Are Oral Nicotine Pouches Safe?

They’re neatly arranged behind the counter at the local convenience store, near the cigarettes and smokeless tobacco. They’re showing up at parties. You may have seen a coworker use them or you may have tried them yourself. Nicotine pouches are becoming a popular alternative to smoking. But are they safe?

Many healthcare professionals say there’s no easy answer to that question. Nicotine pouches are so new that clinical research on their health impact is limited.

The topic “has been prevalent on social media quite a bit,” says Justin McGoldrick, MD, enterprise vice president of medical affairs and graduate medical education officer at Covenant Health. “Nicotine has been problematic in tandem with tobacco for many years. What’s happening in the world now, though, is that we’re seeing new delivery options just with nicotine, with the pouches being the newest and most novel delivery.”

While cigarette smoking has significantly decreased over the years, tobacco companies have introduced various products to retain customers and attract newer, younger users. Recent statistics show a decline in traditional smoking, but an increase in the use of smokeless nicotine products, including nicotine pouches.

What Are Nicotine Pouches?

Nicotine pouches, which you may have seen packaged under labels like Zyn, On! and Velo, are small, pre-portioned packets. The pouch is placed between the gum and lip, and nicotine is absorbed through the lining of the mouth. These pouches are made without tobacco leaf – that’s what sets them apart from some other smokeless products.

“There’s a separation of the tobacco and nicotine salts, so it’s a direct delivery of nicotine that’s unpredictable,” Dr. McGoldrick explains.

How Are Nicotine Pouches Different From Other Smokeless Nicotine Products?

The idea of enjoying nicotine without smoking is nothing new. Smokeless nicotine products like chewing tobacco, snuff and snus have been around and used for a long time. But nicotine pouches operate differently.

Chewing tobacco and snuff involve placing shredded or ground tobacco in the mouth, which often requires spitting. Snus, a moist powder tobacco product, is placed under the upper lip, similar to nicotine pouches. Snus typically contains tobacco leaf, although there are non-tobacco versions.   

Nicotine pouches are tobacco-free. Nicotine is extracted from the tobacco plant and combined with other ingredients like flavorings and sweeteners. Each pouch typically contains 2-8 milligrams of nicotine, varying by brand and strength.

Are Nicotine Pouches Safer Than Vaping?

The safety of nicotine pouches compared to vaping is still under investigation. Both methods deliver nicotine without combustion, reducing exposure to harmful tar and many carcinogens found in cigarette smoke.

Still, the long-term health effects of both nicotine pouches and vaping are not yet fully understood. Current studies suggest that while nicotine pouches may pose fewer risks than smoking, they are not without potential harm. 

What Does Nicotine Do to Your Body?

Regardless of the form in which it is consumed, nicotine has several side effects. Dr. McGoldrick says the primary concern is addiction. 

“No matter how we look at it, nicotine can cause addiction – and it’s very easy for nicotine to cause addiction,” Dr. McGoldrick says. 

There are many resources available to help those who are struggling with addiction, but nicotine pouches aren’t always included in those resources and materials. That’s likely to change if the pouches continue to be a popular alternative to smoking.

“We’re seeing more people in the education community becoming aware, and there are addiction resources in healthcare, too,” Dr. McGoldrick says. “Whether it’s a primary care doctor or other specialist, no matter what touchpoint you have, the resources to help with addiction are out there.” He also emphasizes the importance of a strong network of support from family and friends to recover from nicotine addiction.

Other side effects of nicotine use can include:

• Increased heart rate and blood pressure
• Narrowing of arteries
• Potential for heart disease and stroke
• Insulin resistance leading to Type 2 diabetes
• Adverse effects on brain development in adolescents

Can Nicotine Cause Cancer?

While nicotine itself doesn’t directly cause cancer, it is considered a tumor promoter, meaning it can support the growth and spread of cancer cells. In other words, nicotine may not be the initial trigger for cancer, but it creates an environment conducive to cancer growth.

Research indicates that nicotine can also damage DNA and interfere with cell repair processes, increasing cancer risk indirectly. Studies published in medical journals such as the National Library of Medicine and the International Journal of Cancer, support these findings.

The Health Risks of Nicotine Pouches

Nicotine pouches seem to carry fewer risks than traditional smoking or vaping, but they can’t be called safe. There are significant health risks, chief among them nicotine addiction and its known effects.

“We don’t have the evidence yet to say what the long-term side effects of nicotine pouches are going to be, but we do know that nicotine causes problems,” Dr. McGoldrick says. “We know nicotine is very addicting. And we know that those who smoke and are exposed to significant amounts of addictive nicotine don’t heal as well.”

The decision to use nicotine pouches should not be made lightly, and should only be considered by and for responsible adults. The pouches can be helpful as a stepping stone away from smoking, but shouldn’t become a permanent habit. 

“For those who have leveraged this as a success toward tapering from tobacco use, I think the next level of encouragement needs to be tapering off nicotine pouches, too,” Dr. McGoldrick says.

Am I Addicted to Nicotine?

Addiction can creep up almost unnoticed, like weeds through the cracks in a paved road. While each person experiences addiction differently, certain signs tend to be common among most people who have become too dependent on substances like nicotine. 

Take note of the behaviors listed below and ask for help if you realize nicotine has become a problem for you.

• Unusual changes in behavior
• Isolation from usual activities and/or loved ones
• Lack of self-care, poor hygiene
• Changes in sleeping and eating patterns
• Needing more of the substance to feel normal
• Unusual depression, anxiety or changes in mood
• Extreme defensiveness when confronted
• Paranoid or suspicious behavior, such as hiding and feelings of shame
• Inability to attend work and school without the substance, or a decrease in performance without it
• Cravings that can lead to putting yourself or others in danger

Peninsula, a division of Parkwest Medical Center, offers addiction recovery services in a supportive environment. For more information about these services, call 865-374-LINK or visit online. Peninsula’s website features a helpful virtual chat option to help you take the first steps toward recovery.

You can also call the Tennessee Tobacco Quit Line (1-800-QUIT-NOW), or talk to your physician or other healthcare provider about available resources.