Pouches Scrutinized
Scientists at Georgetown University’s Lombardi Comprehensive Cancer Center have synthesized evidence from 62 studies related to the use of oral nicotine pouches to better understand their potential impact on public health. The findings have been published in Nicotine and Tobacco Research.
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,” said the study’s corresponding author, Nargiz Travis, in a statement.
The investigator’s analysis was based on 45 academic and 17 industry-funded studies, mostly from the U.S. Sales of the products have been concentrated in Scandinavia and the U.S., mainly because of the established smokeless tobacco market in these regions.
In the U.S., the researchers found, based on nationally representative surveys, that through 2023, oral nicotine pouches were currently used by 1.5 percent of all youth while lifetime use by young people was under 2.5 percent.
In terms of awareness of the products, between 35 percent and 42 percent of U.S. adolescents and young adults have heard of oral nicotine pouches, and 9 percent to 21 percent of tobacco-naive (nontobacco users) youth surveyed were not opposed to trying them. U.S. adult usage estimates varied widely across surveys; in 2023, 0.8 percent to 3 percent of Americans currently used the products while 3 percent to 16 percent used them at some point in time. In view of rising nicotine pouch sales trends in 2024, their use in the U.S. population has likely increased.
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.
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 mg to 6.73 mg 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 the U.S., 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.
One of the studies included in the authors’ analysis was a U.S. survey of young adults 18 years to 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 percent), flavors (26 percent) and the ability to use in places where other tobacco products are prohibited (26 percent) were among the main reasons for trying the pouches. The availability of flavors (31 percent) was the main motive for use in another U.S. 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,” said Travis.