The FDA has issued marketing authorization for only a limited number of nicotine pouches in 3 mg, 6 mg, and 9 mg strengths. Some companies now sell products containing up to 30 mg of nicotine per pouch. These products are not authorized for sale and are being sold illegally.
“As a pulmonary, critical care, and sleep medicine physician, I have several concerns about nicotine pouches,” Kathuria said.
“One is cardiovascular toxicity. Research shows nicotine in any form is a toxin, and avoiding combustion doesn’t avoid CV risk.
One example is the brand Iceberg with fruity flavors like “Strawberry Mango Gum,” which are available for purchase online. Kids could access them by simply clicking a button stating they are 18 years old.
“We know fruity flavors and nicotine can be appealing to kids,” UW-CTRI Director Dr. Hasmeena Kathuria said, “and these high-nicotine products could get kids addicted quickly.”
“Another is oral health. Early evidence shows mucosal irritation, inflammation and lesions from pouch use. Some products contain trace amounts of carcinogens.
“It’s especially concerning for young people. We know nicotine affects attention spans, learning, sleep, mood and impulse control. And reports show babies and infants have ingested pouches and ended up in emergency care.”
Pouches may have a roll in reducing the harm caused by smoking. UW-CTRI’s Options 2 Study, for example, is researching whether pouches can help people go longer between cigarettes. However, the pouches in the study are not 30 mg. The study is only for adults who already smoke.
Nicotine pouches are made of microfiber. In addition to nicotine and flavors, they can also contain sweeteners and pH adjusters. They are designed to be placed between the gum and lip where nicotine is absorbed via the oral mucosa with no need for spitting.
Nicotine pouches contain either nicotine powder or salts, which are chemically synthesized or extracted from tobacco leaves. However, they do not contain cut, ground, powdered or leaf tobacco itself (like snus).
Saliva moistens the pouch; nicotine dissolves and is absorbed through oral tissues, typically producing a slower, steadier rise in nicotine than inhalation via a cigarette. This, in part, is why it’s tricky to compare the nicotine in pouches to cigarettes. Not all of the nicotine in a product is absorbed into the bloodstream, the nicotine varies by brand and duration of use.