The Decibel - The newest nicotine product to spark old fears

Episode Date: November 20, 2023

Health Canada recently approved the sale of Zonnic, a nicotine pouch that you pop into your mouth. Even though its maker – Imperial Tobacco Canada – says it’s meant to help people quit smoking, anti-smoking advocates are worried that it will actually get young people addicted to nicotine. This is in part because of how Health Canada is regulating it.Carly Weeks is a health reporter with The Globe and Mail and she explains the details around the regulation of this product and why it’s not being treated like the last nicotine product that got teens hooked, vaping.Questions? Comments? Ideas? E-mail us at [e-mail]

Let's go back to 2019. Before the pandemic, one of the biggest health concerns out there was the rising number of teens who had started vaping. E-cigarettes were a fairly new product from tobacco companies at the time. And now, there's another one. About a month ago, something called Zonic hit shelves in Canada. It's a nicotine pouch, a little white bag with synthetic nicotine inside. You tuck it up under your lip and it dissolves into your gum. Just like vaping, this product has some anti-smoking advocates really worried.

So health reporter Carly Weeks is on the show, and she's going to explain why people are criticizing Health Canada again for its regulation of an addictive substance, and why teens in particular might be at risk. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail. Carly, thank you so much for being here. Oh, anytime. I guess we should really start by explaining, why do tobacco companies say that they created this product?

In Canada right now, there's one nicotine pouch that's recently been approved, and it's distributed by Imperial Tobacco Canada. Essentially, what Imperial Tobacco is saying is that this is, you know, a nicotine pouch that's recently been approved and it's distributed by Imperial Tobacco Canada. Essentially what Imperial Tobacco is saying is that this is, you know, a nicotine replacement product, just like, you know, a gum or a lozenge or a patch, the kind of thing we've seen for a couple of decades. It's out there to help people stop smoking. And it's sort of a less risky way to get people who have that addiction to nicotine the satisfaction for their craving without all of the health risks that come with tobacco. Okay, so if they're kind of like nicotine gum in that sense, so they're sold at pharmacies,

I would imagine. Interestingly, this is where the products start to diverge. So traditionally, the nicotine replacement therapy market has been dominated by products made by pharmaceutical companies who sell them in pharmacies. I think that's probably where most of us have become sort of familiarized with seeing them, right near the pharmacy counter. In this case, these products, with the exception of Quebec, where I understand they're sold in pharmacies only, in the rest of Canada, these products are being sold in convenience stores and gas stations. There is apparently an online market for nicotine pouches in general. And basically anyone of any age can have access to these products is sort of the concern here. Okay, so there's no age restriction then on who can buy these products? products. Exactly. These products were approved as a natural health products in Canada. And this is a very specific sort of subset of products that are regulated by Health Canada. So it's not a drug, it's not a tobacco, it's not a vaping product, it's a natural health product. Natural health

products have been regulated in Canada for a number of years in a different manner than they are in many other countries. So countries like the U.S., for instance, these products are often sold like natural health products, homeopathic remedies. They're often sold without sort of any regulatory oversight. The Canadian government decided that it would start analyzing the safety and efficacy data and actually sort of give each of these products their unique number, sort of this idea that we're making the products that are being sold to this idea that we're making the products that are being sold to Canadians safer, and we're making sure that they're effective. These rules have come under a lot of criticism, though, for really not requiring a very high bar for evidence.

So in essence, in order to have a natural health product approved, all you really need to do is show that there's a historic usage of these products. So the regulatory bar, many would argue, is not very high, which has enabled these nicotine pouches to sort of piggyback on the wider market for nicotine replacement products. So basically, if it's up to four milligrams of nicotine, it can be approved as a natural health product in Canada and essentially can be sold virtually anywhere. Wow. And so you said four milligrams of nicotine. So that's what's in these little pouches. I guess, how does that compare to what is in a cigarette, Carly, in terms of nicotine content?

I mean, it depends sort of like when brand to brand and that kind of thing. We've certainly seen in the e-cigarette market, for instance, e-cigarettes that have had, you know, many times about four milligram mark. So four milligrams is not particularly high. But for someone who is not used to consuming nicotine, that is certainly more than enough to, you know, become addicted. What are the health consequences that we know of using these pouches? So even if it's, you know, four milligrams of nicotine, what is the effect that's going to have on someone? Nicotine is one of the most addictive substances that, you know, that on earth, right? Obviously, that's why the tobacco industry has maintained its hold, even though people know it's deadly, they continue to smoke, right? So on its own, nicotine can be deadly in and of itself when you separate it out from tobacco. So especially, you know, if young children ingest it, it's a poison. It's really, I think, when we start to get into, you know,

the four milligrams of usage and things like that, say if you're, you know, a teenager in high school who's being exposed to these kinds of products, the risks are not necessarily about the poison aspect, although certainly that is on the radar. The risk really is about the addictive quality of this. And I think this is where we get into the weeds of this whole debate. So is this being used as a less risky alternative to cigarettes? Or is this a way to introduce young people to the world of products that contain nicotine? Like basically, is this a way to introduce people to the much wider market for higher concentration nicotine products that contain

tobacco and are known to cause cancer and all kinds of other harms. Why do people say that these nicotine pouches are also targeting teenagers? I had a back and forth exchange with Imperial Tobacco this week. They maintain that their commitment is to getting less risky alternatives to smoking in the hands of people. They're really aimed at reaching the adult smoker market. And they also claim that the advertising campaigns, the marketing that they're doing is no different from what you might see for a nicotine gum. But however, I think you just need to take a look at some of the tactics they're employing to see that these two things are not the same. So for instance, you know, a lot of the advertisements and social media campaigns that are out there for the nicotine pouch that's on the market in Canada

are really kind of evoking a lifestyle. So, you know, it's like a bunch of like young, good looking people, all like at a restaurant that's like really well lit, that looks like, you know, sort of that fun atmosphere that's surrounding them. And then, you know, one of the young men at the table just slips this nicotine pouch in his mouth and it's marketed as discreet and convenient. If you look back at some of the vintage cigarette ads, as I have done this week, all featuring like young, attractive people, you know, sometimes it's like it's a cowboy with his, you know, hat on beside a truck or it's, you know, like a couple in a loving embrace.

It's really selling a lifestyle. This is not really about selling smoking cessation. Yeah. Well, it's interesting, too, like just from when I'm looking at the packages, pictures of the packages, right, they're like they're very colorful. They're bright. Like they honestly they it kind of evokes more candy than it does like a cigarette. Right. Definitely. Yes. Young people are being exposed to these colorful in-your-face ads online because they're definitely being targeted to people. I've received them in my own Instagram account, just targeted ads

since I've started doing research on this topic. You know, so whether it's on your phone or in real life, you know, young people are definitely being exposed to these ads. And I think the concern is, where is that going to lead us? What do they taste like? This is actually a great and probably one of the most fundamental questions to answer. Apparently,

these taste great. I've not tried them myself. I'm not a nicotine or tobacco user. But these products come in a variety of very appealing flavors, you know, so like mint and tropic breeze. And, you know, even the names of the flavors kind of evoke like a fun sort of like a lifestyle. The Rob Cunningham from the Canadian Cancer Society was remarking to me like tropic breeze is not a flavor. It's like an aspiration. So, you know, the whole idea of flavors, if you ask Imperial Tobacco Canada, what they will say is that flavors are identified as very important to the adult market. They want a product that doesn't taste bland or like tobacco. They want something that tastes appealing.

Okay. But what we also know from plenty of evidence, and this is certainly true with e-cigarettes, is that young people report flavors as being one of the top components that sort of is getting them to use e-cigarettes in the first place. So the idea is that if these flavors were stripped away, young people would likely not be using a lot of the e-cigarettes that are out there. If it tasted like tobacco, you know, they would say, this is not for me. This is what has prompted many provinces to outright ban flavored vaping products, saying that this is just too dangerous and risky, knowing that young people in survey after survey will cite flavors as the reason that they continue to use these products. So flavors, especially those that are like fruit, candy flavors, those kinds of

things, they seem very much designed to draw in young people, despite the protestations of tobacco companies. Okay, so there's definitely this concern around young people using them, Carly, but I guess do we know if teens are in fact actually using these pouches? What we know from around the world is that the market is very robust among young people, and it seems as though particularly among young men. In other countries, the usage has sort of gone off the charts, and it's been so significant that the Netherlands recently banned the sale of nicotine pouches outright, saying that these are just too dangerous. These are not smoking cessation tools, basically denying all of the tobacco industry's arguments, saying that this product represents a danger to public health. Other countries have talked about looking at bans.

The UK, there's been a recent expose by The Guardian there looking at how, you know, Instagram influencers are being paid to promote these products. So it's kind of like a Wild West where, you know, the popularity is taking off and regulators are chasing after trying to figure out how they can close this barn door. I mean, this may be an obvious question, Carly, but like, how is this legal? How are you able to market and sell a nicotine product to kids? It's surprising in many ways. But really, what the tobacco industry has done is kind of take advantage of existing rules to get into this marketplace. So when I was speaking to the Canadian Cancer Society about this earlier this week, they basically explained, like, look,

we've had these rules in place, this natural health product, these regulations in place for many years. And in those rules, it certainly is, you know, legal to sell nicotine containing products to anyone. It's not been a problem up until now. And I think what the tobacco industry realized is that we have an opportunity here to use these rules that makes it completely legal for us to sell these products, to advertise them, to do whatever to any age. And so we should point out, yeah, this is what they're doing is completely legal. Health advocacy groups are saying this is textbook, you know, nicotine addiction 101 for young kids. We need to get these things regulated yesterday.

We'll be back after this message. So, yeah, can we put this into a broader context, Carly? Like, what are the smoking rates in Canada these days? Yeah, certainly. Smoking rates are at historic lows. So if you look back to, like, the 1950s, the 1960s, you know, as many as half of people smoked in Canada. It was, you know, as many as half of people smoked in Canada. It was, you know, incredible. That's really before we understood the true harms. Now, the most recent data from 2021 shows that about 12% of Canadians 15 and older are current smokers. That's 14% of males,

11% of females, and only about 9% of males and 8% of females smoke daily. So it's still high. And, you know, this year alone estimated that 23,000 people will die from lung cancer. It's an incredibly deadly disease. So even though, you know, cigarette usage has gone down, it's still such a high burden of disease from tobacco. Vaping is sort of where a lot of the concern is regarding youth because there's so many restrictions on tobacco on the sale, the marketing, advertising. So really young people are not sort of becoming introduced to smoking cigarettes like they were, you know, back in the day. Now it really is e-cigarettes. So if you look at some of the really alarming data that's come out, again, 2021 data, about one in three Canadian students in grades 7 to 12 saying they had ever tried an e-cigarette.

One in three. That does seem pretty high. students in grades 10 to 12, about one in four grade 10 to 12 students use e-cigarettes on a monthly basis. And that's a really sort of stunning metric. Even if you're using it monthly, experts say that is sort of enough of a pattern of use to indicate that you're at very high risk of becoming sort of addicted for life. I mean, those are the years if you're going to develop an addiction to nicotine, the chances are it is going to develop when you're in those critical high school years where you're taking risks and you're very prone to succumbing to peer pressure. It's not, you know, a 35-year-old who's trying a nicotine pouch for the first time. So that is why there is such alarm over these high rates of e-cigarette usage. What's Health Canada's track record been on regulating tobacco and nicotine? Canada has been a world leader in

the fight to bring smoking rates down. We were the first country in the world to introduce graphic warning labels on cigarette packages. We've led the way in a number of other ways. And you can just see the evidence in the smoking rates declining to where they are. Now, there is a goal to bring the smoking rates down to 5%. I believe it's by 2035. Tobacco industry executives will say the only way to get there is by embracing the use of nicotine pouches. And this is where we get to health Canada's faltering is it seems to be on responding to new threats, you know, things that are sort of happening and being really reactive to them. You know, tobacco was on the market for how many decades has cost how many, you know, hundreds of thousands of lives in Canada alone. There is actually still an ongoing court battle to decide just how much the tobacco companies owe provinces for health care costs, how many billions.

And so the argument here is that why are we showing up late to the party again? You know, we have a chance to be proactive here and to, sure, get smoking cessation devices into the hands of people who legitimately need them, but keep them out of the hands of children. Okay, Carly, it does feel a little bit like we've had a very similar conversation before. Like, I'm thinking about vaping, knee cigarettes. They've only, I guess, been on the market for about a decade or so. But I do remember like we've had conversations over the last few years about kids and vaping and the dangers there. I guess, what are the lessons that we learned from that? It would appear very few lessons were learned because it's really interesting when you look back at the e-cigarette market and how that exploded.

So places like Juul that have, you know, rose up and really sort of captured this youth market by doing exactly what we've already talked about, you know, selling sort of a lifestyle, sponsoring events, concerts, you know, giveaways, doing all kinds of like really cool product placement, paying influencers. I mean, you name it, the e-cigarette industry has done it like the candy colored packages, neon sort of advertisements, like really sort of. And the flavors too, right? All the candy flavors. The flavors have remained one of the biggest components that have like sort of gotten people through that door. Like the door has been opened by the advertising that the flavors sort of are really what it seems to be what are that driving force to getting people to use these products and keep using them. And so it was really interesting and sort of troubling to watch how

this unfolded in Canada. So e-cigarettes for the longest time remained unregulated. It was, you know, they were simply were not legal. And eventually the government was pressured into creating a regulatory regime to govern vaping. It's still not quite done. They've promised to ban flavors. They haven't done so. Like there's a bunch of problems still with the existing legislation. But now we're watching it play out again with nicotine pouches. So are they going to have to, you know, create a regulatory regime each time the tobacco industry comes out with a new product? If so, it's going to do a lot of harm because there's other products that are on the market already elsewhere that have been promised to come here. So the nicotine pouches are just one of a number of products that are on the horizon that the government is going to have to contend with. Right. So now these pouches

are here. And as you've mentioned, Carly, they're in a different category than cigarettes and e-cigarettes, right? They're classified as a natural health product. So I guess what are the rules around selling the nicotine pouches? According to Health Canada, these products are supposed to be labeled as for 18 plus, you know, that you shouldn't take it if you're pregnant or breastfeeding, that kind of thing. The labels that I've seen, I think there's, you know, some small print about this being a nicotine replacement product. This may not be right for everyone. But the main thing you really see are the candy colored outer shell of the package and the name emblazoned on the front. That's kind of really the message that you get from these products.

It's kind of really evocative of like that, yeah, candy colored sort of fun looking package. Visually, it is quite appealing. But is there is there any way to make sure that the label is being respected and it's not being sold to anyone under 18? Yeah, no. In fact, there's not like the tobacco companies will tell you, the government will tell you, you know, there's there's no legal mandate to sell this to people who are over 18 at all. In fact, it's it's quite legal to do just the opposite, to sell this to people who are over 18 at all. In fact, it's quite legal to do just the opposite, to sell it to kids. Now, convenience store owners and associations and the tobacco industry say that's not what's happening. They're being responsible. But,

you know, obviously the fact that there's no way to actually enforce these labels, there's no legal authority to do so, is a huge problem. And it again kind of underscores the fact that the problems with the current natural health product regulations, which kind of, you know, give this guise of being natural and good and safe when in fact, you know, we can have this kind of thing happen. Okay, so now we're at this place where we've got nicotine pouches being sold. I guess, what do anti-smoking advocates, what do they think that Health Canada should actually be doing in order to regulate these and make sure that they don't end up in the hands of kids?

I mean, they're saying basically stop the sale, pull the license, get these things off the market or make it prescription only. Once we can deal with the immediate threat, then create sort of regulations around this. Close these loopholes that allow nicotine-containing products to be sold legally to children. So before we end here, Carly, I guess I just want to come back to the big picture of how bad nicotine addictions can be, right? Because if Health Canada has so much information on this, if we've known this from decades past, how bad it can be, I guess, why wouldn't we just make all nicotine products only available at pharmacies or with a prescription or something, like have a kind of intense regulation around it? That is a really good question. I mean,

I think that some of this comes down to simply, you know, not recognizing the threat for what it is for not being proactive enough. I mean, I think governments in general are often, you know, sort of criticized for being too reactive. And I think that's sort of is what is at play here. I don't think anyone in the government wants to see kids become newly addicted to products. But I think that for one reason or another, you know, whoever sort of is in charge of looking at this area maybe has not recognized the risk for what it is or has not been able to garner enough of a response. And certainly, you know, it's led to the situation where,

you know, you can bet that there's young people in Canada using these products who will become addicted to nicotine for life. Carly, thank you so much for taking the time to speak with me today. Thank you for having me. That's it for today. I'm Maina Karaman-Wells. Our producers are Madeline White, Cheryl Sutherland,

and Rachel Levy-McLaughlin. David Crosby edits the show. Adrienne Chung is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.