maybe nicotine pouches is not the solution for everyone, the same way that snus was not the solution for women in Sweden. But safer nicotine products are definitely the way to go.
14:37 - 14:48
[Brent Stafford]
So if snus for men and nicotine pouches for women do the trick and help millions to get off smoking, why does tobacco control push so hard to tax or ban these products?
14:52 - 15:50
[Carissa Düring]
I keep asking myself that question. It's such a weird combination of disinformation and weird delusions of this idea of ending nicotine as we've discussed. And I think they're just not informed well enough and the information that they decide to take in, it is the information that they want and not the one that actually reflects reality. They choose which kind of science they want to read and which kind of reality they want to accept. You would say that if they would really care about lives and saving lives and stop smoking, they would let go of this zero nicotine policy or idea. It's a Nirvana fallacy. It's when you think that there is a solution that doesn't really exist in reality. So you lose track of what can actually work and what can actually help people.
15:50 - 15:58
[Brent Stafford]
Public health, the media, politicians, they all claim to be focused on saving the youth. So in your experience, are they on the right path there?
16:00 - 17:02
[Carissa Düring]
No, absolutely not. I mean, as I said, youth will be smoking. And in most countries where politicians are saying, oh, we want to protect the youth, they're already smoking. They're already consuming nicotine. At least... speaking from people that are above 18 they should have the right to have safer nicotine alternatives and when it comes to protecting those that are not 18 and they are not legal adults we need to make sure that there are safer mechanisms in place as we have in Sweden in order to protect them but It's just focusing on the wrong thing. It's a very important balance to have, protecting the youth and protecting also the adult smokers and giving them safe alternatives. But the problem is when you're going banning things, you cannot protect anyone. You cannot protect regulations or safety of the products and you cannot make sure that underage people will get a hand on nicotine products. So you're not doing anyone any favors by banning it.
17:03 - 17:12
[Brent Stafford]
But surely, though, the warning is that nicotine vapes and pouches are a gateway to smoking for youth.
17:14 - 17:45
[Carissa Düring]
You know, if nicotine pouches were a gateway for youth, then. we should have a lot higher smoking rates in Sweden, shouldn't we? We shouldn't have seen this drop in 70% smoking rates if it were the case that nicotine pouches is a gateway because we've had an increase in the usage of nicotine pouches in this age group. So that doesn't make sense. And we also, we have real life evidence that that is not what's happening.
17:45 - 17:54
[Brent Stafford]
One of the tools public health uses to promote scare stories about youth use is the past 30-day use metric. Are you familiar with that?
17:54 - 19:04
[Carissa Düring]
Yes, unfortunately I am. That is one thing that I've had to encounter here, discussing and debating with state-funded NGOs that are promoting what they say are facts around tobacco and nicotine. And they say that smoking among this age group in Sweden has increased. And if you look at that statistics, which one is it that has increased? It is the past 30 days smoked once or like some time smoker. And if you've had such a decrease in smoking rates in a group, you would kind of expect to see the like occasional smoker rates go up, right? That just makes sense. But they don't have... It's hard in Sweden, right? Because all the statistics is talking in our favor. So if you are a prohibitionist, an anti-nicotine advocate, you kind of really need to bend the statistics to make it look like you are right. Because it's not speaking in your favor.
19:05 - 19:18
[Brent Stafford]
So Carissa, let's talk about the European Union. We constantly hear about disposable vapes and flavor bans, and we also hear about restrictions on using nicotine pouches in public. What's that all about?
19:20 - 19:54
[Carissa Düring]
The European Union is really following in the footsteps of the WHO and are more or less actively ignoring Sweden and a few other countries that are actually standing up as well. for nicotine pouches and they are doing really everything they can to pass legislation banning nicotine pouches or taxing them very heavily and trying to find ways to get around countries like Sweden that will not accept this just to get their way more or less.
19:56 - 20:09
[Brent Stafford]
So there's a bunch of different efforts, I guess, is best to say. You've got individual countries that do some banning. Now you've got the EU wanting to bring in a significant increase in taxes. Tell us about that.
20:11 - 21:52
[Carissa Düring]
Yeah, they want to, they are going to propose a significant increase on taxes on nicotine pouches and other safer nicotine alternatives, which is really insane it would increase its by several hundred percent and they're fighting as much as they can to get this through which would really be detrimental for the nicotine consumers. But it is also difficult because the EU doesn't have legislation around this that is the same for every country, right? So that is kind of the battle that's been going on for several years. They're trying to get some legislation in, which is probably in itself a sane idea, but the idea that... they are using in order to try to ban it even though there is no countries they are not agreeing on this which eu countries are the most hostile to safer nicotine products i would say that is france and the netherlands they are um really horrible. I mean, France has banned just having nicotine pouches. So me as a Swede, I cannot travel to France and bring nicotine pouches for personal consumption there, which is horrible. And it's so ridiculous that the Netherlands is so actively fighting nicotine pouches, being a country that has a lot of other much harsher drugs legalized.
21:52 - 22:08
[Brent Stafford]
You've got countries that, you know, from here over here in North America, countries that I always thought were very open and liberal because, of course, it's Europe. And you're describing something that is crazy, that you can't even bring a nicotine pouch with you in France.
22:10 - 22:49
[Carissa Düring]
Yeah, no, the fines are really, really heavy on that. And I think we have a very interesting example as well with our neighboring country, Denmark. They're seen as our libertarian counterparts. They have much less loss on alcohol consumption. You can drink from 16-year-olds and stuff like that. They're the fun neighbor. But they have actually gone and tried to work against Sweden in the negotiations before the COP conference and trying to really go the ban route, which It's totally insane.
22:49 - 22:56
[Brent Stafford]
Now, there's a lot of smoking, though, in France, isn't there? How can they be so anti-savor nicotine?
22:56 - 23:35
[Carissa Düring]
I ask myself that question so often. I don't really know what they're afraid of because they have such high smoking rates. And I think about that a lot. And I think about how lucky I am being a woman born in Sweden and not a woman born in France. Because if I was in France, I would be a heavy smoker. And I see that. I mean, when I've been out backpacking as well, like every French woman that I met They were all heavy smokers. If they would have a safer alternative as we would have in Sweden, we could save so many lives just theirs.
23:36 - 23:41
[Brent Stafford]
Talk a bit, if you would, about Sweden's pushback in the EU.
23:41 - 25:39
[Carissa Düring]
Well, it's really a positive change in comparison to what we've had before. Our Swedish politicians have been very relaxed about the nicotine pouches and the situation in the European Union, and they haven't really defended our model until the recent government that we've had that has really gone strongly on this. So what we could see at last COP was that Sweden, maybe for the first time, really stood up against the anti-harm reduction activists and they were really standing up for snus and nicotine pouches in an active way. So that is giving me a lot of hope looking forward for the regulations that are proposed by the European Union and the discussions that are going to come in the year that we have ahead of us. Within Sweden, who's the ally? That's a very interesting question. So, well, we have, of course, most politicians are on our side because we have 1 million consumers in Sweden of nicotine pouches. And we're just a population of 10 million. So that's a lot of people. So nobody would actually go against nicotine pouches. However... the public health agency is not very friendly because they go more the same way that the WHO is going, trying to ban or doing things that are not in accordance with what the government says. So the government are very pro and they are trying to ask the public health agencies to do like a relative risk analysis and those kinds of things. And they are just actively working against that. So we have a lot of activists inside the public health agency.
25:39 - 25:44
[Brent Stafford]
Well, that sounds like the same old same old story is here.
25:44 - 26:06
[Carissa Düring]
Yeah, but it's just unfortunate. I mean, Sweden is the role model, right? And we have to fight so much here to have these conversations and to get heard and not have disinformation around nicotine pouches to come out. So I can't imagine how difficult it is in other countries as well.
26:07 - 26:11
[Brent Stafford]
Carissa, is the WHO having a positive impact on the battle to end smoking?
26:12 - 26:37
[Carissa Düring]
Absolutely not. They are being counterproductive and I think they're at this point doing a lot more harm than good. And if they would just stop what they're doing and listen, we could save so many lives. But for every year that they choose to ignore us and not have that conversation with us, many, many lives are lost.
26:38 - 27:05
[Brent Stafford]
Carissa, the 13th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products and tobacco harm reduction, takes place again this year in Warsaw, Poland, from June 3 to 5, 2026. The conference theme is prohibition and public health. In your mind, what are some of the solutions to address how prohibitionist thinking has come to dominate public health policy around nicotine?
27:06 - 28:05
[Carissa Düring]
I think that the best way to change the situation is through advocacy and through talking with actual consumers. If I just get a little theoretical here for a moment, I usually think about the Hayek's social change model of how politicians, ultimately, they are the ones making the decisions, right? But for that to happen, you need to have public opinion with you. And we get public opinion through advocates and through consumers and mobilizing everyone. And when they have mobilized the politicians, they will do this. Unfortunately, though, I think that the activists working in the public health agencies and the WHO, they are very hard to convince. So I think we need to sort of go around them rather than through them.