Veteran Smoking Harm Reduction: The Critical FDA ZYN Decision

Why the January 2026 TPSAC Meeting Is About Facts—Not Feelings

Let’s begin with something refreshingly uncontroversial: veteran smoking harm reduction starts with a simple fact—veterans use tobacco at higher rates than non-veterans. Not marginally. Not debatably. Consistently and across product types.

That’s not rhetoric—it’s epidemiology.

A 2026 analysis of the National Health Interview Survey covering more than 78,000 U.S. adults found that veterans had significantly higher odds of current and former tobacco use across nearly every category, including cigarettes, cigars, pipes, smokeless tobacco, and polytobacco use (Cornacchione Ross et al.). Veterans using VA healthcare were at even higher risk for combustible tobacco use.

This matters—because on January 22, 2026, the FDA’s Tobacco Products Scientific Advisory Committee (TPSAC) will decide whether ZYN nicotine pouches may be marketed with Modified Risk Tobacco Product (MRTP) claims. And that decision will either reflect the science—or continue a long tradition of confusing moral discomfort with public health strategy.

Authorization Is Not Endorsement (And Never Was)

Zyn products were authorized for sale in January 2025 through the FDA’s Premarket Tobacco Product Application (PMTA) pathway. That authorization did not permit reduced-risk claims. It permitted sale.

An MRTP order is different. It requires evidence that a product reduces exposure to harmful constituents and that communicating his information benefits public health at the population level—including among people who already smoke.

This distinction exists because facts matter. Or at least, they’re supposed to.

Veterans Aren’t “Choosing Nicotine.” They’re Navigating Risk.

The 2026 NHIS analysis found that veterans had 41.6% lifetime cigarette use compared to 21.7% among non veterans, and significantly hire rates of cigars, pipes, and smokeless tobacco (Cohrnacchione Ross et al. 2026). Veterans enrolled in VA healthcare showed higher odds of current cigarette and combustible tobacco use, not lower.

That tells us something uncomfortable: access to care alone does not lead to veteran smoking harm reduction.

The supplemental tables go further. Veterans relying solely on VA healthcare had the highest prevalence of current tobacco use (27.1%) and combustible tobacco use (23.0%), compared to veterans with non-VA insurance.

In other words, the veterans most connected to the healthcare system are often the ones still smoking.

Combustion Is the Villain. Nicotine Is the Variable.

Nicotine is addictive. That’s settled. But combustion is what drives cancer, cardiovascular disease, and pulmonary morbidity. The FDA itself recognizes that tobacco products exist on a continuum of risk, with combustible products at the top and non-combustible products lower on the scale.

That isn’t radical. It’s chemistry.

The FDA writes, “For adults who smoke, switching completely from cigarettes to e-cigarettes may reduce exposure to many harmful chemicals present in cigarettes. However, it is important that they switch completely from cigarettes to e-cigarettes to get the full health benefit” (FDA). The same should be said for pouches. The science is clear on both points—and pretending otherwise does not protect anyone.

If MRTP claims are denied despite evidence of reduced exposure, the message to veterans isn’t “quit.” It’s “we don’t trust you with accurate information.” It’s working against veteran smoking harm reduction.

That’s not prevention. That’s paternalism.

Veteran Smoking Harm Reduction Isn’t Permission. It’s Triage.

Harm reduction gets accused of being soft because people confuse acknowledgment with approval. They are not the same thing. One is realism. The other is denial dressed up as virtue.

Veterans smoke more than civilians. Veterans with pain smoke more. Veterans with trauma smoke more. This isn’t conjecture and it isn’t a character flaw. It’s what happens when stress, conditioning, and neurobiology collide over time. Pretending otherwise doesn’t produce abstinence—it produces attrition.

The choice in front of clinicians and policymakers isn’t between nicotine use and moral victory. It’s between continuing to inhale combustion byproducts or reducing exposure while keeping people engaged in care. Calling that reduction “permission” is a category error. No one is endorsing nicotine. We are preventing preventable harm.

Triage isn’t surrender. It’s what you do when someone is bleeding and you don’t lecture them about long-term cardiovascular health. You stop the bleeding first—because dead patients don’t quit smoking.

Context for Veterans and Clinicians

If any of this sounds familiar, it’s because clinicians working with veterans have been standing in this tension for years. The question is never whether smoking is harmful. The question is which harm is happening right now and whether we’re willing to reduce it without demanding perfection first.

I’ve written previously about veteran smoking harm reduction and this distinction in Smoke vs. Nicotine: What Veterans Need to Know Now From This 2025 Study, where the evidence makes one inconvenient point unavoidable: combustion—not nicotine—is what drives the most severe health consequences for veterans who smoke. That distinction isn’t semantic. It’s physiological, and it’s the reason non-combustible products are even part of this conversation.

I’ve also explored what smoking looks like from the inside—in the nervous system, not the policy memo—in Cigarettes, Cravings, and EMDR: What the Feeling-State Protocol Tells Us About Smoking. Smoking isn’t just a habit. It’s a conditioned emotional state, reinforced over time, and it doesn’t dissolve on command. Clinicians know this. Veterans live it.

What TPSAC Is Really Deciding

Seen in that context, the question before the Tobacco Products Scientific Advisory Committee stops being abstract and becomes almost embarrassingly specific. TPSAC is not being asked whether nicotine is good. It is not being asked whether quitting is better-whether Veteran smoking harm reduction is important. Those debates are over.

What TPSAC is actually deciding is whether accurate information about relative risk is allowed to exist in public. Whether adults—particularly veterans—can be trusted with distinctions between products that kill through combustion and products that do not. Whether silence is safer than clarity.

Authorizing a product to be sold is not endorsement. Allowing its risk to be described honestly is not encouragement. It’s disclosure. And if that disclosure is denied despite evidence of reduced exposure, the message isn’t caution—it’s distrust.

Public health doesn’t collapse because people know too much. It collapses when we decide they can’t handle the truth.

References

Cornacchione Ross, Jennifer, et al. “Tobacco Product Use and Type by Military Veteran Status: Findings from the National Health Interview Survey, 2021–2023.” Nicotine & Tobacco Research, vol. 28, no. 1, 2026, pp. 79–89. Oxford University Press,https://academic.oup.com/ntr/article-abstract/28/1/79/8270818.

U.S. Food and Drug Administration. Modified Risk Tobacco Products (MRTP).https://www.fda.gov/tobacco-products/ctp-newsroom/modified-risk-applications-zyn-nicotine-pouches-now-under-fda-scientific-review

U.S. Food and Drug Administration. FDA Authorizes Marketing of 20 ZYN Nicotine Pouch Products after Extensive Scientific Review. 2025. https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-20-zyn-nicotine-pouch-products-after-extensive-scientific-review

Vermillion, Timothy. “Smoke vs. Nicotine: What Veterans Need to Know Now From This 2025 Study.” Paradise Institute, 29 Dec. 2025. https://paradiseinstitute.com/2025/12/29/smoke-vs-nicotine-what-veterans-need-to-know-now-from-this-2025-study/.

Vermillion, Timothy. “Cigarettes, Cravings, and EMDR: What the Feeling-State Protocol Tells Us About Smoking.” Paradise Institute, 25 Nov. 2025. https://paradiseinstitute.com/2025/11/25/cigarettes-cravings-and-emdr-what-the-feeling-state-protocol-tells-us-about-smoking/.