If you are trying to stop smoking, you may have heard of nicotine patches or gum to help reduce cravings. But how about nicotine pouches ? Small, tobacco-free sachets containing a powder made up of nicotine, flavourings and other additives, nicotine patches are placed between the upper lip and gum to release a nicotine buzz without the damage to lungs.
Author
- Dipa Kamdar
Senior Lecturer in Pharmacy Practice, Kingston University
Nicotine pouches were first introduced to the UK market in 2019. Common brands in the UK include ZYN, Velo and Nordic Spirit. Nicotine pouches are similar to snus - loose tobacco in a pouch that is used in the same way as nicotine pouches. Although snus has been used for many years in Scandinavia, it was banned in the UK in 1992. Today's generation of nicotine pouches are marketed as a way to get the benefits of nicotine without the harmful effects of cigarettes or vapes.
So, are they a helpful tool for those trying to kick the habit?
Nicotine replacement therapy
Nicotine replacement therapy (NRT) is available to buy over-the-counter in the UK. Common brands include Nicorette and Niquitin. NRT comes in different forms such as patches, lozenges and chewing gum. Nicotine pouches haven't been approved for use as NRT - so why are they becoming a popular alternative to smoking and vaping?
Pouches are heavily marketed on social media and, unlike NRTs, they're readily available from supermarkets and shops from as little as £5 per box. Social media influencers are sponsored to promote nicotine pouches as "clean", discreet and convenient. They come in a wide range of flavours, from cinnamon to citrus, which attracts younger consumers .
Recent research found that approximately 1% of adults and 1.2% of youths aged 11-18 years-old reported currently using nicotine pouches. However, over 5% of adults and more than 3% of youths said they had used these pouches at some point. Although these are relatively low figures, data shows nicotine pouches are becoming increasingly popular in the UK and US.
Unlike NRT, nicotine pouches are classed as consumer products, so are not regulated by the Medicines and Healthcare products Regulatory Agency . Since they do not contain tobacco, nicotine pouches cannot be regulated by the Tobacco and Related Product Regulations either. This means there is no age restriction to buy them.
Instead, nicotine pouches are governed by the General Product Safety Regulations , which means they are not regulated as stringently as NRT. Companies producing NRTs must apply for a marketing license because medicinal products have to undergo extensive testing to show they are safe and effective. This is not the case for nicotine pouches.
'Healthy' nicotine?
Nicotine acts on receptors in the brain, releasing chemical messengers including the "happy hormone" dopamine. These chemical messengers are responsible for the pleasurable feelings and addictive behaviour that people often experience when using tobacco or nicotine products. The faster a drug is absorbed and activates brain receptors, the higher the addiction potential.
Research shows that nicotine is released more slowly from pouches compared to cigarettes, so it may be less addictive than cigarettes. However, pouches can also vary in the amount of nicotine they contain - evidence shows some have very high levels, higher than cigarettes and NRT.
Pouches can be marketed as a "clean" form of nicotine consumption - but, although they are smoke-free, they can contain other chemical ingredients such as pH adjusters like sodium carbonate, which allow nicotine to be absorbed in the mouth more easily. Pouches do not contain tobacco, which contains many chemicals and cancer-causing agents. However, nicotine on its own can still be harmful.
Common side effects of nicotine pouch use include nausea, vomiting, headaches and heart palpitations. Nicotine causes the body to release of chemicals such as adrenaline and noradrenaline. Studies show increased levels of these can raise heart rate and blood pressure and the heart's need for oxygen.
Animal studies suggest that nicotine use during teenage years can cause long-term changes in the brain and behaviour as well as an increased likelihood of using other drugs, lower attention levels and mood problems.
Young people have more nicotine receptors in the areas of the brain related to reward. This makes nicotine's effects stronger in teenagers than in adults.
Currently there is not enough evidence to confirm nicotine pouches are harmful to oral health but dentists are concerned about their potential effects . Last year, a review found that oral side effects include dry mouth, sore mouth, blisters on the gums and sometimes changes in the gum area - such as receding gumline - where the pouches were placed. This is similar to side effects of oral NRT. Unlike NRT, which is normally used for a three-month course, pouches may be used for longer - potentially raising the risk of side effects.
Belgium and the Netherlands have banned nicotine pouches because of the potential risks. In the UK, the new Tobacco and Vapes bill will allow the government to regulate the use of nicotine pouches so that they can only be sold to people aged 18 and older. Advertising will be banned and the content and branding regulated.
This could be a welcome move for those concerned that nicotine pouch brands are targeting young people who've never smoked. But, for current smokers looking for a product to help them quit, it might be wise to opt for the regulated NRTs - even if the flavours aren't as appealing.
Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
