Nicotine pouches are smokeless alternatives to tobacco. They contain nicotine salts that dissolve through the gums. Marketing claims that nicotine pouches are lower risk than tobacco.

Nicotine pouches are a newer way to consume nicotine, so research is ongoing into their effects on the body. Some people use them as a way to quit smoking tobacco. However, other methods of smoking cessation have stronger evidence supporting their safety. These include nicotine replacement therapy.

This article rounds up the available studies into whether nicotine pouches are harmful and discusses other products that may help people quit nicotine altogether.

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There is not enough research available on the effects of nicotine pouches to say whether they are harmful.

In theory, nicotine pouches are less harmful than burning and inhaling tobacco. Nicotine is highly addictive, but it is the other chemicals in tobacco that increase a person’s risk of cancers, lung problems, and heart disease. Even smokeless tobacco can increase a person’s risk of mouth cancer.

The Food and Drug Administration (FDA) regulations for non-tobacco nicotine (NTN) are not as strict as those for tobacco products. For this reason, there may not be the same pressure on nicotine pouch manufacturers and marketers to be clear about nicotine content and the risks of the products.

A 2022 study of 44 nicotine pouch products and two nicotine-free pouches found that 26 of the samples contained cancer-causing chemicals known as tobacco-specific nitrosamines (TSNAs). The same study advised that 29 of the products did not clearly state how much nicotine they provided or gave vague descriptions.

No long-term data currently suggests that nicotine pouches are helpful for those looking to quit tobacco or slowly reduce nicotine intake.

As nicotine pouches are a new product, their long-term side effects are unclear. However, the short-term effects might include:

Some nicotine products also deliver a similar amount of nicotine to other smokeless tobacco products, such as snus or snuff, at a similar speed. While a 2020 study concluded that there were “no significant adverse effects,” the FDA warns that nicotine remains highly addictive. This may lead a person to continue using tobacco even if the aim is to stop.

Nicotine is a stimulant drug. When a person ingests nicotine in a pouch, cigarette, or other delivery system, it enters the bloodstream and moves to the gland that pumps out a stress chemical called adrenalin. This increases:

It also activates the reward system in the brain, releasing a feel-good chemical called dopamine. Over time, nicotine can change how the brain functions.

This means that stopping nicotine can lead to feeling sick — a condition known as nicotine withdrawal. These withdrawal symptoms can peak within a few days and last for several weeks.

The modern tobacco market has seen a huge increase in the availability of smokeless products that claim to help people manage nicotine addiction by reducing smoking.

However, the research for many has limits or is short term. Also, smokeless tobacco products still contain at least 4,000 chemicals, 30 of which have connections to cancer development.

E-cigarettes

E-cigarettes and vapes provide nicotine in the form of an e-liquid vapor instead of tobacco smoke. According to the National Institute for Drug Abuse (NIDA), around 4.7% of people in the United States reported vaping nicotine within the previous 30-day period.

In 2021, researchers conducted a meta-analysis of studies on the effects of e-cigarettes on efforts to quit smoking. They determined that 9–14% of people who tried to quit by vaping found that it worked. In contrast, only 4–7% of smokers who used other nicotine replacement methods, such as patches, quit successfully.

However, vaping’s long-term effects are unclear based on current research. E-cigarettes can contain high doses of nicotine, making addiction more likely. It might also increase a person’s risk of several health problems, including:

Snus, snuff, and dip

This is a type of tobacco that people place in the mouth in the same way as nicotine pouches, in its moist form, or sniff, in its dry form. Dipping tobacco, or “dip,” is another form of moist snuff.

While snus still exposes users to some potentially harmful chemicals in tobacco, a 2019 review suggests that it has a lower risk of lung cancer, mouth cancer, pancreatic cancer, and heart disease than smokable tobacco products. However, limited data suggests that snus might increase a person’s risk of developing diabetes.

Snus may help people move away from smoking, although not tobacco or nicotine use, according to a 7-year study published in 2020.

Chewing tobacco

This is tobacco that people chew in different forms, such as loose leaves, twists, or plugs. While people may chew tobacco to reduce how much they smoke or cut out smoking altogether, chewing tobacco is still a known cause of oral cancer and other oral health problems, such as a receding gumline.

The safest option is to go nicotine free and cut out all forms of tobacco, even for people who do not smoke it.

Some nicotine replacement therapy products have a sturdy evidence base showing that they may be effective. According to the American Cancer Society (ACS), these may help a person become almost twice as likely to quit. They are available over the counter and include:

  • Patches: These are wearable on the skin, steadily releasing a small amount of nicotine.
  • Gums: Chewing these releases nicotine while it dissolves in the mouth.
  • Lozenges: People looking to quit smoking can suck on these like hard candy. Lozenges release nicotine slowly as they dissolve.

Stronger inhalers and nasal sprays are available with a physician’s prescription.

People often combine this with other resources for smoking cessation for longer-lasting results, including:

It is best to speak with a clinician about evidence-based options instead of resorting to an unproven product that suggests a supportive role in smoking cessation in its marketing.

Nicotine pouches contain nicotine salts that dissolve into the gums. However, there is very little evidence available to confirm its long-term health risks.

Even though nicotine pouches contain fewer harmful chemicals than smokeable tobacco, they still contain cancer-linked TSNAs and carry a risk of several side effects, including nausea, hiccups, and mouth irritation.

No available evidence supports nicotine pouches or other smokeless tobacco products as smoking cessation aids. Those who need support in quitting smoking can supplement nicotine with NRTs to reduce withdrawal while using proven interventions to help with the psychological and emotional aspects of quitting.