The Netherlands recently banned all tasty flavors in e-liquid and only allows nicotine portions with the same nicotine content as aubergines.
Now they want to tighten the law even further and ban all nicotine pouches, just to be on the safe side.
What is really happening in a country where cannabis is allowed to flow relatively freely, but all alternatives to cigarettes are seen as the devil's invention? Vejpkollen asked activist Rob de Lange and nicotine pouch inventor Karl Fagerström.
Since the Dutch government put forward a proposal to ban nicotine pouches completely the commitment to address harm reduction in the country has increased significantly. But this is in a country where opposition to new nicotine products is deeply rooted, with a taste ban for e-cigarettes since the beginning of the year and a highly medicalized view of nicotine.
"Harm reduction and smoking cessation are all about medicines like nicotine tablets and patches here. It's hard to get anyone to listen to us consumers. It has become a toxic environment around anything to do with harm reduction." notes Rob de Lange, involved in the association Acvoda which has been working since 2013 to promote harm reduction for the nearly 3.5 million people who smoke in the Netherlands.
"Things are moving slowly," he says. While virtually all flavors are now being phased off the shelves of vejp shops, the government also wants to go after nicotine pouches. Any product that has the potential to lure nicotine users away from the deadly habit of inhaling smoke day in, day out to get their fix will be removed. Almost. Because while the Netherlands has become a nightmare for vejpers and snuffers - it's also a wet dream for those interests who think nicotine should only be sold as medicinal products.
Nicotine portions = vegetables
Nicotine pouches in the Netherlands are a complicated story. Technically, the products are already on the market. But with a very low nicotine strength, equivalent to the nicotine content of an eggplant. The reason for this is that the pouches, which are made of plant cellulose, are regulated as vegetables, with all that this implies. Since many vegetables contain nicotine naturally, legislators have decided that the eggplant - which contains the most natural nicotine - should be the benchmark for other products in the segment.
"It's ridiculous really. With such low nicotine levels, nicotine pouches are neither attractive nor effective tools for smokers who want to quit" says Rob de Lange.
Chewing gum not attractive to smokers
Ironically, it was restrictions on nicotine content that led to the development of the modern nicotine pouch. Karl Fagerström, Swedish associate professor of psychology, addiction researcher and inventor, had been working on smoking cessation products since the mid-1970s. He helped develop both nicotine gum and nicotine patches, but recognized the limitations of these products when it came to smoking cessation.
"The problem was that many smokers didn't really like using these products. They got heartburn and other side effects and soon went back to cigarettes again" says Karl Fagerström to Vejpkollen when we talk about how the nicotine pouch was developed in the early 2000s.
Swedish snus the inspiration
For Karl Fagerström it was the experience of the smoking cessation philosophy of the 80s and 90s that inspired the development of better tools to help smokers quit.
"I come from a country where many people use snus instead of smoking. And they obviously liked it, because many Swedes stopped smoking that way. But what would happen if you combined the pure nicotine we used in nicotine patches and chewing gum, packaged it in a pouch and used it as snus?"
Too weak as a medicine
And so the first nicotine pouch was born. The problem was the nicotine content. As a medicine, the only reference was nicotine gum, where the highest concentration tested was 4 mg.
"The equivalent amount in snus is closer to 10 mg - and this was one of the reasons why Swedish snus became significantly more effective in smoking cessation than other products on the market," notes Karl Fagerström.
But spending millions trying to get a stronger product approved as a medicine was not possible, he says.
"So I had to give up. Nicotine pouches with such a low nicotine content didn't work the way I wanted. It was only when products such as e-cigarettes appeared on the market that things actually started to loosen up. The EU approved e-liquid as a mainstream consumer product in 2015. As the nicotine content was allowed to be 20 mg/ml in the e-juice, it also opened the door for the new nicotine pouch - not as a medicine but as a product on the open market" says Karl Fagerström.
Replaced smoking in Sweden
The modern nicotine pouch typically has a nicotine content of between 6 and 12 mg - a concentration that delivers nicotine equivalent to Swedish snus. The difference was the wide variety of flavors that could be combined with the nicotine. The products are popular in Sweden and today the pouches, along with snus and e-cigarettes, have replaced smoking in many groups in Sweden. 4% of men smoke while 20% use snus (including nicotine pouches).
Women, who have long smoked more than men in Sweden, have also started using nicotine pouches - especially young women. Between 2015 and 2022, the proportion of women 16-29 who smoke daily decreased from 11% to 4%. At the same time, the share of nicotine snus users in this group is around 15%. 8% use e-cigarettes.
"Since the launch of nicotine pouches, we have seen smoking decline, and almost disappear, in different population groups. And it's important to point out that it's consumers who choose, not doctors or quitters. At the same time, a certain fashion has perhaps emerged, where young non-smokers have started using nicotine pouches. Many of them might have started smoking anyway, but we don't know that." says Karl Fagerström.
Clear impact on smoking
Nicotine pouches, along with snus and e-cigarettes have simply been proven to work as a substitute for cigarette smoking. And it's not just in countries like Sweden and Norway. Similar developments can be seen in United Kingdom, USA and New Zealand, where smoking is declining at a faster rate than in countries that in one way or another restricts access to smoke-free nicotine alternatives. Nicotine medicines as the only smokeless nicotine source has simply proven to be less effective than other products on the open market. At least in terms of reducing smoking rates, something that many believe is the whole point with the products.
Consumers are being ignored
But hopes that the Dutch government would reverse course on the issue of harm reduction are slim. At least according to activist Rob de Lange. He and the organization Acvoda have repeatedly tried to persuade the government to include a consumer perspective in nicotine policy.
"There have been times when we have been in the media to give our point of view. But we always get less time and attention compared to our opponents. So far we have not been allowed to participate in any debates where politicians are present" says Rob de Lange.
E-cigarettes should taste bad
The Dutch flavor ban for e-cigarettes is also one of the most elaborate in the world. In short, from 2023, e-liquid can only be flavored with 11 different flavorings. These are characterized by a hint of hay, rotten wood and ash. According to a government study, these 11 substances make an e-cigarette "taste like tobacco smoke" - something that should keep both young and old away from the products. Faced with the taste ban, Acvoda members demonstrated outside Parliament.
"We had a brief chat with the Health Minister. But once inside the plenary hall, he said that the ban was not aimed at the "nice vejps" who were demonstrating outside. The ban was to prevent young people from vejpa. So they are well aware that the ban affects us, but simply ignore it" says Rob de Lange to Vejpkollen.
20% smoke in the Netherlands
Whether it's e-cigarettes or nicotine pouches, the Dutch attitude towards alternative nicotine products is limiting the country's ability to reduce smoking in the country, says Karl Fagerström. The goal is to have less than 5% of the population smoking by 2040. Currently, almost 20% of the adult population smokes.
Should allow the alternatives
Alongside some 10 other Swedish researchers and NGOs, he is now trying to change the Dutch government's mind:
"Bans and restrictions on products that have the potential to help smokers quit should not be implemented without careful consideration. When so many people smoke, the government should instead focus more on getting smokers to quit, or switch to less harmful products. If we want to reduce smoking to the same low levels as in Sweden, consumers should be able to choose alternative sources of nicotine." Writes Karl Fagerström in a letter to the Dutch government.
"Tightly regulate nicotine"
At the same time, he points out that the regulation of new nicotine products should be very strict, as in Sweden.
"Age limits and restrictions on marketing, content controls and an upper limit on nicotine content are essential. At the same time, even stricter restrictions on cigarettes and cigarette sales should be introduced in parallel," writes Karl Fagerström.
Almost religious resistance
Rob de Lange believes that the harm reduction situation in the Netherlands is unlikely to change overnight. Rational arguments don't seem to bite politicians, says Rob de Lange.
"There are almost religious undertones in the resistance. It's a bit like saying that suffering is a part of life and that it should be difficult to stop smoking - certainly not enjoyable. This is coupled with a precautionary principle that says "We should not make the same mistakes as with cigarettes". Add to this the strong influence of biased 'experts' and anti-tobacco activists, and it's hard to hope for too much." Rob de Lange to Vejpkollen.
Yes, in Holland it is particularly absurd given their liberal attitude to cannabis. In any case, the Swedish Social Democrats are quite consistent when it comes to opposing all forms of drugs and stimulants regardless of the risks.
Again, the anti-nicotine and tobacco lobby are prohibitionists, sadists, control freaks and totalitarian fanatics. Some of them probably suffer from mental disorders. This is proven by the fact that they do not want to allow alternative methods of nicotine consumption that are in principle no more dangerous than, for example, coffee drinking and moderate wine consumption. The fact that they also want to ban tobacco-free snus shows that it's not even just about vejpning because for them it's "immoral-because-it-looks-like-you're-smoking". Then there are also some people who don't want to quit smoking cigarettes and have tried different alternatives and didn't like them. I know a couple of such people myself. The prohibitionist fascists should just leave them alone.