Nicotine pouches are rising in popularity, touted as the ideal alternative to smoking or vaping, whilst providing a discreet experience. But are they truly as harmless as they appear? Researchers from Georgetown University have delved into the rapid increase in nicotine pouch use.
Oral nicotine pouches are small, pre-portioned packets that contain nicotine and other ingredients. They are placed between the gum and upper lip, allowing the nicotine to be absorbed through the lining of the mouth. Unlike snus, which grew in popularity in Sweden and originated over 200 years ago, nicotine pouches do not contain tobacco. Instead, they come in a wide range of enticing flavours such as tropical and menthol.
The research team from the Lombardi Comprehensive Cancer Center conducted a comprehensive synthesis of evidence from 62 studies related to nicotine pouches, investigating the potential harmful consequences.
Nicotine pouches were used by 1.5% of all youth in 2023
The researchers discovered that in 2023, 1.5% of all youth used nicotine pouches and lifetime use was under 2.5%. Regarding product awareness, 35% to 42% of US adolescents and young adults have heard of oral nicotine pouches. Among tobacco-naïve youth, 9% to 21% expressed openness to trying them. Adult usage in the US varied widely, with 0.8% to 3% currently using the products in 2023 and 3% to 16% having tried them at some point. Given the rising sales trends in 2024, it is likely that nicotine pouch use has increased within the US population.
The findings suggest fewer chemical compounds are present in the pouches and occur at lower levels than in cigarettes and smokeless tobacco, except formaldehyde. However, an analysis of 27 nicotine pouches of different brands, nicotine strengths and flavours showed a wide range of total nicotine content from 0.89 to 6.73 milligrams per pouch.
“Because oral nicotine pouches do not contain tobacco leaves, they are often marketed as tobacco-free, but we found that descriptor may confuse the understanding of the source of nicotine and may be associated with the perception that they are not as harmful as other tobacco products,” said the study’s corresponding author Nargiz Travis, MSPH, Project Director for the Center for the Assessment of Tobacco Regulations (CAsToR) at Georgetown Lombardi. “In the US, oral nicotine pouches are currently neither authorised by the FDA for marketing as a modified-risk product nor approved as a cessation product. It is important to know that nicotine is an addictive chemical with harmful health effects, regardless of whether it is synthetic, meaning tobacco-free, or derived from tobacco.
The analysis was based on 45 academic and 17 industry-funded studies, mostly from the US.
Nicotine pouches: An important asset to the tobacco industry
In one US survey, the researchers found that many young adults aged between 18-34 years used cigarettes and e-cigarettes. The survey found that among those who had tried nicotine pouches, curiosity about the product (28%), flavours (26%), and the ability to use in places where other tobacco products are prohibited (26%) were among the main reasons for trying the pouches. The availability of flavours (31%) was the main motive for use in another US sample of adult current nicotine pouch users.
Leading brands of the products are currently owned by major tobacco companies. The authors note that a substantial investment in marketing by the companies suggests that oral nicotine pouches are becoming increasingly important to the tobacco industry.
“As more evidence on oral nicotine patches becomes available, and more importantly, more independent studies become published, it will be essential to conduct further analyses comparing the findings of industry vs. non-industry sponsored research and critically assess the quality and risk of bias of such studies,” concluded Travis.
