Smoking kills 1.35 million Indians annually; experts point to lower risk of nicotine alternatives            

Tobacco kills 1.35 million Indians every year, but quit rates remain very low despite widespread awareness.

With India spending more than Rs 1.77 lakh crore annually on tobacco-related diseases, health care experts called for innovative, science-backed harm reduction strategies, including the use of smoke-free nicotine alternatives.

Dr Pawan Gupta, senior consultant, Pulmonary Medicine at BLK-MAX Super Specialty Hospital, Delhi, said that for patients with COPD or cardiovascular risks, every cigarette avoided matters.

"Scientific reviews, including those by the Royal College of Physicians (UK), show that non-combustible nicotine delivery carries significantly lower risks compared to smoking. That evidence cannot be ignored," Gupta said.

Public Health England (PHE, UK) has estimated that smoke-free nicotine alternatives are up to 95 per cent less harmful than smoking because they remove tar and combustion.

Globally, nicotine pouches have gained traction as discreet oral alternatives to cigarettes. These products are now available in 34 countries, including Sweden, Norway, the United States and Denmark.

Dr Sunaina Soni, Assistant Professor, Department of Physiology, AIIMS-CAPFIMS Centre, said, "Traditional cessation tools often have limited success in India. Safer, tobacco-free nicotine alternatives, when strictly regulated, could support smokers in moving away from cigarettes.

"No smoke, no tar, no combustion: that is the critical difference. Science speaks, and it’s time we consider safer nicotine," she said.

While nicotine pouches are not risk-free, Soni said that when used as substitutes for smoking, they could play a meaningful role in India's journey towards its stated goal of reducing tobacco use by 30 per cent by 2025 under the WHO NCD Global Target.

The burden of tobacco in India is immense, with one in 10 Indians dying prematurely due to tobacco-related diseases.

According to the Centres for Disease Control and Prevention, quit rates in India remain low—only about 7 per cent of smokers successfully quit unaided.