From the betel-stained smiles of Southeast Asia to Scandinavia’s sleek pouch packaging, the rise of oral nicotine is not a one-size-fits-all story. Regional traditions, risk perceptions, and regulatory choices are shaping the path of harm reduction around the world, highlighting both promise and pitfalls.
Southeast Asia: Tradition Meets Resistance
Southeast Asia is home to more than 80% of the world’s 301 million smokeless tobacco users, with oral stimulants like gutkha, paan, and betel quid forming part of long-standing cultural practices. Yet despite this familiarity with oral nicotine, the entry of modern, tobacco-free nicotine pouches has been slow, claiming just 1% of the market.
Several barriers hinder progress. Governments in Cambodia, Singapore, and Laos have banned nicotine pouches outright, citing concerns over illegal imports and youth use. Meanwhile, countries like Malaysia are only now beginning to explore formal regulation. This reluctance persists even in the face of rising oral cancer rates linked to unregulated and highly toxic traditional products.
The result? Safer alternatives remain out of reach for most adults, while black-market and poorly manufactured pouches are starting to fill the void. The region’s harm reduction potential remains largely untapped, caught between cultural legacy and regulatory inertia.
Scandinavia: From Cultural Acceptance to Global Model
In stark contrast, Scandinavia showcases what a mature, regulated oral nicotine market can look like. Sweden, in particular, has become a global leader, not just in pouch sales, but in smoking reduction. Nicotine pouches and traditional snus are embedded in everyday life, accepted across generations and genders.
Sweden’s nicotine pouch market exceeded $470 million in 2024 and is projected to continue growing rapidly, driven by consumer health awareness and strong trust in regulated products. Moderate nicotine strengths (3mg/pouch) are most popular, but lower-strength variants are gaining ground as occasional and lifestyle users join the fold.
This cultural normalization is underpinned by responsible policy. Scandinavian countries are moving toward harmonized rules, such as common nicotine limits, to improve enforcement and cross-border coherence.
USA: Innovation, Adoption, and Public Debate
In the United States, nicotine pouches are gaining traction, especially among tobacco-experienced adults. In 2022, around 0.4% of adults reported using pouches, and up to 16% of young adults with prior tobacco use had tried them. Among youth, lifetime use remains low but not negligible.
The product’s discreetness and variety of flavors are appealing, but these very traits also stoke concerns. Regulators and health advocates fear pouches may entice non-smokers or underage users into nicotine dependence.
As a result, calls are growing for stricter oversight, marketing limitations, and clearer labeling. Whether pouches will be broadly accepted as a harm reduction tool, or stigmatized like previous tobacco innovations, remains an open question in U.S. policy circles.
Africa: Culturally Familiar, Legally Ambiguous
In Africa, oral traditions hold significant cultural weight. In many communities, stimulants like snuff or tobacco sachets are used by elders, women, and across generations. These forms of oral use are not without harm, but they provide a culturally familiar foundation.
This cultural context matters. When properly regulated, tobacco-free nicotine pouches could serve as a safer substitute, especially if policymakers recognize their alignment with existing traditions. By connecting new innovations to familiar formats, African countries have an opportunity to embrace harm reduction in a culturally resonant and pragmatic way.
What We’ve Learned
- Southeast Asia has a deeply rooted oral tobacco culture but resists modern pouches, risking black-market growth.
- Scandinavia is a model for mainstream, safe pouch use and public health gains.
- The U.S. faces a tug-of-war between innovation and youth protection, amid growing adult adoption.
- Africa presents a unique opportunity to link modern harm reduction to traditional oral practices.
As the global nicotine pouch landscape evolves, it is clear: local culture, policy, and consumer trust shape success. Effective harm reduction must meet people where they are, not just with safer products, but with regulation and messaging that reflect cultural realities.
