Can Nicotine Pouches Help Quit Smoking?

The FDA has not approved nicotine pouches as a smoking cessation tool as of May 2024. That said, these products deliver nicotine without smoking, chewing tobacco, or vaping, which offers an alternative for managing nicotine cravings while avoiding smoking-related health risks.

This guide explores key aspects of nicotine pouches, including:

• Their mechanism of action

• Safety concerns and potential health risks

• How they compare to traditional cigarettes

We'll also evaluate their potential role in smoking cessation and compare them to FDA-approved nicotine replacement therapies (NRTs) such as gums, patches, and lozenges.

What Are Nicotine Pouches?

Nicotine pouches are small, tobacco-free oral products designed to deliver nicotine. Each pouch typically contains a standardized dose of nicotine, usually ranging from 2 mg to 10 mg, though the exact amount varies by brand and product. Users place the pouch between their lip and gum, where nicotine is absorbed through the oral mucosa, similar to other oral nicotine products like gum and lozenges.

Unlike traditional cigarettes, which deliver nicotine through inhalation, nicotine pouches release nicotine gradually into the bloodstream. This slower release can help manage nicotine cravings throughout the day without the harmful byproducts associated with smoking, such as tar and carbon monoxide. The absence of smoke or vapor distinguishes nicotine pouches from both smoking and vaping products.

Nicotine pouches differ from FDA-approved nicotine replacement therapies (NRTs) such as patches, gums, and inhalers, as they are not classified as cessation aids. While patches provide a slow, steady release of nicotine and inhalers mimic the hand-to-mouth action of smoking, nicotine pouches primarily serve as a portable method for nicotine consumption. The act of placing a pouch in the mouth may also serve as a replacement for some habitual smoking behaviors.

How Nicotine Pouches Work

Nicotine pouches contain a blend of nicotine, fillers, flavorings, and stabilizers that maintain the pouch's structure in the mouth. When placed between the gum and lip, nicotine is absorbed directly into the bloodstream through the oral mucous membranes. This absorption method differs from smoking, where nicotine enters the body through the lungs, resulting in a more rapid effect. The gradual absorption of nicotine from pouches may help manage cravings, though it doesn't provide the immediate impact associated with smoking or vaping.

These pouches are available in various strengths, allowing users to tailor their nicotine intake. Usage patterns can vary based on individual smoking habits, but typical recommendations suggest using one pouch every one to two hours to control cravings effectively.

Nicotine Pouches: Common Types & Brands

Nicotine pouches come in various forms, strengths, and flavors.

Ingredients: Nicotine pouches typically contain a blend of nicotine, plant fibers, flavorings, and stabilizers. Unlike smokeless tobacco, they're tobacco-free. The nicotine is either synthetically derived or extracted from tobacco plants. Flavors range from mint and menthol to fruit and spice varieties.

Nicotine Levels: Pouches offer various strengths, usually between 2 mg and 10 mg per pouch. The choice depends on the user's nicotine dependence. Those transitioning from smoking often prefer higher-strength options, while those aiming to reduce nicotine intake may choose lower-strength alternatives. Common levels include 3 mg, 6 mg, and 9 mg per pouch, though this varies by brand.

Flavor Varieties: Nicotine pouches come in a wide array of flavors, including mint, citrus, coffee, and berry. Mint and menthol are popular for their refreshing qualities, while fruit flavors appeal to those seeking a more diverse taste experience.

Several brands dominate the nicotine pouch market, each with its own range of products:

• ZYN: A widely recognized brand, ZYN offers pouches in 3 mg and 6 mg strengths, with flavors like Cool Mint, Wintergreen, and Citrus. They're known for clean, tobacco-free nicotine delivery and broad availability across the US and Europe.

• On!: On! pouches come in strengths from 2 mg to 8 mg, with flavors including Cinnamon, Mint, and Citrus. The brand is notable for its small, discreet pouches and diverse flavor selection.

• VELO: VELO provides a wide range of flavors and strengths (2 mg, 4 mg, and 7 mg). Popular options include Black Cherry, Dragon Fruit, and Spearmint. VELO is known for innovative pouch designs and smooth nicotine release.

• Rogue: Rogue offers pouches in strengths up to 6 mg, with flavors like Peppermint, Wintergreen, and Honey Lemon. They emphasize their tobacco-free, spit-free format, appealing to users seeking convenience.

Like flavored nicotine e-liquids, nicotine pouches face increasing regulatory scrutiny. The FDA has heightened oversight of flavored nicotine products to curb their appeal to minors. Some jurisdictions have already restricted or banned flavored tobacco and nicotine products, potentially affecting the future availability of certain flavors.

Can Nicotine Pouches Help Quit Smoking?

As of May 2024, the FDA has not approved nicotine pouches as a smoking cessation aid. However, smokers who switch entirely to nicotine pouches may experience a reduction in harm compared to continued smoking. These pouches eliminate exposure to many toxic substances found in cigarettes and smokeless tobacco products, including those that cause lung cancer and respiratory diseases. This makes nicotine pouches a potentially less harmful option for nicotine delivery, though not without risks.

Concerns and Limitations

Addiction Risk: While nicotine pouches may reduce exposure to tobacco-specific toxins, nicotine remains highly addictive. Continued use can perpetuate nicotine dependence, making it challenging for users to quit entirely. Health experts caution that although nicotine pouches may help some reduce cigarette use, they could also contribute to prolonged nicotine addiction.

Lack of FDA Approval: The FDA has not approved nicotine pouches as a smoking cessation tool. This sets them apart from established nicotine replacement therapies (NRTs) like patches, gum, and lozenges, which have undergone clinical testing and proven effective for quitting smoking. Without FDA approval, there are no guarantees regarding the safety or effectiveness of nicotine pouches as a long-term solution for smoking cessation.

Limited Research: Despite their growing popularity, research on the long-term effects of nicotine pouches, particularly their role in smoking cessation, remains limited. Current studies suggest that while these pouches may help manage nicotine withdrawal symptoms, they aren't necessarily effective in helping users quit smoking completely. More research is needed to determine their potential as a smoking cessation tool.

Are Nicotine Pouches Safer than Cigarettes?

As of May 2024, the FDA acknowledges that smokeless products like nicotine pouches may reduce exposure to harmful chemicals found in combustible cigarettes. Since nicotine pouches don't involve inhalation, they eliminate the risks of lung damage associated with smoking. However, while these pouches may present a lower health risk compared to smoking, they aren't without potential dangers.

Exposure to Harmful Substances

Though often marketed as tobacco-free, nicotine pouches still deliver nicotine—a highly addictive substance linked to various cardiovascular risks, including increased heart rate and blood pressure. These pouches also contain additives and flavorings whose long-term effects remain unclear. Unlike e-cigarettes, which can expose users to harmful substances through heating elements, nicotine pouches don't involve vaporization, thus avoiding these specific risks. Nevertheless, more research is needed to fully grasp the long-term impact of nicotine pouches on oral and cardiovascular health.

Oral Health Risks

Nicotine pouches can significantly affect oral health. Regular use may cause gum irritation, mouth sores, and eventually, gum recession—exposing teeth to decay and sensitivity. Continuous exposure to nicotine and friction from the pouch can worsen oral issues over time. More severe concerns include the risk of developing leukoplakia—white patches in the mouth that have the potential to become cancerous.

Nicotine pouches are associated with additional oral health concerns, including dry mouth, halitosis (bad breath), and tooth discoloration. The nicotine salts in these products can stain teeth, while chronic dry mouth may increase the risk of dental caries.

Addiction and Dependency

Nicotine pouches are highly addictive, like other nicotine products. Users can swiftly develop a dependence, even without daily use. As consumption increases over time, quitting becomes more challenging. This difficulty is compounded by the marketing of nicotine pouches as a convenient, portable option.

Effects on Brain Development

Nicotine poses a significant risk to adolescents and young adults, as it can impair brain development, particularly in areas responsible for attention, learning, and impulse control. Since the brain continues developing until around age 25, younger users are especially vulnerable to nicotine's long-term effects, including a heightened risk of developing other addictions later in life.

Cardiovascular Risks

Nicotine pouches can elevate heart rate and blood pressure, potentially increasing the risk of cardiovascular diseases like hypertension and heart attacks. While more research is necessary, preliminary studies indicate that regular use of nicotine pouches may pose risks, particularly for individuals with pre-existing heart conditions.

Potential Toxicity and Long-Term Effects

Despite not containing tobacco leaves, nicotine in these pouches remains toxic, especially for pregnant individuals. Prenatal exposure can lead to adverse developmental outcomes. Moreover, while nicotine doesn't directly cause cancer, it can act as a tumor promoter, potentially accelerating the growth of existing cancers.

Nicotine Replacement Therapy (NRT)

The FDA has approved several types of Nicotine Replacement Therapies (NRT). Each offers a unique method of nicotine delivery to help manage cravings and withdrawal symptoms. NRT provides a safer alternative to smoking by delivering controlled doses of nicotine without the harmful chemicals found in cigarettes.

Nicotine Patches

Nicotine patches are transdermal patches that release nicotine slowly over a 16–24 hour period. The nicotine is absorbed through the skin into the bloodstream, helping users maintain steady nicotine levels and reduce cravings throughout the day. This approach is particularly effective in avoiding the nicotine level fluctuations associated with smoking.

• How to Use: Apply the patch to a clean, dry, and hairless area of the body, such as the upper arm or torso. Rotate application sites daily to minimize skin irritation. Wear patches for 16 to 24 hours, depending on the brand, and dispose of them properly.

• Advantages: Nicotine patches are user-friendly, requiring only one daily application while providing consistent nicotine dosing. They're discreet, wearable under clothing, and help break the hand-to-mouth habit associated with smoking.

• Disadvantages: Some users may experience skin irritation. Wearing the patch overnight can cause vivid dreams or sleep disturbances. Additionally, patches deliver nicotine more slowly than other methods, potentially delaying relief from intense cravings.

Nicotine Gum

Nicotine gum is a fast-acting form of NRT that helps control cravings by delivering nicotine through the mouth's mucous membranes. Available in 2 mg and 4 mg doses, it allows users to tailor their nicotine intake based on their level of dependence.

• How to Use: Chew the gum slowly until you feel a tingling sensation, then "park" it between your cheek and gums. Once the tingling fades, chew again. Repeat this process for 20–30 minutes. To ensure proper absorption, avoid eating or drinking for 15 minutes before and during gum use.

• Advantages: Nicotine gum offers quicker craving relief than patches, giving users control over their nicotine intake throughout the day. Its flexibility allows for as-needed use, adapting to individual needs.

• Disadvantages: The taste and texture can be off-putting for some users. Improper use may cause mouth irritation or jaw discomfort. Additionally, it can adhere to and potentially damage dental work, making it unsuitable for certain individuals.

Nicotine Lozenges

Nicotine lozenges are another form of NRT that delivers nicotine orally. These slow-dissolving tablets release controlled doses of nicotine, which is absorbed through the mouth's lining. They come in 2 mg and 4 mg strengths.

• How to Use: Place the lozenge in your mouth and let it dissolve naturally—don't chew or swallow it. Occasionally move it from one side to the other until it's gone, typically taking 20-30 minutes.

• Advantages: Nicotine lozenges are convenient, discreet, and versatile. They offer quick craving relief and can be used as needed in various settings.

• Disadvantages: Some users dislike the taste. Overuse can lead to nicotine overdose, while long-term use may cause mouth irritation and dental issues.

Nicotine Inhalers

Nicotine inhalers deliver nicotine through buccal absorption—via the mouth and throat lining, not the lungs. By mimicking the hand-to-mouth action of smoking, inhalers help users transition away from cigarettes while addressing both physical and psychological aspects of the habit.

• How to Use: Insert a nicotine cartridge into the mouthpiece and take shallow puffs. Each cartridge typically lasts for about 20 minutes of use.

• Advantages: Nicotine inhalers provide quick craving relief and simulate smoking, benefiting those who miss the physical act. They also offer flexible dosing options.

• Disadvantages: Users may experience throat irritation or dislike the taste. Inhalers tend to be pricier than other NRT options.

Combination Therapy

Combination therapy involves using two different types of NRT simultaneously. For example, a long-acting patch provides consistent nicotine levels, while a short-acting option like gum or lozenges addresses immediate cravings. This approach can be more effective for some users.

• Advantages: Combining NRT methods can boost quitting success by tackling both steady nicotine withdrawal and sudden urges. It also lets users fine-tune their nicotine intake to match their specific needs.

• Disadvantages: The primary drawback is cost, as using multiple products is pricier. Moreover, using more than one type of NRT may increase the likelihood of side effects.

Why Use Nicotine Replacement Therapy?

Nicotine Replacement Therapy (NRT) offers significant advantages for those trying to quit smoking. The American Cancer Society reports that, as of June 2024, smokers using NRT are nearly twice as likely to succeed compared to those who attempt to quit unaided. NRT provides a controlled, safer method to reduce nicotine dependence, allowing smokers to gradually wean off their addiction. This approach minimizes withdrawal symptoms and cravings, making the quitting process more manageable and lowering the high relapse rates associated with abrupt cessation.

Extensive research supports NRT's effectiveness in smoking cessation. As of 2018, individuals using NRT are 50–60% more likely to quit smoking successfully compared to those using placebo or no treatment. A 2018 meta-analysis of randomized controlled trials confirmed that NRT significantly boosts the chances of long-term smoking abstinence.

Other FDA-Approved Smoking Cessation Medications

Beyond Nicotine Replacement Therapy (NRT), the FDA has approved two key medications to aid smoking cessation: bupropion and varenicline.

Bupropion: Originally an antidepressant, bupropion also mitigates nicotine withdrawal symptoms and curbs smoking urges. It affects brain neurotransmitters—notably dopamine and norepinephrine—which are implicated in nicotine addiction.

• Dosage and Use: Treatment typically begins 1–2 weeks pre-quit date. The standard dosage starts at 150mg once daily for three days, then increases to 150mg twice daily.

• Potential Side Effects: Common side effects include insomnia, dry mouth, and dizziness. Some users may experience mood changes or increased blood pressure. Rarely, seizures can occur. Caution is advised for individuals with a history of seizures, eating disorders, or heavy alcohol use.

Varenicline: Varenicline targets brain nicotine receptors, simultaneously reducing smoking pleasure and easing withdrawal symptoms. It partially activates these receptors while blocking nicotine from binding to them.

• Dosage and Use: Treatment typically begins one week before the quit date. The regimen starts with 0.5mg once daily for three days, then 0.5mg twice daily for four days, followed by 1mg twice daily for the remainder of treatment.

• Potential Side Effects: Common side effects include nausea, vivid dreams, insomnia, and headaches. Some users report mood and behavior changes, depression, or suicidal thoughts, particularly those with a history of mental health issues. It's crucial to monitor these symptoms and promptly report concerns to a healthcare provider.

Summary

Nicotine pouches are small, tobacco-free products placed between the lip and gum to deliver nicotine. They gradually release nicotine, helping manage cravings without the harmful chemicals found in cigarette smoke. Although not FDA-approved for smoking cessation, these pouches are marketed as a less harmful alternative to cigarettes.

Nicotine pouches pose health risks, particularly to oral health. Prolonged use may lead to gum irritation, mouth sores, and gum recession. Moreover, nicotine's highly addictive nature can prolong dependency, making it challenging for users to quit entirely. Cardiovascular risks, such as increased heart rate and blood pressure, are also concerns, especially for those with pre-existing heart conditions.

While nicotine pouches may help some smokers reduce their cigarette intake, more research is needed to understand their long-term effects. As with other nicotine replacement therapies (NRTs), combining their use with behavioral support, such as counseling, can enhance their effectiveness in smoking cessation efforts.

Resources to Quit Smoking

• Smokefree.gov - Provides tools, tips, and support that can help you quit smoking.

• Centers for Disease Control and Prevention (CDC) - Quit Smoking - Offers resources on how to quit smoking, including tips on quitting, benefits of quitting, and quit plans.

• American Cancer Society - How to Quit Using Tobacco - Provides detailed information on why to quit, how to quit, and dealing with the emotional and physical aspects of quitting.

• Mayo Clinic - Quit Smoking - Features articles, tools, and tips on quitting smoking and overcoming addiction.

• Truth Initiative - Provides innovative tools and resources for young people, including a text-to-quit program.

Glossary

• Nicotine Replacement Therapy (NRT): FDA-approved treatments that provide nicotine in controlled doses, such as patches, gum, lozenges, and inhalers, to help people quit smoking.

• Oral Mucosa: The moist lining of the mouth where nicotine from pouches is absorbed into the bloodstream.

• Gum Recession: A condition where the gums pull away from the teeth, exposing the roots, often caused by irritation or long-term nicotine pouch use.

• Leukoplakia: White patches that can form on the mucous membranes in the mouth, potentially leading to cancer if left untreated.

• Buccal Absorption: The process of absorbing substances through the mucous membranes in the mouth, as with nicotine pouches or gum.

• Tumor Promoter: A substance, like nicotine, that can encourage the growth of existing cancerous cells without causing cancer directly.