Young men, former smokers most likely to try nicotine pouches, new study shows

Young men and people who already smoke cigarettes or use e-cigarettes are the most likely to use nicotine pouches, suggests new research that tracks the early uptake of one of the tobacco industry’s latest products.

The study, led by epidemiologist Amanda Palmer of the Hollings Cancer Center at the Medical University of South Carolina, is among the first to measure how widely the nicotine pouches are being used. 

Results were published in the peer-reviewed journal JAMA Network Open.

Researchers analysed answers from almost 23,000 participants in the 2022-23 Population Assessment of Tobacco and Health Survey, a long running US project that began tracking tobacco use in 2013. 

Wave 7, the most recent release, was the first to ask about nicotine pouches.

Although overall uptake was “modest,” fewer than 1% of teenagers and 3.34% of adults reported ever trying the product.

Palmer said the numbers reveal clear demographic patterns.

“The highest odds of use were among late-adolescent and young-adult males who had already tried or were still using cigarettes, e-cigarettes, or smokeless tobacco,” said Palmer. 

“That baseline will help us understand where this market may head next.”

Oral nicotine pouches look like tiny tea bags filled with a crystalline nicotine-salt powder rather than shredded tobacco leaf. 

Users slip the pouch between gum and lip, absorbing the drug through the mouth’s lining in a way similar to Swedish snus. 

Because they contain no leaf, they are not covered by Canada’s Tobacco and Vaping Products Act. 

Only one brand, Zonnic, is licenced for sale in Canada, and federal regulations require pharmacies to keep the menthol, mint, and unflavoured varieties behind the counter.

Public health experts see the pouches as a double-edged sword. 

On one hand, the study notes that many users are current or former smokers. That could make the product a lower-risk alternative to combustible cigarettes and even to some e-cigarettes, which heat liquid nicotine and produce aerosols that can irritate the lungs.

“From what we know right now, the nicotine pouches are pretty safe. And they might even be safer than e-cigarettes,” said Palmer. 

“If people who smoke switched to something like a nicotine pouch, that would be a win for public health.”

On the other hand, the team warns that flavoured versions could entice teenagers who have never smoked. 

Like vaping devices before them, pouches deliver nicotine, an addictive drug linked to mood disorders, financial strain, and long-term dependence.

Because the products are so new, scientists lack data on chronic use. Palmer’s group plans to follow PATH respondents to see whether early adopters keep using pouches, move back to cigarettes, or quit nicotine altogether.

Palmer says that surveillance is crucial. 

“Public health did a great job informing people that smoking is extremely harmful,” said Palmer. 

“But quitting is hard, and people are looking for alternatives. We have to balance giving smokers off-ramps while preventing a new generation from becoming dependent.”

For now, the researchers say, the market remains small. Yet the rapid growth of e-cigarettes in the past decade suggests the trajectory can change quickly for nicotine pouches.

“These numbers may look modest today,” said Palmer. 

“They looked the same for e-cigarettes not that long ago.”