Despite decades of progress in tobacco control, smoking remains widespread across Europe. In countries like Germany, millions continue to smoke with little motivation to quit, leaving policymakers and scientists searching for pragmatic ways to reduce the toll of combustible tobacco. A recent article in Internal and Emergency Medicine by aerosol chemist Reinhard Niessner brings the toxicological evidence into sharper focus: smoke-free products (SFPs), including e-cigarettes (ECs), heated tobacco products (HTPs), and nicotine pouches (NPs), expose users to significantly fewer and lower concentrations of harmful toxicants compared with cigarettes.
Why Smoke-Free Products Matter
Cigarettes produce around 6,500 chemical components, more than 100 of which are classified as harmful or potentially harmful. These toxicants, not nicotine itself, are the drivers of smoking-related cancers, heart disease, and respiratory illness. By eliminating combustion, SFPs remove sidestream smoke and drastically reduce toxicant exposure.
Studies consistently show:
- E-cigarettes reduce emissions of harmful and potentially harmful constituents (HPHCs) by 80–99.9% compared with cigarettes. Polycyclic aromatic hydrocarbons (PAHs), a major class of carcinogens, are almost negligible in EC emissions.
- Heated tobacco products cut toxicant levels by more than 90% on average. Levels of tobacco-specific nitrosamines (TSNAs) and PAHs are dramatically reduced, resulting in a toxicological profile far below that of conventional cigarettes.
- Nicotine pouches contain no tobacco and show toxicant levels comparable to pharmaceutical nicotine replacement therapies (NRTs). Most analyses detect no measurable PAHs, and TSNAs are reduced to trace or non-detectable levels.
Taken together, the toxicological data make a compelling case: switching from combustible cigarettes to smoke-free products substantially reduces exposure to known carcinogens.
What the Biomarkers Show
It’s one thing to measure toxicants in the lab, but what about real-world effects on users? Biomarker studies in people who have switched from cigarettes to SFPs demonstrate significantly lower levels of tobacco-related toxins in the body. Some models estimate the cancer potency of HTPs to be 40–50 times lower than cigarettes, while ECs could be 100–500 times lower. Nicotine pouches, with their minimal toxicant profile, are also expected to carry a markedly reduced risk.
The Gaps That Remain
While the evidence is strong, Niessner highlights key research needs:
- Long-term studies to track health outcomes in SFP users.
- Standardized testing methods for nicotine pouches, which currently lack internationally agreed protocols.
- Stronger quality control, including eliminating TSNAs entirely and setting nicotine concentration limits to ensure consistent safety.
- Open scientific dialogue, with transparent collaboration between independent researchers and industry scientists, much as is seen in pharmaceutical regulation.
Why This Matters for Harm Reduction
For GINN, the takeaway is clear: science supports the role of smoke-free products in reducing harm, particularly for adult smokers unwilling or unable to quit nicotine altogether. While these products are not risk-free and should never be promoted to youth or non-smokers, they are vastly less harmful than cigarettes. Denying access to safer alternatives ignores the evidence and risks prolonging the burden of smoking-related disease.
Conclusion
Nicotine is addictive, but combustion is deadly. The toxicological evidence now confirms what many in harm reduction have long argued: smoke-free products represent a pragmatic and effective way to reduce the toll of smoking when paired with responsible regulation and consumer education. Policymakers must move beyond one-sided debates and embrace proportional regulation that protects youth while giving adult smokers access to reduced-risk choices.
As Niessner concludes, the totality of scientific evidence points to smoke-free products playing a useful role in curbing both individual and societal risks associated with smoking.
