The irony of these nicotine product pricing differences is that India is the world’s largest supplier of pharmaceutical grade pure nicotine, which is utilized by firms worldwide to manufacture NRTS and other alternative nicotine products. If India is to address the nicotine replacement demands of approximately 300 million users while saving a million fatalities from tobacco use each year, the tobacco and nicotine product landscape must be drastically altered.
India is the world’s second largest user (300 million), third largest producer, and fifth largest exporter of tobacco. According to the GATS (2016-17), little less than 30% of adult Indians now use tobacco in some manner. The huge dominance of (a) smokeless tobacco (SLT) products (e.g., khaini, gutkha, zarda, mishri, etc.) over smoked tobacco, and (b) bidis (a cheap, local form of rolled cigarette made of tobacco flakes wrapped in a tendu leaf) over cigarettes distinguishes India from many other, primarily developed countries. Today, over 21% (199.4 million) of adults in India use SLT, while over 10.7% (99.5 million) use smoked tobacco. Surprisingly, bidi smoking (71.8 million smokers) greatly outnumbers cigarette smoking (37.5 million smokers). SLT and smoked tobacco products are also often used together.
The principal psychoactive ingredient in all tobacco forms and products is nicotine, a neuro stimulator that generates a perceived sensation of pleasure and well-being in its users due to their dependency on its psychosomatic benefits and as a consequence of withdrawal symptom alleviation. The user experiences need and want for nicotine after its breakdown and subsequent ejection from the body, maintaining the cigarette seeking habit. WHO’s International Agency for Research on Cancer classifies tobacco, betel (Areca) nut, and several additives (over 50 compounds) used in various SLT preparations, as well as over 150 substances in cigarette smoke.
Nicotine is not classified as a carcinogen by the IARC. As a result, a nicotine-dependent user mistakenly seeks craving satisfaction from a plethora of dangerous cigarette alternatives while also ingesting a massive load of Class 1 human carcinogens. Risky forms of tobacco products, which contain a wide range of toxicants and carcinogens, make India the global capital of oral cancers and are responsible for over a million deaths each year.
Tobacco smoking continues to be the leading avoidable cause of death and disease worldwide. It is not simple to quit smoking. Access to quitting (“cessation”) support, such as phone quit lines, nicotine replacement products like nicotine gums, patches, and lozenges, and trained healthcare professionals, should be at the heart of any country’s tobacco control efforts. Recognizing these concerns, WHO and India responded by placing nicotine-containing pharmaceutical preparations in the form of nicotine replacement therapies (NRTS) on the essential list of medicines. Furthermore, a slew of tobacco control measures from the World Health Organization’s Framework Convention on Tobacco Control (FCTC) have been implemented into India’s tobacco products rules (the “COTPA” act) in order to minimize tobacco use in all forms. Despite such efforts, the drop in tobacco use in India remains dismal, falling short of the objectives established by the FCTC and Indian officials.
India’s nicotine product pricing paradox: The most lethal types of tobacco are the cigarettes
