Nicotine pouches (NPs) are a relatively new addition to the growing array of safer nicotine products. These pouches contain nicotine sourced from tobacco plants or created synthetically. To create a more enjoyable user experience, the ingredients are blended with various flavors and other food-grade components, such as taste enhancers, and sweeteners.1 Enclosed in dissolvable permeable membranes, the contents of these pouches are gradually released when placed between the upper lip and gums. As a result, they are absorbed by the oral mucosa into the systemic circulation without any need for spitting.1 While the use of NPs is similar to oral tobacco products like Swedish snus, it is crucial to highlight that NPs solely contain extracted nicotine and do not include any tobacco leaf.2
The Foundation for a Smoke-Free World recently issued a request for proposals titled “Nicotine Pouch Products: Implications for Tobacco Cessation and Harm Reduction” (available here). We invite researchers to explore the full scope of this funding opportunity and to contribute their expertise to further our collective knowledge on nicotine pouches.
Traditional smoking accounts for 7.7 million deaths annually, making it the leading cause of preventable death on the planet.3,4 Despite the tireless efforts of countless governmental and non-governmental organizations spanning over half a century, toxic tobacco use has yet to be contained.5 The primary harm from tobacco use stems from the combustion process, which creates toxic smoke containing tar and carbon monoxide.6 Nicotine, which constitutes up to 3% of tobacco, is an alkaloid and is considered relatively safe.6,7 Therefore, the innovative advancement in isolating nicotine from other harmful constituents of tobacco offers a critical opportunity to mitigate the substantial harm caused by combustible tobacco use thus far.
A recent study by Azzopardi et al. positioned NPs close to nicotine replacement therapy (NRT) on the tobacco toxicity continuum.1 The study evaluated 26 compounds present in oral tobacco products, including harmful and potentially harmful constituents (HPHCs) recognized by the FDA, and found that the levels of these constituents were comparable to those in NRTs. An earlier study conducted by Nutt et al. found that the use of nicotine replacement therapies (NRTs) was associated with a mere 2% of the toxicity observed in combustible tobacco. 8 Initial clinical trials have proved NPs to be an acceptable tobacco cessation tool, which is preferred over NRT patches and gums for smoking cessation.9-11
The reported low toxicity of NPs and their acceptability to smokers is a highly promising development for various reasons. First and foremost, NPs can offer a safer alternative for smokers who crave the taste, aroma, and nicotine levels associated with combustible cigarette use, potentially reducing the death and disability burden of traditional smoking. Additionally, NPs can significantly decrease environmental pollution caused by billions of discarded cigarette butts every year. Finally, the synthetic production of nicotine or the use of minimal amounts of tobacco-derived nicotine in NPs could free up large hectares of land for food production.
However, this progress also poses several potential risks. The perception and dissemination of the “relatively safe” message will be a crucial concern. Commercial interests and fierce market competition might lead companies to make unwarranted claims, necessitating careful regulation and oversight. Unethical entities may also potentially target and entice the youth, who are increasingly distancing themselves from combustible tobacco currently. Vulnerable populations, such as those with mental health conditions, may be more prone to using nicotine in excessive amounts or higher than safe doses. Finally, the effects of NP use in the long term may take time to manifest, particularly in patients with specific conditions like immune disorders, mental illnesses, diabetes, cardiovascular diseases, and malignancies.
In summary, nicotine pouches have the potential to be a valuable addition to the portfolio of safer nicotine products, if appropriate public health and regulatory measures are in place. To reduce the immense death and disability caused by toxic tobacco use, stakeholders, including manufacturers, regulatory agencies, health professionals, and consumer groups, must collaborate to ensure the responsible and ethical use of these products.
The Foundation for a Smoke-Free World recently issued a request for proposals titled “Nicotine Pouch Products: Implications for Tobacco Cessation and Harm Reduction” (available here ). We invite researchers to explore the full scope of this funding opportunity and to contribute their expertise to further our collective knowledge on nicotine pouches. Together, we can navigate the path to safer nicotine consumption and work towards a smoke-free world.
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