Are Nicotine Pouches Safer Than Smoking?

Cigarette use in the United States is at an all-time low — great news, as the tobacco in cigarettes can cause cancer.

But people are still finding ways to use nicotine, an addictive chemical found in tobacco. According to the National Institute on Drug Abuse (NIDA), more than 20 million people in the U.S. report that they’re dependent on nicotine, and nearly 25% of 12th graders say they’ve used nicotine recently.

“Non-tobacco nicotine products like nicotine pouches are quickly flooding the market,” shares pulmonologist Humberto Choi, MD. “Many people see them as a healthier alternative to tobacco products, and young people are drawn to them. But even though they don’t have tobacco, nicotine products can be harmful.”

Dr. Choi shares what you need to know about nicotine pouches.

What are nicotine pouches?

Nicotine pouches are small, rectangular pouches filled with powdered nicotine, preservatives and other fillers (for flavor). The pouches don’t include tobacco leaves, so they aren’t considered to be carcinogens (cancer-causing). They’re sold in varying strengths, but typically have a high concentration of nicotine.

“These tiny pouches can be especially attractive for young people,” Dr. Choi says. “Companies market nicotine pouches in colorful packaging, and they come in flavors like berry and peppermint.”

To use a nicotine pouch, you put it between your top lip and gum and leave it in place for 15 to 45 minutes — depending on the brand. Your body absorbs the nicotine through the tissue lining your mouth, and it enters your bloodstream.

Within 10 seconds of entering your body, nicotine reaches your brain, where it causes a release of adrenaline. Most people feel immediate pleasure and a slight jolt of energy.

Are nicotine pouches addictive?

The buzz you get from nicotine doesn’t last long, and most people tend to miss the feeling when it’s gone. The more nicotine you use, the more nicotine your body needs to get back to that buzzy feeling, leading to addiction.

When people say it’s challenging to stop smoking, it’s because of a nicotine dependency. NIDA reports that half of smokers try to quit each year, but only 6% succeed. Nicotine pouches are often used as a step-down from smoking because they continue to provide nicotine as you withdraw from tobacco products. But for people who’ve never used nicotine, the pouches can create problems where they didn’t exist before.

“Nicotine is highly addictive,” Dr. Choi states, “and the nicotine dose in some pouches can be higher than in cigarettes. Using a high-dose pouch can be like smoking multiple cigarettes at one time.”

Are nicotine pouches safe?

Nicotine pouches only became available in the U.S. in 2014, so we don’t know all their long-term effects. But we know that nicotine:

• Can be toxic to fetuses.
• Harms young and developing brains.
• Increases the risk of addiction to other drugs.

“We’re seeing more and more reports of young people who regret beginning to use nicotine pouches,” Dr. Choi says. “They only see the negative effects once they have symptoms, some of which can be severe. But by then, they are addicted, and it’s hard to stop.”

In the short term, he adds that nicotine pouches may cause stomach pain and tooth discoloration. And while experts still don’t know exactly what health issues nicotine pouches may cause, possible long-term effects may include:

• Cancer of the throat, mouth or pancreas (if nicotine is swallowed).
• Dental problems, including tooth loss and discoloration.
• Gastrointestinal (GI) issues, such as gastrointestinal reflux.
• Gum conditions, including gum disease, inflammation and infection.

“Some of the symptoms nicotine pouches cause may seem minor at first,” he cautions. “But when you ignore those symptoms and continue to use them, the damage builds and may cause serious health issues over time.”

Here’s how nicotine pouches compare to some other nicotine-containing products.

How nicotine pouches differ from other products

Nicotine pouches (and vapes, or e-cigarettes) don’t have tobacco, so they may carry less risk of cancer than traditional cigarettes. In terms of delivering nicotine, pouches differ from smoking and vaping in several ways, including:

• Absorption: When you smoke or vape, your body absorbs nicotine through your airway tissue and lungs. When you use a pouch, you absorb nicotine through the tissue in your mouth.
• Dosage: As pouches come in varying strengths, some may provide more nicotine than cigarettes or vapes. High-dose pouches may build nicotine tolerance quickly and speed up the addiction process.
• Metabolization: As you absorb nicotine differently when you use a pouch versus smoking, it also enters your bloodstream differently. Dr. Choi says nicotine may enter your circulatory system faster in pouch form, but it’s difficult to compare and hasn’t been fully studied.

Nicotine pouches also differ from chewing (smokeless) tobacco. Chewing tobacco contains cancer-causing carcinogens, while pouches do not, as they’re tobacco-free. But both smokeless products involve absorbing nicotine through mouth tissue. That means you absorb and metabolize nicotine in the same way. As a result, pouches and chewing tobacco can affect both your gum and GI health.

Bottom line: Are nicotine pouches bad for you?

If you’re trying to quit tobacco use, nicotine pouches may be helpful. But they’re addictive and pose their own health risks. If you want to quit smoking, talk to a healthcare provider about the most effective, safest ways to quit.

And if you don’t smoke, be aware: Pouches aren’t a safe alternative to cigarettes.

“Don’t underestimate the potential health risks associated with nicotine dependence,” Dr. Choi stresses. “Just trying nicotine pouches can be highly addictive, and it’s a substance our bodies don’t need. Nicotine has potentially severe short-term and long-term effects. I wouldn’t consider any product like that to be safe.”