A proposal by Palau has initiated a United Nations review that could classify nicotine as a controlled psychotropic substance. Proponents have framed the initiative as a public health measure, but tobacco harm reduction advocates warn that international nicotine prohibition would confuse the risks associated with smoking with the much lower risks associated with nicotine itself.
The controversy began when Palau notified the United Nations Secretary-General under the 1971 UN Convention on Psychotropic Substances, starting a process that could lead to a scientific review by the World Health Organisation’s Expert Committee on Drug Dependence (ECDD). The ECDD recommends to the Commission on Narcotic Drugs (CND), which decides whether substances should be internationally scheduled.
Discussing the matter on Counterfactual, tobacco harm reduction expert Clive Bates explained that the intention seems to be classifying nicotine this way only when “extracted from tobacco or in its synthetic form (i.e., as used in vapes, pouches, inhalers, etc.), but not in tobacco, and to exempt medical uses of nicotine.” A concerned Bates added that therefore this sounds like nothing but a full-on attack on non-pharmaceutical nicotine alternatives successfully used for smoking cessation. “So this initiative is pitched solely at the non-tobacco, non-combustible forms of nicotine – and therefore constitutes a frontal attack on the idea of tobacco harm reduction.”
Nicotine must be separated from smoking
Nicotine is addictive of course, but its risk profile is actually quite similar to that of other popular stimulants, such as coffee, and it is certainly not the direct cause behind smoking-related cancers, heart disease, or respiratory problems. This distinction opens the door for encouraging smokers who either can’t or don’t want to quit nicotine entirely to think about switching to options that carry lower risks.
The experience of countries that have restricted products like vapes shows the potential consequences. Across those nations that have banned or severely limited non-combustible nicotine products, smoking remains widespread, and safer alternatives have just moved underground, where they are unsafe. THR experts have incessantly explained that banning the products does not eliminate nicotine demand; instead, it leaves smokers dependent on the most harmful nicotine delivery—combustible tobacco.
The role of THR in the overlap of substance use
Adding more weight to the argument, recent research from the Global State of Tobacco Harm Reduction (GSTHR) highlights the importance of applying harm reduction principles consistently across public health. People with drug use problems have smoking rates two to four times higher than the general population. Smoking contributes significantly to premature death in this group, yet tobacco use has received far less attention in drug treatment and recovery settings.
GSTHR’s reports on tobacco harm reduction in drug services emphasise how crucial it is to weave support for those aiming to quit smoking into regular health and social care systems. Rather than insisting on total nicotine abstinence, these services can offer reliable information about safer alternatives and help individuals make informed decisions. This approach fits well with the broader harm reduction philosophy: reducing avoidable risks while recognising that changing behaviour often takes time.
Similarly, a recent GFN panel, titled “Drugs and Tobacco Reduction: Shared Challenges, Shared Solutions,” explored how smoking and other forms of drug use often intersect. Participants stressed that overlooking tobacco use among people who use drugs effectively denies them access to a broader range of health-improving interventions.
Magdalena Bartnik, founder and director of the Polish harm reduction organisation PREKURSOR, described safer nicotine products as an important component of health-focused support services. She explained that many individuals use nicotine as a coping mechanism (a point that has repeatedly stood out in research) and that reducing the risks associated with smoking does not necessarily require complete nicotine abstinence. For that reason, tobacco harm reduction can offer a practical pathway to improved health outcomes.
Policy should focus on deadly cigarettes
To this effect, many tobacco harm reduction advocates argue that global policy discussions should focus on the behaviour causing the greatest harm: smoking. The challenge for public health is not just reducing nicotine use but reducing exposure to toxic products created by combustion. A policy framework treating cigarettes and smoke-free nicotine products as equivalent risks may discourage smokers from switching and unintentionally preserve cigarette consumption.
Research from organisations including GSTHR, along with evidence from countries that have seen significant declines in smoking through the availability of safer nicotine products, suggests that harm reduction can complement traditional prevention and cessation strategies.
The debate surrounding Palau’s proposal therefore represents more than a question about international drug scheduling. It raises a fundamental issue about how public health approaches risk, choice and innovation. To cut down on tobacco-related deaths, many experts believe that the focus should be on making credible, lower-risk alternatives more accessible rather than limiting them. While nicotine pouches and other smoke-free products aren’t completely without risk, they present a chance to lessen harm for millions of adults around the globe when compared to ongoing cigarette smoking.
