While oral nicotine pouches were introduced as a potentially less harmful alternative for smokers, a new review raises concerns that their wide range of flavors and marketing tactics risk hooking youth.

RT’s Three Key Takeaways:

  1. A review of 62 studies raises concerns that oral nicotine pouches, marketed as a less harmful alternative to smoking, could become a gateway to nicotine addiction for youth. 
  2. With flavored varieties and “aggressive marketing,” especially on social media, these tobacco-free pouches risk appealing to young people who don’t currently use tobacco or nicotine, potentially creating a new pathway to nicotine dependence, researchers find.
  3. Researchers say more independent research is needed on the long-term impacts of these products.

A comprehensive synthesis of evidence from 62 studies related to the use of oral nicotine pouches provides “a much-needed assessment” of how these products could lead to potentially harmful consequences if used by young people.

Oral nicotine pouches were first introduced in the US in the past decade and are pre-portioned white granular packets containing nicotine placed between the gums and lips. They are marketed as tobacco-free and are sold in various flavors and nicotine strengths.

“Oral nicotine pouches are rapidly increasing in popularity. While they may present a less harmful nicotine alternative for cigarette users, there is considerable concern about them becoming a new form of nicotine dependence, especially in youth who don’t use tobacco or nicotine,” says the study’s corresponding author Nargiz Travis, MSPH, project director for the Center for the Assessment of Tobacco Regulations (CAsToR) at Georgetown Lombardi, in a release. “As with electronic cigarettes, the wide variety of flavors and aggressive marketing campaigns that we are seeing, especially via social media, have the potential to appeal to youth, providing a new pathway to nicotine dependence.”

The findings by Georgetown University’s Lombardi Comprehensive Cancer Center scientists and colleagues appeared in Nicotine and Tobacco Research.

A Deep Dive into Current Studies

The investigator’s analysis was based on 45 academic and 17 industry-funded studies, mostly from the United States. Sales of the products have been concentrated in Scandinavia and the United States, mainly because of the established smokeless tobacco market in these regions.

In the United States, the researchers found, based on nationally representative surveys, that through 2023, oral nicotine pouches were currently used by 1.5% of all youth while lifetime use by young people was under 2.5%. In terms of awareness of the products, between 35% to 42% of US adolescents and young adults have heard of oral nicotine pouches, and 9% to 21% of tobacco-naïve (non-tobacco users) youth surveyed were not opposed to trying them. 

US adult usage estimates varied widely across surveys. In 2023, 0.8-3% of Americans currently used the products while 3-16% used them at some point in time. In view of rising nicotine pouch sales trends in 2024, their use in the US population has likely increased.

A Look at the Ingredients

The investigators’ findings suggest fewer harmful chemical compounds are present in the pouches and occur at lower levels than in cigarettes and smokeless tobacco, with the exception of formaldehyde. However, an analysis of 37 oral nicotine pouches of different brands, nicotine strengths, and flavors yielded 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,” says Travis in a release. “In the US, oral nicotine pouches are currently neither authorized 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.”

Young Adults Cite Flavor as a Motivating Factor

One of the studies included in the authors’ analysis was a US survey of young adults 18-34 years of age, many of whom used cigarettes and e-cigarettes. The survey found that among those who had tried nicotine pouches, curiosity about the product (28%), flavors (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 flavors (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 versus non-industry sponsored research and critically assess the quality and risk of bias of such studies,” concludes Travis in a release.

Photo 224463077 © Andrey Popov | Dreamstime.com