Oral tobacco, symbol of difficult law enforcement in India

Although banned in several Indian states, oral tobacco products remain in circulation and are more widely consumed nationally than smoked tobacco. This finding of impunity also applies to tobacco advertising and the sale of tobacco products to minors, highlighting the challenge of the application and effectiveness of the regulations adopted.

In an article published in The Lancet on April 8, 2023, a group of Indian and British oncologists and dental surgeons sound the alarm on the use of oral tobacco in India[1]They are particularly concerned about the trade in gutkha (or gutka), a chewing tobacco product that is very popular in India.

Oral tobacco, more widespread in India than smoked tobacco

Gutkha is a mixture of areca nuts, calcium hydroxide, catechu (betel palm), tobacco, flavorings and additives. Placed under the lip or in the cheek, this powder mixes with saliva and releases nicotine. Since 2012, several Indian states have enacted measures to ban these products, which have had no effect: manufacturers have launched a similar nicotine-free product, pan masala, which comes with a small sachet of tobacco free of charge, allowing consumers to prepare their own gutkha.

Gutkha use is overtaking cigarettes and bidis in India, with 199.4 million people (21.4 per cent of adults) consuming oral tobacco, while 99.5 million smoke tobacco products (10.7 per cent of adults).[2], for a total of 267 million tobacco users (28.6 % of adults). This penchant for oral tobacco results in a very high prevalence of oral cancers and oral diseases. The high overall prevalence of smoking contributes to an increase in non-communicable diseases (NCDs)[3] which the already fragile Indian healthcare system is struggling to cope with.

Difficulties in enforcing tobacco regulations

India, whose population has officially surpassed that of China[4], is also notable for its difficulty in enforcing anti-smoking regulations. While gutkha manufacturers have been able to circumvent local bans on these products, they also fail to enforce regulations on health warnings on packaging by failing to display these visuals or by displaying them with incorrect wording. In addition, laws prohibiting advertising of tobacco products and the sale of these products to minors are constantly flouted. The world's third largest producer and third largest exporter of tobacco by volume, India remains very permissive towards the tobacco industry, despite its ratification in 2005 of the Framework Convention on Tobacco Control (FCTC).

Keywords: India, gutka, oral tobacco, chewing tobacco.

©Generation Without Tobacco

MF

[1] Arakeri G, Rao V, Patil S, Brennan P, Unsuccessful ban on gutkha and need for tobacco control in India, The Lancet, vol. 401, issue 10383, p1154, April 08, 2023

[2] Welding K, Saraf S, Iacobelli M, Smith KC, Puntambekar N, Gupta PC, Cohen JE. Beyond Gutka: Evidence of Illegal Smokeless Tobacco in Rural and Semi-urban Areas in India. Nicotine Tob Res. 2022 Apr 28;24(6):929-932.

[3] Ramesh S, Kosalram K. The burden of non-communicable diseases: A scoping review focusing on the context of India. J Edu Health Promot 2023;12:41.

[4] India becomes the most populous state in the world, ahead of China, GéoConfluences, published on March 14, 2023, consulted on April 13, 2023.