Nicotine Pouches: What to Know About the Latest Trend

May 02, 2024

A person puts a round container in their back jeans pocket.

Smoking rates have plunged in recent decades. However, a variety of products have flooded the market, touted as having fewer health risks. The latest example is nicotine pouches. Often marketed to appeal to young adults and downplay side effects like lung cancer, other concerns remain.

What are Nicotine Pouches?

A nicotine pouch is a small, permeable sack that’s designed to be placed between the lip and the gums, similar to chewing tobacco. It doesn’t contain tobacco, only nicotine and other inactive ingredients. Like vape products, pouch flavors include mint, citrus and other popular flavorings. Depending on the manufacturer, a pouch may contain anywhere from 1-12 milligrams of nicotine.

While the pouches don’t pose the cancer risks associated with smoking and chewing tobacco, nicotine is the primary reason people struggle with quitting smoking.

“Nicotine is highly addictive in all forms,” says University Hospitals medical toxicologist and addiction medicine specialist Ryan Marino, MD. “Nicotine pouches carry the same risk for people to develop dependence, withdrawal and addiction.”

Who’s Using Them?

There are concerns that young people may be more likely to start using nicotine patches because they believe they are safe or safer than other products. Recent surveys of 15-24 year-olds showed that roughly:

16% had used nicotine pouches
12% were current users
73% of current users also smoke cigarettes
Current users were more likely to be age 21+, male and lower income

The Health Effects of Nicotine

Nicotine use, particularly the chronic or heavy use most often associated with addiction, can affect brain development and lead to long-term disabilities and other health issues.

“Adolescents appear to have higher risk for developing nicotine addiction, and nicotine is believed to have effects on brain development, particularly in learning, attention, mood and impulse control,” says Dr. Marino. “It’s hard to say what the long-term effects are with a new product, but there’s enough information to warrant concern in younger people.”

Nicotine can also raise blood pressure and increase heart rate in the short term, but seems less likely to cause long term cardiovascular problems in the same way as tobacco does. Tobacco products are associated with significant cardiac risks and the development of heart disease.

“Nicotine is not inherently safe,” says Dr. Marino. “It is easy to accidentally end up with adverse side effects ranging from nausea, stomach upset and diarrhea to palpitations and dizziness. Beyond these effects, nicotine can be quite toxic in higher doses, so people should be careful how much they consume. It can be particularly toxic for small children, especially when it comes to the flavored formulations.”

Nicotine Replacement for Smokers

For current smokers, nicotine pouches can be an option to help them quit. Because they don’t contain tobacco, they can provide a net positive for a current smoker’s health.

“Smoking is the unhealthiest way to consume tobacco and nicotine products. Other forms of tobacco, like chew, are still a cancer risk even though they won’t damage the lungs,” says Dr. Marino. “Pure nicotine products like pouches pose a risk for dependence and addiction along with other health effects and health problems but won’t cause lung disease or cancer.”

“As someone who treats the worst complications from addictive substances, it is always concerning to me when people start using potentially addictive substances or when we see increases in people using them” says Dr. Marino. “With that said, I think nicotine pouches are a valuable tool for people who use other nicotine products, particularly by allowing people an option to stop or reduce tobacco product use.”

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