International health experts have warned Bangladesh’s lawmakers that proposed restrictions on oral nicotine pouches would be a backward step in the fight against smoking, which is killing more than 130,000 people in the country every year, a press release said.

In a recent press release, Smoke Free Sweden has urged the Bangladesh Standards and Testing Institution (BSTI) to revise a proposed national standard that would limit tobacco-free oral nicotine pouches to 7mg of nicotine per serving.

In a formal submission to BSTI, the international collective of doctors and public health experts warned that the proposed limit could make nicotine pouches too weak to provide adult smokers with a satisfying substitute for cigarettes.

Smoke Free Sweden leader Dr Delon Human said Bangladesh could accelerate the decline in smoking by regulating nicotine products according to the harm they cause.

“The central public health challenge in tobacco control remains combustible smoking,” Dr Human said.

“Effective tobacco regulation should therefore distinguish clearly between combustible tobacco products and non-combustible alternatives.”

The submission recommends raising the maximum nicotine content to at least 16.6mg per pouch, which would be more consistent with the nicotine delivery of a cigarette. It notes that Sweden has adopted a limit of 20mg per serving for tobacco-free oral nicotine products on its journey to achieving official smoke-free status, with daily prevalence below 5%. 

“A nicotine ceiling set too low relative to the nicotine delivery of a combustible cigarette risks making regulated pouches an unsatisfying substitute for adult smokers,” Dr Human said.

“None of that potential can be realised by a product that adult smokers find unsatisfying.”

Research shows that wider adoption of tobacco harm reduction products, combined with improved quitting services and earlier cancer diagnosis and treatment, could prevent as many as 920,000 premature deaths in Bangladesh by 2060.

“Bangladesh has an opportunity to develop a forward-looking regulatory framework for tobacco-free oral nicotine pouches that draws on the best available international evidence, including Sweden’s experience,” Dr Human said.

“A framework that focuses primarily on reducing combustible tobacco use while providing proportionate, clear and consistent regulation for smoke-free alternatives offers the greatest prospect of reducing tobacco-related disease and death in Bangladesh.”

More than one in three adult men in Bangladesh smokes, while the country has made only limited progress in reducing cigarette use. Smoking prevalence fell from 23% to 17% between 2015 and 2022 despite tobacco taxes, graphic health warnings and public smoking bans.

Smoke Free Sweden’s Tale of Two Nations: Bangladesh v New Zealand report shows how Bangladesh is falling behind countries that have combined conventional tobacco controls with access to safer nicotine alternatives.

Over the same seven-year period, New Zealand nearly halved its smoking rate, bringing it down to 6.9% after integrating regulated smoke-free alternatives into its strategy. Bangladesh’s smoking rate remains more than twice as high.