Nicotine pouches—small packets of nicotine powder placed between the gums and lips—are tobacco-free, but are they truly safer than cigarettes, vapes, chewing tobacco, and other nicotine products?
A product with historic roots
The practice of soaking tobacco leaves in water and pressing them between the gums and lips because popular among Swedish aristocracy in 1637 before taking off across Europe. Over time, the product became known as snus—dried and powdered tobacco leaves packed into small pouches that are placed between the gums and lips. Because of its similar appearance to Swedish snus, nicotine packets are sometimes called white snus. Unlike Swedish snus, however, nicotine pouches are tobacco-free. The nicotine found in both products is derived from tobacco or created with synthetic (lab-manufactured) nicotine.
Nicotine pouches were introduced to the United States in 2014. Since then, the United States market has grown to $6 billion—the largest nicotine pouch market of any country in which the product is available.
A new item on the market
“Nicotine pouches are like a teabag in that the nicotine—along with flavorings, sweeteners, preservatives, and fillers—are packaged in a sealed, but permeable pouch,” explains Sook-Bin Woo, DMD, a physician in Oral Oncology. “When the pouch comes into contact with saliva, the nicotine and flavorings dissolve and leach out, and are then absorbed through the lining of the cheeks and gums. It’s less messy and more convenient and discreet than, say, chewing tobacco or cigarettes.”
Nicotine is a naturally occurring stimulant found in tobacco plants and is the primary reason why tobacco products are addictive. It can be naturally derived from plants or manufactured synthetically in a lab. Depending on the brand, a single cigarette contains between 6 and 28 milligrams (mg) of nicotine, with an average of 10-12 mg. When smoked, a person inhales about 1-2mg per cigarette.
Nicotine pouches—ZYN, Velo, Juice Head, FRE, and Lucy are common brands—contain comparable nicotine levels, ranging from 3-12.5mg per pouch. A subsequent 1-2mg is absorbed through the mouth. Nicotine pouches also contain variable amounts of flavorings, sweeteners, preservatives, and fillers.
The body absorbs nicotine better when the preparation of it is more alkaline. “Nicotine pouches with a higher alkalinity may provide a quicker ‘hit’ than those with an acidic, or lower, alkalinity.”
Because tobacco products and nicotine pouches typically contain comparable amounts of nicotine, they carry similar risks for developing addiction (a complex disease that causes compulsive substance use despite harmful consequences).
Clever marketing
With convenience, less mess, and appealing flavors factored into product design and packaging, nicotine pouches have become popular among young adults—a prime developmental stage for nicotine to affect brain development and make it harder to quit later in life.
Nicotine pouches come in a variety of flavors, such as mint and cinnamon, but are also available in fruit flavors, such as watermelon and peach. “Those are typically flavors that would appeal to teenagers, even though it is not legal in the U.S. for anyone under the age of 21 to purchase tobacco or nicotine products, including nicotine pouches,” says Woo. “It’s rare for a person to start smoking or using tobacco or nicotine products in older adulthood. It’s much more common during the rapidly changing and often experimental teenage and young adult years.”
New product, different risks
While nicotine pouches are tobacco-free, they are not without risks. With tobacco products, the risk of certain cancers derives from carcinogens (substances known to cause cancer), which result from:
- Growing of tobacco, such as arsenic, a carcinogen found naturally in soil and pesticides
- Curing of the tobacco leaves, which produces tobacco-specific nitrosamines
- Smoking of the plant’s leaves, which leads to the formation of formaldehyde
Nicotine itself is not a known carcinogen, but it can cause cardiovascular disease, including heart disease, and can reduce saliva production. With less saliva to neutralize acids and bacteria, there is a higher risk of:
- Tooth decay and cavities
- Gum recession
- Bad breath
- Leukoplakia (white patches in the mouth that are precancerous)
In children and teenagers, nicotine also affects brain development. “During the childhood and teenage years, the brain circuitry matures as a young person develops cognition, executive control, and emotional regulation, as well as an understanding of what gives pleasure,” explains Woo. “Studies have shown that nicotine negatively influences areas of the brain associated with learning, memory, and reward, making it harder to quit using tobacco or nicotine products later in life.”
Other ingredients, such as preservatives and flavorings in nicotine pouches, may also cause oral irritation. “This is something to keep in mind if a person has any allergies or sensitivities,” says Woo.
One step at a time
The action of lighting and smoking a cigarette—alone or with others—is a ritual, and the oral-manual habit is hard to break. This is very different from chewing nicotine gum or sticking on a nicotine patch, says Woo.
“There is no ritualization with nicotine pouches,” she adds. “For those who smoke around others, there is no social component with a pouch. If someone has moved past the ritualization, nicotine pouches may be a way to reduce nicotine dependence on the path to quitting—similar to using nicotine gum or patches.”
Bottom line
Regardless of the product, it is best to not start using tobacco or nicotine at any age.
“My recommendation is always not to start,” says Woo. “I would also recommend that patients who wish to stop smoking speak with their primary care provider regarding using nicotine pouches to find the appropriate dose that is safe for them. I’d also recommend being especially careful about not using multiple nicotine products at the same time, such as the pouch and the patch, to reduce the chances of overdosing.”
To help you quit, talk to your primary care provider or care team about counseling, medicines, or other helpful resources.