Washington state has long championed harm reduction policies. Washington allows Narcan to be purchased without a prescription to combat opioid overdoses and was the first state to introduce a program to help individuals afford pre-exposure prophylaxis (PrEP) drugs that prevent human immunodeficiency virus (HIV) infection. But when it comes to nicotine, the state has abandoned this evidence-based approach.
Starting Jan. 1, Washington will impose a 95 percent wholesale tax on nicotine pouches, nearly doubling their price and making them far less attractive as an alternative to cigarettes, which are substantially more dangerous. Nicotine, while addictive, is not the cancer-causing agent in tobacco. The principal harm from tobacco stems from lighting it on fire and inhaling the resulting smoke. For nicotine pouches, there’s no tobacco, no smoke, just a small pouch of cellulose fibers, nicotine, and some flavorings.
Making the case in favor of the tax hike, the American Cancer Society told the Washington legislature, “It is important that all tobacco products, including nicotine pouches, are taxed at a parallel rate to encourage people to quit, rather than switch to a cheaper product.”
Taxing products equally, despite their unequal risks, is the exact opposite of desirable fiscal and public health policy. The rationales for taxing cigarettes are reasonably straightforward: first, to ensure non-smokers do not bear the financial costs of smoking-related diseases; second, to incentivize smokers to quit; and third, to impose an economic barrier to young people who might start smoking.
The reasons for heavily taxing a safer alternative to cigarettes are less justifiable, and the trade-offs are starker. Hiking taxes on nicotine pouches may encourage some people to quit nicotine for good. It’s just as likely, if not more, that some people who would’ve switched to pouches precisely because they are cheaper than cigarettes will instead continue smoking. There’s precedent for these substitution effects from other nicotine products, with a significant body of research showing that higher taxes on e-cigarettes translate to increased cigarette sales.
Considering that half of lifelong smokers die from a smoking-related disease, and no such risk exists for nicotine pouches, treating the two as equally dangerous for purposes of tax policy places Washington on the wrong side of the cost-benefit ledger.
Low-risk oral nicotine alternatives to cigarettes save lives. In Sweden, snus, which is similar to nicotine pouches but uses leaf tobacco in small pouches, has been around for more than 100 years. As a result, most adults who want to use nicotine in Sweden don’t smoke cigarettes but use snus instead. Consequently, Sweden enjoys the lowest smoking and lung cancer rates in Europe.
Hitting nicotine pouches with hefty taxes isn’t just poor public health policy; it’s highly regressive. Smoking is disproportionately concentrated among low-income households. For those smokers who wish to quit but have so far been unsuccessful, the chance to switch to a product that gives them the nicotine they desire without the smoke that may one day kill them is one thing. Combining this health benefit with the prospect of saving a significant chunk of money by switching to a cheaper product provides a strong incentive for smokers to kick their habit for good.
Unfortunately, Washington is squandering this opportunity, despite smoking still being the leading cause of preventable death in the state, with more than 8,000 Washingtonians dying each year. If harm reduction works for opioids and sexual health, why is Washington abandoning it for nicotine?