Oral Nicotine Pouches: Rising Popularity and State of the Science

Nicotine pouches are noncombustible products that contain nicotine but no tobacco plant material. With rising popularity and increased media attention surrounding ZYN and other nicotine pouch brands, questions remain about whether empirical evidence exists on the public health effects of these products. This review highlights how nicotine pouches, including ZYN, are rising in appeal and prevalence of use, particularly among adolescents and young adults. The use of nicotine pouches is also more prevalent among people who use other tobacco products (vs those who do not), including electronic cigarettes (e-cigarettes), and some people report using nicotine pouches to help reduce or quit the use of e-cigarettes or combustible tobacco products. Nicotine pouches deliver amounts of nicotine similar to other tobacco products and do so at a rate similar to other oral nicotine products, including some US Food and Drug Administration (FDA)-approved nicotine replacement therapies. In addition, nicotine pouches have the potential to be tobacco harm-reduction products if unintended harms can be minimized, although more research is needed to determine the health effect profile of nicotine pouches under naturalistic use conditions. Overall, additional research is needed to verify the results from industry-funded studies, further understand product characteristics that influence nicotine delivery and health effects, and translate findings to real-world use behaviors. This additional research could help determine whether nicotine pouches have a robust evidence base to meet the public health standard by which FDA evaluates new tobacco products.