Nicotine policy is increasingly being shaped not only by legislators and regulators, but by the channels through which products are made available to adults. In several countries, pharmacies have emerged as a focal point in this debate, acting either as formal gatekeepers of access or as trusted retail environments for smoke-free nicotine products. How pharmacists are positioned within regulatory frameworks has meaningful implications for harm reduction, adult autonomy, and the credibility of public-health messaging.
Nicotine pouches sit at the centre of this discussion because they occupy a regulatory grey area. They are non-combustible and therefore lower on the continuum of risk than cigarettes, yet they are not licensed nicotine replacement therapies. Policymakers have responded to this ambiguity in different ways. Some have chosen to restrict access tightly through pharmacy-only models, while others permit over-the-counter sales in pharmacies as part of a broader consumer-product framework. Canada and Lebanon illustrate these contrasting approaches.
In Canada, nicotine pouches are currently subject to a pharmacy-only access model. This framework was introduced primarily in response to concerns about youth exposure and the visibility of nicotine pouches in convenience retail settings. By relocating sales into pharmacies, regulators sought to limit impulse purchasing, reduce marketing exposure, and place these products within a healthcare-adjacent environment. The intent was precautionary: to allow adult access while signalling that nicotine use carries risks and should not be normalised among non-users.
This model offers clear regulatory advantages. Age verification is more consistent, product availability is easier to monitor, and pharmacists can contextualise nicotine pouches within conversations about smoking cessation and reduced-risk alternatives. From a policy perspective, pharmacy-only access allows regulators to demonstrate control and responsiveness without resorting to outright bans.
However, pharmacy-only models also raise questions about unintended consequences for adult smokers. Tobacco-control research consistently shows that ease of access influences switching behaviour. Products that are perceived as medicalised, inconvenient, or difficult to obtain may discourage smokers from experimenting with alternatives, particularly those who have not succeeded with traditional cessation aids. In such cases, smokers may continue using cigarettes simply because they remain the most accessible option.
Lebanon presents a markedly different regulatory and practical reality. Nicotine pouches are explicitly permitted for sale, purchase, and use, subject to health warnings and restrictions on health claims, but without excise taxation or flavour bans. Importantly, they are not classified as nicotine replacement therapy. NRT remains a separate medicinal category in Lebanon, listed on the national essential drugs list and subject to pharmaceutical regulation. This distinction places nicotine pouches firmly within a consumer-product framework, even when sold in pharmacy settings.
In practice, nicotine pouches in Lebanon are widely available over the counter and are increasingly stocked by pharmacies alongside other harm-reduction or cessation-adjacent products. Trade and harm-reduction reporting suggests that approximately 1,500 pharmacies across the country now carry nicotine pouches, and in some cases they are the only nicotine products these outlets sell. Pharmacists reportedly view demand as coming primarily from adult smokers seeking substitutes for cigarettes, reinforcing a practical harm-reduction positioning even though formal cessation claims are not permitted on packaging.
Operationally, Lebanese pharmacies treat nicotine pouches as adult-only consumer products rather than prescription medicines. Sales do not require a prescription, products may be placed on shelves or behind counters depending on the outlet, and age-gating generally aligns with broader nicotine norms. While this does not constitute formal clinical endorsement, the inclusion of nicotine pouches in pharmacies appears to signal professional acceptance of their role as lower-risk alternatives relative to smoking.
The contrast between Canada and Lebanon highlights a central policy question: does restricting access through pharmacy-only models improve harm-reduction outcomes, or can over-the-counter availability within pharmacies achieve similar youth protections while preserving accessibility for adults who smoke? Lebanon’s approach suggests that it is possible to maintain clear regulatory boundaries between medicinal NRT and consumer nicotine products, while still leveraging pharmacies as trusted retail environments rather than gatekeeping institutions.
At the same time, Lebanon’s relatively permissive framework is not static. Lawmakers have begun calling for tighter regulation and potential taxation of nicotine pouches, indicating that the current environment may evolve toward more formal controls. This underscores the importance of adaptive regulation that responds to evidence, market behaviour, and public-health outcomes rather than fixed assumptions about venue or product category.
International experience increasingly suggests that effective nicotine regulation depends less on where a product is sold and more on how clearly risks are communicated and managed. Strong product standards, accurate labelling, strict youth protections, and transparent public communication about the continuum of risk are consistently associated with better outcomes. Pharmacies can play a valuable role in this ecosystem, but their function should be carefully defined.
As nicotine policy continues to evolve, pharmacists will likely remain influential actors in regulatory debates. The challenge for policymakers is not whether pharmacists should be involved, but how their involvement can support harm reduction without inadvertently restricting adult smokers’ access to less harmful alternatives. A regulatory framework that balances protection, proportionality, and accessibility will be better positioned to reduce smoking-related harm than one that relies solely on restriction by channel.
