BY ELIZABETH SCHWARTZ, MMS COMMITTEE ON MENTAL HEALTH AND SUBSTANCE USE
The tobacco industry continues to shape-shift for American consumers with the rise in sales of oral “tobacco-free” nicotine pouches. Nicotine pouches are currently the fourth most used type of tobacco device, behind e-cigarettes, cigars, and cigarettes,
according to the 2023 Annual National Youth Tobacco Survey of the U.S. Food and Drug Administration (FDA).
While oral nicotine pouches do not contain tobacco, they do contain nicotine, a highly addictive substance. These new pouches continue to be marketed to young people, with a variety of flavors like those that attracted youth to e-cigarettes. Nicotine
pouches have a strong presence on social media, making them, again, targeted towards
young people.
The Massachusetts Medical Society Committee on Mental Health and Substance Use is sharing information on this product to ensure physicians and other health care professionals are aware of how it can affect their patients.
What are nicotine pouches?
Nicotine pouches are small, white triangles that contain nicotine powder manufactured by popular brand names such as Zyn, On!, and Velo. Sold in youth-appealing colorful containers, they are available in a variety of flavors, including mint, cinnamon,
menthol, and fruit flavors. The pouches are placed between the cheek and the gum, similar to tobacco dip, allowing absorption of nicotine through the oral mucosa. Nicotine pouches don’t require any spitting, making the smokeless product even
easier to conceal than previous oral nicotine products. A recent cross-sectional analysis stated the highest use of nicotine pouches was among
young adults aged 18−24 years old.
Lack of regulations
Rather than containing shredded tobacco leaf, such as previous oral pouches produced by tobacco companies, nicotine pouches contain nicotine powder. Because the pouches are “tobacco-free,” they are not currently categorized as smokeless tobacco
and are therefore not regulated by the FDA as strictly as tobacco products. This allows brands to produce pouches with different amounts of nicotine concentration, ranging from 3 mg to 8 mg per pouch. Sales of products with higher doses of
nicotine (8 mg) have been increasing at the fastest rate compared to products with
lower doses. This year, On! is expected to produce a new product, On Plus, that contains up to 12 mg of nicotine, according to a consumer products store newsletter.
Health effects of nicotine pouches
Nicotine use under the age of 25, while the brain is still developing, can affect attention and learning, as well as mood.
Studies of adults have linked smoking to poor mental health, including increased stress, anxiety, and depression.
Oral health effects for nicotine pouches are expected to be similar to those of previous oral tobacco products. These effects include irritation and/or recession of the
gums where the pouch is placed, mouth and throat soreness, and mouth ulcers. Hiccups and coughing have also been seen.
As nicotine pouches become more common and their nicotine doses continue to increase, more and more young adults run the risk of developing nicotine dependence and addiction.
Nicotine in any form is harmful for the developing brain. If your patient has nicotine dependence or addiction, resources are available to help them, including:
- 1-800-QUIT-NOW and
- smokefree.gov, which connects individuals to a FREE, trained quit coach by phone or online.
Elizabeth Schwartz is a second-year medical student at UMass Chan Medical School and a student member of the MMS Committee on Mental Health and Substance Use, writing on behalf of the Committee.
