Earlier this month, Iceland's Office of Health Promotion and Science launched consultations on a draft law on nicotine products. If passed, the law would introduce age limits for nicotine consumption, ban e-cigarette flavors deemed appealing to children, and set a maximum allowable nicotine concentration.

No one thinks that children should be taking nicotine products, and it would be wise to impose age restrictions on things like sachets and gum. The current minimum age to buy e-cigarettes in Iceland is 18. The proposed bill intends to introduce the same restrictions on other nicotine products. Identity requirements and potential fines for retailers have increased compliance rates, as the examples of Germany and Canada show.

However, other aspects of the proposed law seek to protect children at the expense of adult smokers and e-cigarette users - a theme we see repeated elsewhere in the world. The underlying assumption that nicotine is everyone's enemy is worrying. A better understanding of the facts about nicotine and flavor will drive Iceland's efforts to reduce smoking already successful.

According to reports, the adult smoking rate in Iceland today is only 7%, which is the lowest in Europe except Sweden, which has widely adopted smokeless snuff as an alternative to cigarettes. As recently as 2014, Iceland reported an adult smoking rate of 14%; the rise of e-cigarettes among tens of thousands of Icelanders is partly due to the rapid decline in smoking rates.

E-cigarettes are much safer than smoking. However, nicotine consumption has traditionally been associated with smoking, and this association continues to distort perceptions.

The truth is that nicotine is relatively harmless - unlike the toxins in tobacco smoke.

According to the Yorkshire Cancer Research Centre in England, nicotine is not the cause of death from smoking. Nicotine is not a carcinogen; there is no evidence that continued use of nicotine alone increases the risk of cancer. Of the three leading causes of death from smoking (lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease), none are caused by nicotine. The dangers of smoking come from thousands of other chemicals in tobacco smoke.

Nicotine is also used in nicotine replacement therapy, which explains its harmless properties. Multiple studies have found that it can also enhance cognitive function and reduce the risk of Parkinson's disease.

Quitting smoking is difficult. If nicotine is safe, then the goal of tobacco control should be to support safer ways of consuming nicotine. Thanks to innovation, there are several ways to do this. Some smokers prefer nicotine pouches and gum, or the form of smokeless tobacco as seen in Sweden. For many others — 82 million people worldwide by one recent count — e-cigarettes are the best way to quit and quit smoking, and carry health risks.

Flavor bans drive e-cigarette users back to smoking or into riskier illegal markets. Does Iceland want to prove it?

Given all this, how can there be a reason to limit the amount of nicotine an e-cigarette user might consume? When e-cigarette users are overwhelmingly former or switching smokers, allowing whatever nicotine concentration will best help them quit is a clear public health imperative.

The flavors of e-cigarettes that Iceland has also proposed to ban are also essential elements in helping many smokers quit. They are often wrongly described as having a unique appeal to children, but adults also prefer them.

Flavor bans are driving e-cigarette users — as do teens — back to smoking or into riskier illicit markets.

A 2020 survey of e-cigarette users in Canada, the U.K. and the U.S. found that, in response to flavor bans, "28.3% would find a way to get their banned flavor and 17.1% would stop vaping. Smoke and smoke instead." Does Iceland want to prove it?

While the makers of new laws may have good intentions, they need a better grasp of these realities. Smart regulation can be achieved without removing key options that smokers need to switch, including child and consumer protection. For now, the legislation could undo years of progress in Iceland.

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