akistan is currently struggling against a public health challenge of a dual nature—the persistence of communicable diseases alongside the rapid rise of non-communicable diseases (NCDs). This “double burden of disease” strains Pakistan’s already crippling healthcare infrastructure and jeopardises the well-being of its citizens. Amidst this complex situation, a new threat has emerged and is spreading at an alarming rate: the ‘tobacco-free’ nicotine pouches. Marketed with a deceptive appeal, these products pose a significant and often underestimated risk to an individual’s health.
Nicotine pouches, small sachets placed between the gum and lip, are widely advertised as a “modern” and “discreet” way to consume nicotine. These pouches, unlike traditional tobacco products, contain nicotine powder extracted from tobacco leaves or synthetically manufactured. Their appeal is enhanced by a wide variety of flavours and a lack of smoke or spit often associated with other tobacco products. Marketed as “tobacco-free” or “tobacco leaf-free,” they have seen a significant recent surge in popularity. This has caused a misconception among lay people that they are harmless. Nicotine is a highly addictive substance with a range of detrimental health effects. Unregulated marketing and rapid increase in use raise serious public health concerns about their long-term effects.
Nicotine is a potent psychoactive compound that can have profound effects on the human body. Its use leads to addiction, a chronic, relapsing brain disease characterised by compulsive drug seeking and use, despite harmful consequences. This addiction, particularly when it begins in youth, can disrupt brain development. Normally, the brain continues to develop until a person’s mid-twenties. Early exposure can impair cognitive functions, including attention and learning, and may increase the likelihood of addiction to other substances later in life.
Proven by clinical trials, the health risks associated with nicotine are extensive and well-documented. Nicotine use has been linked to several cardiovascular issues. It can cause an increase in heart rate and blood pressure, placing added strain on the heart. Long-term use can contribute to the hardening of artery walls, which increases the risk of heart attacks and strokes. These conditions already represent a major part of the NCD burden in Pakistan. The proliferation of nicotine pouches threatens to exacerbate this crisis.
Local effects of these pouches on oral health are also a serious concern. Placing the pouch directly against the gums can lead to irritation and inflammation. Prolonged and repeated use can cause gum recession, where the gum tissue pulls away from the teeth, exposing the roots and increasing the risk of dental caries and tooth loss. While the long-term impact on oral cancer is still under study, the potential for chronic irritation and inflammation of oral tissues is a significant health risk.
The market for nicotine pouches in Pakistan is largely unregulated. Their “tobacco-free” status allows them to bypass many of the regulations and taxes that apply to traditional tobacco products. This regulatory vacuum has created space for aggressive marketing campaigns, especially on social media, that target young adults and adolescents.
Alarmingly, the market for nicotine pouches in Pakistan is largely unregulated. Their “tobacco-free” status allows them to bypass many of the regulations and taxes that apply to traditional tobacco products. This regulatory vacuum has created a gap for aggressive marketing campaigns, especially on social media, that target young adults and adolescents. Appealing flavours and discreet nature of these products make them particularly attractive to this demographic, creating a new generation of nicotine users and perpetuating the cycle of addiction. One recent study highlighted the alarming trend of high nicotine pouch use among young adults in Pakistan, many of whom are unaware of the associated health risks.
The lack of robust regulation, combined with the products’ deceptive marketing, is directly contributing to the nation’s double burden of disease. As NCDs, including cardiovascular diseases and certain cancers, continue to rise, the introduction of easily accessible and addictive nicotine products threatens to fuel this prognosis further. This places an immense burden on Pakistan’s healthcare system and eventually the economy, draining resources that are desperately needed for other public health initiatives.
The National Assembly passed the NIH bill on August 12. It says that “There is a dire need for establishing the national cancer registry to understand the actual burden of disease, and to implement a national action plan for cancer prevention, and management strategies to control the growing epidemic.s
“Through this bill, the structure and governance of the National Institute of Health will be made more effective. The purpose of the amendment is to ensure the reorganisation of the institution and enhance its performance.”
It said that the approval of the bill marked a significant step toward reforms in the health sector and institutional improvement.
To safeguard the health of the general public, particularly the younger population, it is imperative that the government and the regulatory authorities take immediate and decisive action. Including these products in the taxation stream can significantly limit widespread use. The sale and distribution of these products must be brought under strict regulatory control. A comprehensive ban on the sale of nicotine pouches is the most effective and direct way to address this emerging public health threat. This can prevent a new wave of nicotine addiction and associated diseases from sweeping across the country. By eliminating this silent scourge, we can protect future generations and make a tangible stride toward reducing the double burden of disease that plagues our nation. The time for action is now.
The writer is head of the Centre for Health Policy and Innovation at the Sustainable Development Policy Institute. He can be reached at wasif@sdpi.org