Should nicotine be regulated like a narcotic? A Pacific nation makes the case

More than a billion people are dependent on nicotine globally. Now, a tiny archipelago in the Pacific Ocean known for its spectacular coral reefs wants to change that.

The Republic of Palau has asked the United Nations to review the harm caused by the highly addictive substance found in tobacco and vaping products. The nation wants nicotine to be added to a list of substances that the organization regulates, which include narcotics and psychotropic drugs such as amphetamines.

It would effectively make it illegal to sell products containing nicotine that are not considered medicinal, says Renee Bittoun, a nicotine-treatment specialist at the Woolcock Institute of Medical Research in Sydney, Australia. Although Bittoun thinks it is unlikely that nicotine will be added to the list, because tobacco companies will argue strongly against this.

Around 1.2 billion people use tobacco and at least 100 million people use electronic cigarettes, also known as vapes, according to the World Health Organization. The dangers of smoking are well known, increasing a person’s risk of developing heart disease and stroke, as well as many cancers. Tobacco smoking kills more than 7 million people each year, including 1.6 million non-smokers who are exposed to second-hand smoke.

In the past decade, vapes have become more popular, particularly among young people, who are nine times more likely to vape than are adults. Vaping is highly addictive and can cause lung injuries; it might also increase the risk of cancer.

Inconsistent rules

Although nicotine itself does not cause cancer, it is highly addictive, and Palau and public-health researchers argue that it should be regulated in the same way as narcotics and psychoactive drugs. The archipelago says existing global efforts to protect people against the harms associated with nicotine addiction target only tobacco, leaving loopholes for tobacco-free products such as vapes and nicotine pouches.

“This is about our children,” said the nation’s first lady Valerie Whipps, who is chair of the Coalition for Tobacco Free Palau, in a press release. “A new generation of young people across the Pacific are being targeted by products that have never been critically reviewed under UN law.” In 2023, Palau banned vapes from being imported, sold or used. In 2021, 29% of adolescents aged between 9 and 20 years old in Palau had used vapes.

Currently, countries decide how to regulate cigarettes, vapes and other products containing nicotine, says K. Michael Cummings, a tobacco-control researcher at the Medical University of South Carolina’s Hollings Cancer Center in Charleston.

But most countries do not regulate nicotine, meaning that new forms of the compound that are not covered by existing rules can be developed. For example, the regulations for how nicotine pouches — small sachets placed between the gum and lip that release nicotine — are sold and packaged vary across the world. Age limits on who can purchase these products and what health warnings they display differ, too. Some countries treat vapes as tobacco products, whereas others might consider them as consumer or medicinal products.