Oral nicotine pouches deliver lower levels of toxic substances than smoking – but that doesn’t mean they’re safe

Oral nicotine pouches – like Zyn and Velo in the U.S. – appear to be less toxic than cigarettes and deliver comparable levels of nicotine. This makes them an alternative for people who smoke. However, people who’ve never smoked are using them, too, and youth are open to trying them. These are key findings of our recent systematic review^[1], published in the journal Nicotine and Tobacco Research.

Oral nicotine pouches are preportioned pouches sold in various flavors and nicotine strengths. They are similar in appearance and use to traditional ‘snus’^[2], a form of smokeless tobacco placed between the gum and lip, which is popular in Scandinavia. However, unlike snus, nicotine pouches do not contain tobacco leaf. As a result, they are often marketed as “tobacco-free.”

One of the studies in our review found that the “tobacco-free” label is confusing^[3] to some and may lead people to think nicotine pouches do not contain nicotine.

On average, studies in our review showed that nicotine pouches had fewer harmful chemicals, present at lower levels, than in cigarettes and smokeless tobacco, like snus.

This varied by product, though. It could be that different flavorings have different levels of harmful chemicals^[4]. The most common reasons^[5] given for using pouches were curiosity, flavors and the perception that they were discreet and could be used where other tobacco products could not.

Why it matters

More people are using nicotine pouches than ever before^[6].

While manufacturers claim to target people who smoke, we found that 35% to 42% of U.S. youth were aware of oral nicotine pouches. Of those who didn’t use any form of nicotine, we found 9% to 21% open to trying pouches.

As public awareness of these products is growing – due to increased use and increased marketing^[7] – people want to know more about their effects. This includes people who smoke, who might switch to them, people who don’t smoke, who might use them recreationally, and policymakers.

Central to all of this is nicotine. Nicotine is not the component in cigarettes that causes disease and death^[8], but it is the addictive one. Too much nicotine can make you sick, and people who don’t smoke shouldn’t use nicotine products.

At the same time, though, safer forms of nicotine^[9] have been helping people quit smoking for decades.

Cigarettes remain the leading cause of preventable disease and death worldwide^[10] and in the U.S^[11]. If they completely replace smoking, alternative nicotine products have the potential to bring substantial health benefits, both to people who smoke and the people around them.

What still isn’t known

There’s a lot we researchers still don’t know about nicotine pouches.

Hundreds of randomized trials^[12] show nicotine replacement therapies – like gum and patches – are safe and that they help people quit smoking.

There is also an ever-growing number of trials^[13] – currently 49 – showing that e-cigarettes with nicotine help people stop smoking and are substantially less harmful than smoking.

With oral nicotine pouches, however, only a handful of studies exist. Though most studies show that pouches expose users to lower levels of toxic substances^[14] than smoking, these studies were often small, and most were conducted by the tobacco industry, which has a long history of distorting science^[15].

What’s next

We know that smoking is remarkably lethal – cigarettes kill approximately half^[16] of regular users. It’s probably reasonable to assume and not surprising to see data indicating that pouches are less harmful than smoking. That doesn’t mean they are safe, though.

We need large, long-term independent studies to say anything for sure about the health effects of nicotine pouches. People’s use patterns and the marketing need to be carefully monitored to ensure that products aren’t being targeted at groups who don’t smoke, and particularly aren’t targeted at historically disadvantaged or marginalized groups, as they have been in the past^[17].

The Research Brief^[18] is a short take on interesting academic work.

References

1. ^{^} our recent systematic review (doi.org)
2. ^{^} traditional ‘snus’ (www.fda.gov)
3. ^{^} tobacco-free” label is confusing (doi.org)
4. ^{^} different flavorings have different levels of harmful chemicals (doi.org)
5. ^{^} most common reasons (www.tobaccopreventioncessation.com)
6. ^{^} than ever before (iris.who.int)
7. ^{^} increased marketing (theconversation.com)
8. ^{^} component in cigarettes that causes disease and death (cancer-code-europe.iarc.fr)
9. ^{^} safer forms of nicotine (doi.org)
10. ^{^} leading cause of preventable disease and death worldwide (www.who.int)
11. ^{^} in the U.S (www.cdc.gov)
12. ^{^} Hundreds of randomized trials (doi.org)
13. ^{^} ever-growing number of trials (doi.org)
14. ^{^} pouches expose users to lower levels of toxic substances (doi.org)
15. ^{^} long history of distorting science (truthinitiative.org)
16. ^{^} kill approximately half (www.who.int)
17. ^{^} as they have been in the past (truthinitiative.org)
18. ^{^} Research Brief (theconversation.com)