The Truth About Nicotine Pouches

Every year, millions of people struggle with tobacco addiction, with over 1 billion individuals using tobacco products and nearly 7 million dying from related diseases annually. In the U.S., more than 34 million adults smoke cigarettes, and almost 70 percent of them express a desire to quit. Effective cessation methods are critical to support quit efforts. One alternative to traditional tobacco products is nicotine pouches, which have seen a significant rise in popularity over recent years.

The rise in nicotine pouch use is part of a larger trend where users want alternatives that have fewer health risks compared to smoking. However, nicotine pouches are not without risks. The increase in use is raising significant public health concerns.

Sales of nicotine pouches in the U.S. have skyrocketed, increasing 300 times from 2016 to 2020, with nearly 46 million units sold in 2020 alone. This sharp rise is alarming and suggests these products are becoming increasingly popular among youth, who are at higher risk of nicotine addiction. According to the Centers for Disease Control, youth are more susceptible to nicotine addiction and can develop dependence more quickly than adults.

“Despite being tobacco-free, they still deliver a potent dose of nicotine, which can have harmful effects on developing brains,” Irene Boone Phillips, program coordinator of the Lake County Community Tobacco Prevention & Cessation Coalition, a Franciscan Health Foundation lead agency, said. “The rise in nicotine pouch use among young people underscores the need for stricter regulations and better public health education to prevent another generation from becoming addicted to nicotine.

Key Takeaways: Health Risks Of Nicotine Pouches

• Nicotine pouches deliver nicotine without smoke but still pose health risks because nicotine is addictive and affects the cardiovascular system.
• Use can increase heart rate, raise blood pressure and contribute to vascular constriction.
• Long-term use may lead to dependency and withdrawal symptoms such as irritability, anxiety and cravings.
• Oral irritation, gum recession and other oral health concerns can result from regular use.

What Is A Nicotine Pouch?

Oral nicotine pouches are marketed as an alternative nicotine delivery system to help reduce or quit smoking.

Pouches like Zyn, On! and Velo are smokeless, spit-free products placed between the gum and lip. “With increased awareness about the dangers of cigarette smoking and tobacco use, companies have shifted focus to other forms of nicotine delivery systems, such as pouches,” Phillips said. The pouches are small, making their use discreet – so people can use them indoors where smoking is banned, like in schools, malls or restaurants.

Many believe pouches are a convenient way to consume nicotine without the harmful tar and chemicals found in traditional tobacco products. But a new study in the journal Addiction finds they don’t effectively curb nicotine cravings. Unlike smoking, which provides a nicotine spike within 5 minutes, nicotine pouches take 30 minutes to an hour to reach peak effectiveness. Since these are marketed using fun flavors and convenient candy-like containers, researchers are also concerned that these products could result in increased nicotine addiction in a younger population rather than reducing cancer risk among smokers.

How Do Nicotine Pouches Work?

Traditional smokeless tobacco products, like Snus, contain tobacco leaf. But nicotine pouches, like Zyn, are made from nicotine powder.

These small, white pouches contain nicotine, flavorings, sweeteners and plant-based fibers. They are placed between the gum and the upper lip. The nicotine is absorbed through the lining of the mouth directly into the bloodstream.

“Due to the absence of tobacco leaf, the FDA does not classify oral nicotine pouches as a smokeless tobacco product,” Phillips said. This regulatory gap means there isn’t significant oversight on these products. The FDA has not evaluated nicotine pouches for their safety or effectiveness in helping people quit smoking.

Who Is Using Nicotine Pouches?

According to the 2023 National Youth Tobacco Survey, middle and high school students are increasingly using oral nicotine pouches like Zyn. Phillips said, “Predatory marketing tactics are causing the rise in nicotine pouch use among youth and young adults. It relies on social media influencers, the enticing, youth-focused flavors and the low price points that increase purchasing power.”

What Are The Risks Of Using Zyn And Other Nicotine Pouches?

“The biggest concern is that the nicotine concentration is not regulated, and it differs based on the brand,” Phillips said. In the U.S., manufacturers sell nicotine pouches in three, four, six and even eight milligram concentrations. But users often challenge each other to fit multiple pouches under their lips at once.

“You may see someone with four or more pouches in their mouth at once. And that can potentially be equivalent to 20 to 26 milligrams of nicotine rapidly hitting the brain at once,” Phillips said. The amount of nicotine in a single cigarette can vary, but on average, a cigarette contains about 10 to 12 milligrams of nicotine. However, only about 1 to 2 milligrams of nicotine is absorbed by the smoker’s body per cigarette. Using this absorption rate, 20 to 26 milligrams of nicotine is roughly equivalent to the nicotine absorbed from smoking 10 to 13 cigarettes in one sitting.

“One of our national partners reported that kids are even opening nicotine pouches and adding the powder to energy drinks for a boosted nicotine buzz.”

Health risks of nicotine

Nicotine, no matter how it’s delivered, is highly addictive and harmful, especially to young people. “It damages the brain,” Phillips said. Tobacco is also the leading cause of preventable cancers.

Nicotine is toxic to developing fetuses and is a health danger for pregnant people. Other health risks of nicotine include an increased risk of:

• Brain health concerns, including anxiety, depression, impulsivity, irritability and mood swings, problems with concentration, learning and memory difficulties
• Cardiovascular disorders, such as high blood pressure
• Immune system weakness
• Heart attack
• Lung cancer
• Resistance to chemotherapy
• Respiratory, gastrointestinal and kidney disorders

How Can People Quit Nicotine And Tobacco?

Quitting nicotine is tough but not impossible. Each year, millions of people successfully quit using tobacco products. And with the right resources and support, you can do it, too. According to the Centers for Disease Control and Prevention (CDC), about 7.5 percent of U.S. adult smokers successfully quit smoking in 2018. That’s close to over 2 million people.

“For help in quitting tobacco, you have many options. The Truth Initiative funds the EX Program with the Mayo Clinic. The Franciscan Health Aspire Quit Smoking & Vaping Program offers group classes, counseling and other support. To connect with other resources, call 1-800-QUIT-NOW or visit Quit Now Indiana,” Phillips said.

Programs like these provide essential support, including counseling, nicotine replacement therapies and motivational resources. The right support significantly increases your chances of quitting successfully.

Quitting nicotine, including nicotine pouches, improves your health and enhances your overall quality of life. Celebrate each milestone, no matter how small, and know that millions have walked this path and emerged victorious. Talk with your medical provider to get the right help and overcome nicotine addiction safely.