The Future of Nicotine: Ten Predictions for the Next Decade

Predicting the future of nicotine is a hazardous enterprise. The last decade confounded every forecast: the explosive rise and partial fall of JUUL, the COVID-19 pandemic's disruption of smoking patterns, the emergence of synthetic nicotine and nicotine analogues, the passage and repeal of New Zealand's generational sales ban. Anyone who claims certainty about the next decade isn't paying attention. But certain trends are clear enough, and certain dynamics are structural enough, to support evidence-grounded predictions—probabilistic, contingent, and subject to revision, but more useful than mere speculation. Here are ten.

First: combustible cigarette consumption will continue to decline globally, but the decline will be uneven. High-income countries with strong tobacco control and access to alternatives will see accelerated declines—potentially reaching 'smoke-free' status (<5% prevalence) in several nations, following Sweden's lead. Low- and middle-income countries, particularly in Africa and Southeast Asia, will see slower declines or even increases in absolute smoking numbers due to population growth and industry targeting. The global smoking population will become increasingly concentrated in the world's poorest regions, widening the already vast health equity gap between rich and poor countries.

Second: nicotine use will increasingly decouple from tobacco. Nicotine pouches, synthetic nicotine products, and pharmaceutical-grade nicotine formulations will capture growing market share, particularly among younger demographics who have no cultural association between nicotine and smoking. By 2035, a substantial fraction of nicotine users—potentially a majority in some high-income countries—will have never smoked. Whether this represents a public health success (reduced smoking) or a new epidemic (widespread nicotine dependence among never-smokers) is the central unresolved question of the nicotine transition.

Third: the regulatory framework for nicotine will fragment further before it converges. The current divergence—UK embracing harm reduction, Australia rejecting it, the U.S. charting an inconsistent middle path, LMICs looking to the WHO for guidance that remains precautionary—will persist for at least five to ten years. Convergence toward a risk-proportionate framework, if it occurs, will be driven by epidemiological data from the countries that adopted harm reduction early, demonstrating (or failing to demonstrate) population-level benefit. The lag between policy divergence and epidemiological evidence is a decade or more, meaning the current fragmented landscape is locked in for the foreseeable future.

Fourth: the tobacco industry will complete its transformation into a diversified nicotine industry—but cigarettes will remain its most profitable product for years. PMI, BAT, and JTI will continue to derive the majority of their profits from combustible products in LMICs even as they market themselves as 'smoke-free' companies in high-income markets. The contradiction between the industry's transformation narrative and its ongoing dependence on cigarette sales will become increasingly glaring, and the resolution of that contradiction—whether through genuine cigarette phase-out or continued dual-track strategy—will define the industry's relationship with public health for the next generation.

Fifth: youth nicotine use will shift from vaping to oral products. As disposable vape bans proliferate and the social pendulum swings against visible vaping (as it did against visible smoking), youth will migrate toward nicotine pouches, toothpicks, and dissolving tablets—products that are cheaper, more discreet, and harder for parents and schools to detect. The youth nicotine epidemic will not end. It will change form, and the surveillance systems designed to track vaping will be slow to detect the shift, creating another regulatory lag during which a new product category achieves market penetration with minimal oversight.

Sixth: the genetic and neuroscience revolutions will begin to deliver personalized cessation. Pharmacogenetic testing (CYP2A6 metabolizer status) will enter clinical practice for smoking cessation in some healthcare systems, guiding medication selection and dosing. Neuroimaging-based prediction of relapse risk and treatment response will advance from research to pilot clinical application. The pace will be slower than enthusiasts predict and faster than skeptics expect, and the primary barrier will not be the science but the healthcare system's capacity to integrate precision medicine into smoking cessation, which is currently delivered through the least precise channels in medicine—brief physician advice and quitlines.

Seventh: environmental regulation will become as important as health regulation for nicotine products. The disposable vape waste crisis, the carbon footprint of tobacco farming and curing, and the broader environmental impacts of the nicotine supply chain will attract regulatory attention independent of health concerns. Extended producer responsibility, product design standards for recyclability, and environmental taxation will be applied to nicotine products alongside traditional public health measures. The environmental case against disposables is politically powerful in ways that the health case is not—it brings new constituencies (environmental advocates, waste management authorities) into the regulatory coalition.

Eighth: the nicotine analogue arms race will force class-based regulation. Following the pattern established by synthetic opioids and cannabinoids, the proliferation of structurally novel nicotinic receptor agonists will eventually force regulators to abandon molecule-specific scheduling in favor of class-based regulation covering all non-pharmaceutical nicotinic agonists. The transition will be driven by an adverse event—an EVALI-like crisis caused by a novel analogue—that creates the political conditions for regulatory expansion that preemptive action couldn't achieve. The transition will be reactive, delayed, and insufficient, but it will happen.

Ninth: the politics of nicotine will become increasingly partisan and culturally coded in ways that obstruct evidence-based policy. In the United States, vaping will continue its trajectory toward becoming a culture-war issue—associated with libertarianism, anti-establishment sentiment, and distrust of public health institutions. In Europe, the political valence will be more mixed but will increasingly align with broader attitudes toward the EU, regulation, and individual liberty. The politicization of nicotine will make policy less responsive to evidence and more responsive to cultural identity, mirroring the dynamics that have shaped other public health issues from vaccines to climate change.

Tenth, and most important: the global mortality from tobacco will continue to rise for at least another decade before it begins to decline, because the epidemic in LMICs is still maturing. The 7 million annual tobacco deaths today reflect smoking patterns from 20–30 years ago, when smoking in LMICs was lower and smoking in high-income countries was higher. The deaths from current smoking patterns in LMICs—where populations are young, smoking rates are stable or rising, and healthcare capacity is limited—will not peak until the 2040s or later. The tobacco epidemic is not ending. It's shifting geography, and the shift is from countries equipped to handle it to countries that aren't. The most important prediction for the next decade is also the grimmest: the worst is yet to come for most of the world's smokers.