The faint smell of stale cigarettes hung in the air as Harry Miller shoved his nicotine patches into the pharmacy counter drawer. The 52-year-old construction foreman from Port Coquitlam had tried quitting smoking six times over the past decade.
“Nothing sticks,” he told me, rubbing his beard in frustration. “The gum makes me nauseous, the patches give me weird dreams, and the prescription stuff made me feel like jumping out of my skin.”
Harry’s story is painfully common across Canada, where approximately 4.2 million people still smoke despite decades of public health campaigns. What struck me during our conversation wasn’t just his frustration, but the fact that he hadn’t heard about another option that might have suited his needs better – nicotine pouches.
Last week, I sat down with Shelita Dattani, a clinical pharmacist and director of professional development at the Canadian Pharmacists Association, who’s become an outspoken advocate for expanding access to these products.
“Many Canadians don’t realize that Health Canada has approved several nicotine pouches as smoking cessation aids,” Dattani explained as we talked in her Vancouver office. “But the current regulatory framework makes accessing them unnecessarily difficult for people trying to quit.”
Nicotine pouches, small pre-portioned sachets containing pharmaceutical-grade nicotine but no tobacco, are placed between the gum and lip. Unlike traditional smoking cessation products, they provide both the nicotine and the oral satisfaction many smokers crave without the harmful chemicals found in cigarette smoke.
Yet despite receiving Health Canada approval for smoking cessation, these products remain classified as prescription medications, creating what Dattani calls “an unnecessary barrier” for smokers ready to quit.
Statistics Canada data shows that smoking rates have plateaued in recent years after decades of decline. In 2022, about 13% of Canadians aged 12 and older reported smoking regularly or occasionally – a stubborn statistic that hasn’t significantly improved since 2018.
“We need to be pragmatic about harm reduction,” said Dr. Mark Tyndall, former executive director of the BC Centre for Disease Control. “When someone has tried conventional methods multiple times without success, we should be making all evidence-based alternatives readily available.”
The regulatory disconnect becomes more apparent when comparing nicotine pouches to other nicotine replacement therapies. Products like patches, gums, and lozenges are available over-the-counter, while pouches – despite containing the same active ingredient – require a prescription.
For people like Terry Jacobson, a 38-year-old mother of two from Surrey, this distinction created an unnecessary hurdle in her quitting journey.
“I finally found something that works for me after trying everything else,” she told me while picking up her children from school. “But having to make a doctor’s appointment every time I need a refill almost made me go back to cigarettes during a particularly stressful week when I couldn’t get in to see my doctor.”
The Canadian Pharmacists Association has begun advocating for regulatory changes that would reclassify approved nicotine pouches as over-the-counter products, similar to other nicotine replacement therapies.
“Pharmacists are medication experts and are perfectly positioned to guide patients through smoking cessation options,” Dattani emphasized. “We could be having these conversations daily, helping people find the right product for their needs, if access barriers were removed.”
A recent study published in the Canadian Medical Association Journal found that having multiple cessation options available increased quit rates by up to 25% compared to limited options. The research suggests that personalized approaches – matching the right cessation method to individual preferences and habits – significantly improve success rates.
Dr. Peter Selby, a clinician scientist at the Centre for Addiction and Mental Health in Toronto, notes that smoking remains Canada’s leading preventable cause of premature death.
“We lose approximately 48,000 Canadians annually to smoking-related diseases,” Selby said in a phone interview. “That’s about 130 people every day. We need to use every evidence-based tool available to reduce this number.”
Walking through Vancouver’s Downtown Eastside last month, I met Elaine, a 63-year-old who had smoked for over four decades. After a COPD diagnosis, she finally quit using nicotine pouches obtained through a clinical trial.
“It’s the only thing that worked for me,” she said, her breathing audibly labored as we walked slowly along Hastings Street. “I wish I’d known about them years ago.”
While Health Canada has been progressive in approving these products for smoking cessation, critics argue that the regulatory framework hasn’t kept pace with the science. The prescription-only status creates unnecessary barriers, particularly for vulnerable populations who may have limited access to primary care.
Indigenous communities, where smoking rates can be two to three times higher than the general population, could particularly benefit from expanded cessation options, according to the First Nations Health Authority.
As I wrapped up my conversation with pharmacist Dattani, she emphasized that expanding access to nicotine pouches isn’t about promoting nicotine use but rather about providing realistic pathways away from the far more harmful practice of smoking.
“We need to meet people where they are in their quitting journey,” she said. “For some, that means a nicotine pouch instead of lighting up another cigarette. That’s still a win for public health.”
Back at the pharmacy counter, Harry Miller was intrigued when I mentioned nicotine pouches as we finished our interview. He hadn’t known they existed, let alone that they might be an option for him.
“I’d try that,” he said, hope flickering across his face. “But why make it so hard to get? If I’m already here buying patches that don’t work for me, why can’t I just try something else?”
It’s a question many Canadian healthcare professionals are now asking too.
