The Nicotine User's Bill of Rights
What would a just nicotine policy look like from the user's perspective? A thought experiment in centering the people most affected by the policies we debate.
The nicotine policy debate is dominated by institutions—government agencies, public health organizations, industry lobbyists, research funders—whose interests, perspectives, and incentives shape every dimension of the discussion. The people whose lives are most directly affected by nicotine policy—the billion-plus people who smoke, the millions who vape and use pouches, the communities targeted by industry marketing—are systematically excluded from the institutions that make decisions about them. Their voices are mediated through surveys and focus groups, their preferences are modeled rather than solicited, and their expertise—the lived experience of nicotine dependence and the practical knowledge of what helps them quit or switch—is treated as data rather than as expertise. What would nicotine policy look like if it centered the people it affects, rather than the institutions that administer it? This thought experiment—a nicotine user's bill of rights—is an attempt to answer that question.
Right 1: The right to accurate, comprehensible information about the relative risks of different nicotine products. Nicotine users deserve to know, based on the best available evidence, that combustible tobacco products (cigarettes, bidis, cigars) are dramatically more harmful than non-combustible alternatives (vaping, nicotine pouches, snus, NRT). They deserve to know the magnitude of the risk differential—not just 'vaping is harmful' or 'vaping is safe,' but 'vaping is estimated to be 90–95% less harmful than smoking, though not risk-free, and the long-term effects are still being studied.' This information should be communicated clearly, prominently, and without distortion by either industry marketing or public health messaging. The right to accurate information is the foundation of informed choice, and informed choice is the foundation of autonomy.
Right 2: The right to access the full range of reduced-risk nicotine products at prices that make them affordable relative to cigarettes. A nicotine user who wants to switch from smoking to a less harmful product should not face financial barriers (high taxes on vaping products), regulatory barriers (flavor bans that eliminate the products they find satisfying), or access barriers (mail bans, retail restrictions) that make the switch harder than continuing to smoke. The principle of risk-proportionate regulation—making the lowest-risk products the most accessible and affordable—should be operationalized in policy, not just articulated in principle.
Right 3: The right to cessation support that's accessible, evidence-based, and non-judgmental. Nicotine users who want to quit should have access to pharmacotherapy (NRT, varenicline, cytisine) at affordable cost, behavioral support (counseling, quitlines, digital tools) that's evidence-based and culturally appropriate, and harm-reduction pathways (vaping, pouches, long-term NRT) for users who can't achieve complete abstinence. The cessation support should be delivered without judgment, without moralizing, and without the assumption that complete nicotine abstinence is the only acceptable outcome.
Right 4: The right to be free from discrimination based on nicotine use in employment, insurance, healthcare, and public accommodations. Nicotine users should not be denied employment, charged higher insurance premiums, or excluded from healthcare services based on their nicotine use, except where that use poses a direct, demonstrable safety risk. Nicotine dependence is a chronic, relapsing brain condition, not a moral failing, and should be treated as such in employment and insurance contexts. The current practice of nicotine testing and nicotine-free hiring policies is discriminatory and counterproductive, penalizing the most stigmatized health behavior while doing nothing to address the addiction that drives it.
Right 5: The right to participate meaningfully in the policy decisions that affect nicotine users. Nicotine policy should be developed with the participation of the people it affects—not just through public comment periods and stakeholder meetings, but through genuine engagement that treats nicotine users as experts in their own experience. The institutions that make nicotine policy—the WHO FCTC COP, the FDA, national regulatory agencies—should include mechanisms for direct participation by nicotine users and their representative organizations, not just by governments, industry, and public health advocacy groups.
