Europe is escalating its war on safer nicotine by pursuing new restrictions on vaping, nicotine pouches, flavors, and affordability despite overwhelming evidence that these products can displace smoking.
Shot on location at GFN 2026 in Warsaw, Poland, Dr. Konstantinos Farsalinos describes the policy shift as a “tremendous setback.” He examines why Europe is abandoning common sense, refusing to learn from failed prohibitionist policies, and pushing a market serving millions of former smokers toward illicit trade.
Featuring:
KONSTANTINOS FARSALINOS, M.D.
Cardiologist, Public Health Expert
University of Patras, Greece
University of West Attica, Greece
ecigarette-research.org
Transcription:
00:05 - 00:10
[Brent Stafford]
And taking a look at what's going on in Europe, what do you think?
00:10 - 06:14
[Konstantinos Farsalinos]
I think we're experiencing a tremendous setback. And I truly suspect that there is some money being infiltrated in the same way that we have seen traditionally now for more than 10 years in Southeast Asia, in Latin America, usually in developing countries. I think that we're experiencing the same agenda coming to Europe. You know, Europe was one of the first regions globally that regulated harm reduction products, specifically electronic cigarettes, basically in 2013, at a time where research and knowledge about these products from a public health perspective was absolutely minimal. It was possible, basically, to experience a disaster through this due to the lack of knowledge. Still, by using common sense, even in the absence of enough data, they managed to make something which, first of all, stood out as an example for other areas of the world. And it has been pretty successful. I mean, looking at the outcome, what has happened over these years, there were, of course, some problems, mainly restrictions that were unnecessary. For example, the 20 milligram per milliliter nicotine cap. was useless. Not only useless, it was problematic because it prevented some heavy smokers from successfully switching. It made small, practical for a smoker devices obsolete because they couldn't deliver enough nicotine. The 10ml bottle, volume of bottle limit was also useless, you know, based on the toxicity of nicotine, you know, we have washing powder, which is very toxic, but it is sold in 5 and 10 kilogram boxes, not in 10 gram, you know, bottles. I mean, it makes no sense. But, you know, I understand that regulators want to present themselves as doing something, you know, setting some rules. And that was, in my opinion, quite a good compromise, although an unnecessary compromise. Still, over these years, there was no disaster happening in Europe with this alternative to smoking products. On the contrary, there was very limited and confusing information. There were misperceptions by the population about these products. Many smokers are not at all convinced that these products are better than smoking, so they don't even attempt to make any switch to them. And you would expect, naturally, that the upcoming new regulation, the update, is going to address these issues. No. They're addressing imaginary harms and imaginary problems, problems that do not exist. because they want to implement further restrictions in a region, as I said, where nothing disastrous happened over all these years. It doesn't make any sense when you have officials like DigiSante, the director of the European Commission for Health, saying that alternative to smoking nicotine products pose comparable risks to smoking. You don't need to be a scientist, you know. We're not talking about something that was created yesterday, a month or a year ago. We have so much experience. There is so much evidence right now. And it's unprecedented to have such statements made in 2025 and 2026, you know. These are statements that were never were never presented in 2013. These products were pretty novel and we knew nothing about them. So it's a huge setback. And it's going to be disastrous. They're not seeing the situation in Sweden. They continue to ban the availability of snus in the European Union. And snus is the product. And that's the disappointing thing. When you have the product with the most compelling evidence from long-term clinical epidemiological studies in humans about minimal risk, and you still have the European Union banning the sales of these products all over the EU with the exception of Sweden, while in all these countries tobacco cigarettes are sold legally and are available everywhere, you understand that something is wrong. And at some point it gets very disappointing because, you know, there can't be a discussion when one side defies logic and common sense. You know, you get to a point where you think that even engaging into a debate is useless because you're not using common sense. You're cherry-picking evidence. You have thousands of studies and you may be using five or ten which have been misinterpreted, misrepresented and miscommunicated. And what's the outcome of this? I mean, it seems that they make statements in order to support decisions that they have already made. So what's the public consultation? What is the public debate and the dialogue about it, since you seem to adjust your position based on decisions you have already made? It makes no sense. And it's really disappointing because when I first started working in harm reduction in 2011, I thought that it was just a matter of a few years for smoking to be obsolete globally. And it's unbelievable that it's still, after so many years, we're still discussing things that should have been resolved more than 10 years ago.
06:14 - 06:16
[Brent Stafford]
Well, 10 years ago was our first interview.
06:16 - 07:15
[Konstantinos Farsalinos]
Yeah, yeah, yeah. And it's gotten worse. It's gotten worse. Yeah, yeah. It's unbelievable. With so much evidence, with so much real-world evidence, with results from policies that have accepted harm reduction as a tool to combat smoking in big countries, New Zealand, the U.K., And still, Sweden, of course, traditionally, and still everyone is on denial. I mean, or they pretend to be on denial because I don't think that they're not seeing what's happening. For some reason, they have a different view and they have made decisions that they need to support, of course. But, you know, usually you create the arguments in order to make decisions. You're not creating arguments in order to support predetermined decisions. There is no way that this is going to succeed. It's going to be a failure. And unfortunately, it's going to be a public health failure, you know.
07:16 - 07:20
[Brent Stafford]
You have in France now, you can go to jail if you possess a nicotine pouch?
07:20 - 15:29
[Konstantinos Farsalinos]
If you possess, if you use. I mean, we're not doing it now for cannabis. We're not doing it for even other drugs like opiates for personal use. And you're doing it for nicotine. It makes no sense at all. I mean, that's why I said something is happening that we're not really understanding. Because... All these decisions defy common sense. And they're happening in Western countries, you know. Western countries are supposed to have values besides the democracy and the freedom of expression and, you know, the right for self-determination. We're talking about empathy. We're talking about compassion. We're talking about people having the right to do whatever they want with their lives without hurting anyone else, you know. Because, I mean, the nicotine pouch does not even emit anything. You know, you can use it anywhere. No one else is going to be affected by it. No one else is going to be exposed to anything. You mentioned my latest study which was the most comprehensive review of nicotine pouches in terms of risk, in terms of health effects, but also the population impact. There is nothing Better than nicotine pouches, they are on the same level as pharmaceutical NRTs. The only better thing is not to use anything, of course. But on the continuum of risk spectrum, it's extremely low. And, you know, in France, you can buy cigarettes everywhere. You cannot, not only can you not buy pouches, but you're going to be penalized for using pouches. It makes no sense. These are decisions that have been implemented in countries like Thailand, for example, where, you know, Thailand legalized cannabis. At some point, even recreationally, now they're moving back from that. They keep the medicalized part. But you know that in Thailand you cannot vape cannabis, you have to smoke it. I mean, so they are legalizing the most harmful form of, even for cannabis, which is smoking. Why? Because they don't like vaping, because they have prohibited vaping. So, and I'm talking about nicotine vaping. So vaping cannabis, which is going to be much safer than smoking it, no, it's not allowed. It's penalized, even the use of cannabis in vaping form. I mean, And how can you explain things that are so obvious? I mean, you shouldn't be trying, even trying to explain them. It's one plus one equals two. It's that simple. No. And I never expected that Europe, knowing and having the experience with the interaction in 2013, 2014, because at that time I was living in Belgium, so I was very close to Brussels and I was traveling to Brussels when the vapors made a lot of noise at that time. But, you know, activism at that time was very important because of the lack of evidence. Today, under normal conditions, You wouldn't need activism. Still, I think that it's activism the only way of solving this problem in saving tobacco harm reduction in Europe. It makes no sense. The amount of evidence is unprecedented. Over these years, we're talking about thousands of studies, evidence from real world experience, even on the effects of these products, particularly cigarettes, in smoking cessation. Undisputed evidence. No, they don't accept it. They don't accept anything. So at some point you're thinking, whatever I do, they've made a decision. They're going to stick to it. They're going to use whatever argument they want. There is no accountability. You know, that's another problem. And the EU has... very strong basis for accountability. You can't say whatever you can imagine. But still, they get away with it. And I don't know how they're getting away with it. Probably, maybe it's a mistake from our side that we're not applying enough pressure to implement accountability for any statements made publicly, like the ones of comparable risks for these products with smoking. And for the decisions coming from these statements, and it's more than obvious what the decisions are going to be or their intentions at least are. You know, I was in a conference and I was speaking to some Brussels lobbyists who have a lot of experience interacting with regulators and I was asking them, Have you seen what has happened in countries where prohibition was implemented? The black market has exploded and it's an irreversible thing. You will never get over it. And they told me that there is no discussion within the EU now with the excise tax for these products and with the upcoming TPD. No one talks about black markets. And I said, listen, you know, the EU started as a financial institution, you know, basically. Economics play a huge role also in public health. But it's the number one factor you should be looking at. And I'm not even talking about the economic perspective, loss of income for countries. I'm talking purely about the public health issues related to illicit trade. You have no control on the quality or the source of the products. People are exposed to unknown risks. The government is basically losing control of something. So they're trying to regulate something and through their decisions they're losing complete control of it. So it's not regulation when you have an illicit market. It's something completely unregulated. And even When looking at the fears that the regulators claim, youth use and stuff, well, when you have a criminal activity of an illicit market, they're going to target the most vulnerable of the population, and that is youth, of course. That's what they're going to do. And how are you going to stop them? I mean, the cost of the income loss from tax revenues plus the cost of implementing the prohibition, which will never work. I mean, look at, we have examples where this has been the case and it has failed. Denmark, a country which is rich with very limited corruption, developed country within the EU, they tried to ban flavors in cigarettes in 2022. I mean, they banned them. So what happened in 2024 in the government survey on smoking and nicotine products? First of all, use of e-cigarettes among young people aged 15 to 29 was up by 70%. And 63% of them were using fruit flavors, the flavors that were supposed to be banned. And you know what the response was? We need to prohibit more. I mean, you're half pregnant, you need to be a little bit more pregnant. But you have implemented prohibition. There is no more or less prohibition, you know. It's not a restriction, okay, we'll restrict more. It's prohibition. Prohibition is one thing. There is no less or more prohibition. they don't even want to learn lessons from the mistakes that they're doing which have been now proven to be mistakes through their own data and it's not the only case australia is an even worse worse case because australia is an isolated country there are no land borders And of course it's a developed rich country with limited corruption. Look what's happening. I mean they have created a criminal network with smoking and other nicotine product black markets. They don't learn from their mistakes.
15:30 - 15:54
[Brent Stafford]
One of the things that we've learned here in the week here at GFN is that the worldwide global illicit evaper market is $47 billion US a year, which represents 76% of the entire global e-vapor market. So today, three quarters of it all is illicit.
15:54 - 18:01
[Konstantinos Farsalinos]
Well, even in Europe, they considered about 50% of the market irregular. That's how they called it. They meant illicit. Why? because of taxation. You know, in Europe, the regulation, I mean the TPD2 in 2014 was pretty liberal, you could say. But governments started taxing the products and applying restrictions. In some countries we have flavor restrictions, in other countries we have very high cost of introducing new products and then taxing per volume usually of liquid. That's what creates illicit markets. And imagine when you have a TPD2, which was quite a case, as I said, quite a satisfactory regulation, and you still have such a huge black market because of decisions happening after the TPD. Imagine what's going to happen when you... at least what the retention appears to be, apply even more restrictions and making the products many times more expensive. We're talking also about the excise taxes that are going to increase the cost of these products by 200%. So, how can someone be so naive not to understand that we're going to have an explosion of the black market? And you're not going to satisfy neither your economic you know, goals, nor your public health goals. You're going to make everything worse. So you're not going to protect anyone and you're going to instead expose everyone to additional risks that do not exist. So what lacks in the EU is the balance. You know, you need to have a balance and you need to accept that you will never and no decision will ever be 100% beneficial with zero unintended adverse effects. By trying to suggest that prohibition works, you are exacerbating the adverse unintended effects and you're basically eliminating any benefits.
18:01 - 18:20
[Brent Stafford]
There's not just the people that are still currently using combustible tobacco, but there's tens of millions of people who live in Europe that have already made the switch and are using these products. They always get left out of the conversation here because they need to maintain access.
18:20 - 22:01
[Konstantinos Farsalinos]
Yes, and already there is a lot of confusion even among these people. And unfortunately, the vast majority of them, when they lose trust to these products, I mean, it would be fine if they just quit using these products and not use anything. But the vast majority, and I'm telling this from personal experience, the vast majority of them go back to cigarettes. They relapse back to smoking. Very few decide to just abandon use of everything and just not use any nicotine product. Most of them, and it's very easy to lose trust on harm reduction products because there are stories almost on a daily at least if not daily on a weekly basis in mainstream news media there are so many campaigns in social media from even anonymous accounts which act like bots basically which means that someone is doing it on purpose. You know how many times I've seen social media videos about EVALI or popcorn lung disease, things that are not currently a problem. But still, in 2025, 2026, people discussing about Ivali, which was a situation in 2019 and 2020, for which we have official statements from the CDC and the FDA. So it's not a personal opinion what happened, you know, or an assumption. We know what happened. No, six years later. I'll give you an example. Last year, Greece... had a new tobacco and nicotine regulation for all these products. And there was a public consultation. And a representative of the scientific association of respiratory physicians, the Greek scientific association, went to the parliament and said, Many young people die from vaping in the US because they use vitamin E acetate in their liquids. And I have a video in my social media channel showing experimental video at home showing that it is impossible to dissolve vitamin E acetate in an illiquid because vitamin E acetate is lipid soluble the illiquids are water soluble so they cannot mix they separate in the same way that oil and water separates and I have it on video and these people are scientists And they don't even know what the CDC and the FDA announced in 2019-2020. They don't even know that the CDC officially stated on February 25, 2020, that we stopped tracking cases of EVALI. Now they say, they pretend that this is something that is ongoing, that is happening all the time. And that's not the case. But there is no accountability. Who is going to hold them accountable for misinforming regulators? And of course, the citizens, because everyone is going to hear that. That was on TV, basically. So everybody heard it. And you know, when you are supposed to be a scientist, so you have some credibility, people are going to trust you. You know, how can a non-expert go and search online to find out what's really happening? And why would he do that? He's supposed to be trusting you. But nothing, no accountability on anything.
22:01 - 22:06
[Brent Stafford]
Let me ask you about the US. What's your opinion on what's been happening there?
22:07 - 24:25
[Konstantinos Farsalinos]
Until now? Or what are the prospects? I mean, lately, well, I saw something which is quite encouraging. The first approval of non-tobacco flavored vapes. I mean, again, in the US, it's like ignoring reality because, you know, the disposable market has exploded. I still don't understand why there was a flavor ban in the US. It started basically with EVALI. No one touched the cannabis market and everyone attacked the vaping market. And there was no correction afterwards, you know, even after the CDC and the FDA admitted that it was because of illicit THC products. Nothing changed, you know, the bans stayed in place no matter what. So we don't care what's happening, we don't care what happened. It was a good opportunity to just kill the vaping market. But, you know, as I said, I mean, since 2013, 2014, when you try to apply a law, that was made in the US for the sole purpose of preventing new tobacco products, cigarettes basically, from entering the market. That was the purpose of the PMTA, to make it so difficult, so financially unsustainable, And now they're trying to implement this specific law, which was created at a time where none of these products were available. And as I said, the purpose was prevent new products from entering the market. Now saying that this law can be applicable to some new products that have a huge value in terms of public health promotion by substituting for smoking. It's not gonna work. That's why, you know, it's funny that people who are always anti-industry and accuse the industry of trying to kill people support legislation that delivers the whole market to this specific industry and creates monopolies. And I'm always against monopolies as an ideology. And in this case, it's even worse. There is no reason to have monopolies.
24:26 - 25:11
[Brent Stafford]
How is this happening in Europe and US and so forth? How is there not an effective pushback that's happening? And let me put this out to you, is that embedded in tobacco control laws are a prohibition, and I think this is the real prohibition, a prohibition on advertising. And so we can't use the single most effective tools, and that is media, paid media, to be able to guarantee a message goes out to talk about the safety and efficacy of these products. Can't do it because we're tobacco. And I think that's the biggest single handcuff that prevents us from advancing.
25:11 - 29:33
[Konstantinos Farsalinos]
This starts from the fact that smoking has been classified as a disease by the WHO, which means that anything that treats smoking, I mean smoking cessation, is considered a medical treatment. So in order to have a claim But something is therapeutic, smoking cessation is classified as a therapeutic intervention. So anything that wants to claim a therapeutic effect needs to have medicinal approval. So in reality, it is illegal for a manufacturer or a retailer to publicly and officially state that these products are going to help you quit smoking. So you understand, you cannot say, you cannot claim the reason why these products exist. Because on one side, everyone accepts that these products should be available as smoking substitutes to help people quit. On the other side, it is illegal for anyone to claim that this is the case and this is happening, despite having, for example, the Cochrane review on e-cigarettes, which basically says that there is no doubt that they are not just effective, but twice more effective than NRTs. But no, we can write it in a manuscript, you know, in a publication, but as a retailer or as a producer, you cannot say that. So, on one side, the producers are accused of marketing these products in order to attract new nicotine consumers. On the other side, You don't allow them to say that it's a smoking substitute because it's going to be illegal. They're going to face charges. So, I mean, it's a situation where there is no escape, basically. And it's, I mean, one very interesting case, however, I must say, is your country, Canada. And, you know, I can tell you now that my next paper is going to be the contrast between the trends in cannabis legalization versus nicotine prohibition. It's a paper that is currently under review already, so it took me about three months to prepare it. And I think Canada is a unique case scenario. It's the second country that fully legalized recreational use, even created a market for recreational use, the second in the world after Uruguay. But what's the stance of Canada on tobacco harm reduction? It's the exact opposite. Why is it interesting? Because the same arguments used to legalize cannabis globally, which is the right for self-determination, the fact that even if you apply strict prohibitions, you will never eliminate use. Youth use is happening despite the prohibition. These are the arguments. There are even legal cases, I mean, Supreme Court decisions that are against prohibition based on the right for self-determination. So these are arguments that are now used globally to legalize cannabis. And yes, most countries have a medicinal route of legalization, but in reality it's just a bypass to fully legalize it because the rules of getting a medical prescription for cannabis are almost non-existent. Anyone can get a medical prescription claiming things like, I have some insomnia, you know, completely subjective things that cannot be objectively assessed and verified, not even by a physician. So anyway, that's not the problem. The problem is that the same arguments that have been used to legalize cannabis are completely ignored in the case of nicotine by the same people. And that makes no sense. It's a typical case of double standards that makes no sense and that should be voiced because it's embarrassing for these people, you know.
29:34 - 29:50
[Brent Stafford]
Could it potentially be that the wrong strategic and tactical choice was made somewhere back 10, 15 years ago when it was decided that tobacco harm reduction was the right thing to push as opposed to recreational nicotine?
29:51 - 34:04
[Konstantinos Farsalinos]
Wow. Recreational nicotine is happening for centuries, whether we like it or not. It's a cigarette. Even before the cigarettes. Long time before the cigarettes. So recreational nicotine is happening, did happen for centuries and is going to continue to happen. So one route is simply deny reality and think that from tomorrow no one is going to use nicotine. The second option is to face reality and adjust to reality. Recreational nicotine is not a problem by itself. The problem is the source of nicotine intake. This is what has created this public health crisis in the 20th century. It was the source. It was not nicotine itself. And don't forget that for decades, especially of the previous century, cigarette was... almost 100% the only source of nicotine intake. And that is how nicotine was demonized. That is the reason why it was demonized. It was because there was only one product delivering nicotine to the consumer. By itself, nicotine and recreational nicotine use wouldn't be a problem had we not have combustion. It's the combustion that has created the problem. But now, even the WHO is considering nicotine the problem. So they have moved to what should have been called smoking control. It was never called smoking control, it was called tobacco control. Because even tobacco by itself, look at snus for example, to understand what's happening. Of course there are very harmful tobacco products, for example in Southeast Asia, even non-combustible tobacco products which are harmful. But even tobacco by itself, is not necessarily very harmful. And the best case scenario for this, to support this argument, is snus. So, it should have always been smoking control. Although I don't like the word control in general. But it should have been smoking. It was tobacco, and now it's nicotine control. There's no doubt about it. And it's nicotine control, even sacrificing the smoking control. They don't even care about smoking control anymore. That's the impression you're getting. Look at the WHO message on the World No Tobacco Day. It was about vapes. Look at the document they released two or three days before the World Tobacco Day. It was about nicotine pouches saying absolutely nothing about the relative risk and discussing only about marketing. Nothing else. No information for a smoker on what it would potentially mean switching from combustible cigarettes to nicotine pouches. No information on how it can be used either by itself or in combination with other harm reduction products to satisfy nicotine cravings for smokers and help them get rid of combustible tobacco. Nothing. I mean, It's disappointing, you know, and it's disappointing because the WHO has been considered, you know, the holy grail of science and the public health defendants. And for some countries, especially in the developing world where the resources are very limited, They do whatever the WHO is saying. And they're missing historical opportunities. I mean, India banned e-cigarettes. They banned snus. And they are the number one country in the world in oral cancer because of their local, extremely toxic oral tobacco products.
34:04 - 34:07
[Brent Stafford]
So we need WHO to change their mind.
34:08 - 35:54
[Konstantinos Farsalinos]
WHO, yeah, I wouldn't even say change their mind, face reality, you know. Some things, you know, having an opinion is of course a subjective thing, you know, it depends on what criteria you have and so on, but some things are pretty objective, you know. Some things are reality. You cannot deny reality and pretend that you're doing good by denying reality. You cannot congratulate a country which is number one globally in oral cancer rates and deaths from oral cancer and congratulate them from banning a product which is 99% less harmful in that respect or throwing out of the country snus which does not cause oral cancer. and let them use the local products. How can you congratulate that? How can you release statements congratulating India for their decisions? And what happened? They didn't even address the problem that was never existing in the first place. Vaping products were virtually non-existent in India before the ban and they have now flooded the country through an illicit trade So they created a problem with the prohibition, a problem that didn't even exist before the prohibition. So why have they been congratulated? Can anyone tell us? You know, in India it is illegal to do research on vaping. It is illegal to look for use. So the government does everything to pretend that the products don't exist because they have banned them and the products are everywhere. But you can't even display that. You can't even show that.