What to know about nicotine pouches
January 16, 2025
Medically Reviewed | Last reviewed by Jennifer Cofer, Dr.P.H., on January 16, 2025
Nicotine pouches first became available in the U.S. almost a decade ago. Today, they are the second most used tobacco product among high school students, according to the 2024 National Youth Tobacco Survey, with 1.8% of respondents having used nicotine pouches in the past 30 days.
And recently, nicotine pouches have been in the headlines after the Food and Drug Administration (FDA) approved an application allowing some to be marketed in the United States.
So, what are these products, how do they affect health and why are they becoming so popular? To learn more, we spoke with Jennifer Cofer, Dr.P.H., who directs MD Anderson’s EndTobacco™ Program. Read on for six fast facts about nicotine pouches.
Nicotine pouches are a smokeless, spitless product
While nicotine pouches are considered a tobacco product, they don’t actually contain tobacco. Instead, these small white pouches are made of a type of plant fiber called cellulose. Inside each pouch is a blend of nicotine powder, sweetener, flavoring, pH stabilizers and other fillers. Users place nicotine pouches between their lip and gum allowing nicotine to enter the bloodstream. Unlike other tobacco products, there’s no smoking or spitting involved, Cofer explains.
“That's what this new product is touting: that it's a smoke-free alternative,” she says.
Nicotine pouches are linked to health issues
Since nicotine pouches don’t contain tobacco, does that mean they are healthier than other tobacco products? Not exactly. “We wouldn't use the word healthier,” Cofer says.
While nicotine pouches may have fewer ingredients than cigarettes and other smokeless tobacco products, studies have found hazardous substances and possible carcinogens in some nicotine pouches, Cofer says.
Here she shares more about how nicotine pouches impact health.
Nicotine is addictive
Nicotine is harmful and leads to nicotine addiction, Cofer says. This is why she encourages people who have never used tobacco not to start using any tobacco product, including nicotine pouches.
Nicotine disrupts brain development
The human brain develops until age 26. Nicotine use can disrupt this process.
Nicotine impacts the cardiovascular system
Nicotine may affect your heart health if you have or are predisposed to heart disease.
Nicotine may cause oral health issues
Right now, there isn’t data on how nicotine pouches impact oral health. However, Cofer notes that it is possible that nicotine pouches could cause the same types of oral health issues as other smokeless tobacco products, including cavities, gum recession and lesions that could become pre-cancer or cancer.
“Being a new product and not having the exact same ingredients, the verdict is still out. This will be studied for years to come,” she says.
It’s hard to know exactly how much nicotine these products contain
How much nicotine do nicotine pouches contain? The answer is less clear than you might expect.
In the U.S., common nicotine pouch dosages range from 1.5 milligrams per pouch to 12 milligrams per pouch. Internationally, however, studies have been done on pouches containing as much as 47.5 milligrams per pouch.
So, how does that stack up against other tobacco products?
One study found that smoking one cigarette resulted in 11.4 nanograms per milliliter of nicotine in the blood after 30 minutes, while using one 6 milligram nicotine pouch left 17.5 nanograms per milliliter of nicotine in the blood after 30 minutes.
Additionally, nicotine pouches that contain more than 6 milligrams of nicotine may provide users with more nicotine than other conventional tobacco products such as chewing tobacco, Cofer adds.
“Depending on the choice they use, they could have more nicotine than the traditional tobacco products sold currently,” she says.
They aren’t the best choice for tobacco cessation
Because nicotine pouches don’t contain tobacco, they may seem like a good option for people looking to cut down on or quit tobacco products.
In January 2025, the FDA approved a premarket tobacco product application which allows some types of nicotine pouches to be marketed in the United States.
This decision meant that the FDA found the approved nicotine pouches to be a less harmful alternative to cigarettes or smokeless tobacco for adults already using those products. What this approval doesn’t mean, however, is that nicotine pouches are safe for everyone. For young people or people who don’t already use tobacco products, using nicotine pouches could begin a nicotine addiction, Cofer says.
This sentiment is reflected in the FDA’s press release, which says the approval “does not mean these tobacco products are safe, nor are they “FDA approved.””
Another important note is that right now, these nicotine pouches are only approved by the FDA for marketing – not tobacco cessation. If you want to quit smoking or using tobacco products, Cofer recommends speaking to a physician and considering FDA-approved nicotine replacement therapies, such as gum, patches or lozenges.
“If your goal is to be free of the addiction, oral nicotine pouches are not the best way to go,” she says.
New products are designed to attract new tobacco users
While nicotine pouches seem like a relatively new tobacco product, they are far from an unknown one. In fact, Cofer says that many young people are likely already familiar with nicotine pouches.
“If they are between a 13- and a 30-year-old, they've already seen the white pouches in their friends or circles that they hang out with,” she says.
She believes that is due, in part, to the marketing strategies of the giant tobacco corporations. These marketing efforts draw on the same strategies used to market cigarettes and smokeless tobacco products and include social media, print and digital advertising, event sponsorships, incentive plans and giveaways.
So, while the product being sold may be newer, Cofer believes the end goal remains the same: to create a new generation of tobacco users.
“If we want to have a tobacco-free generation, we should also talk about a nicotine-free generation because nicotine is the addictive ingredient found in these tobacco products,” she says.
There’s still a lot we don’t know about their long-term use
In the coming years, researchers will continue to explore the health impact of nicotine pouches, Cofer says.
For now, she hopes that sharing what we do know about their health risks and the addictive properties of nicotine may be reason enough to avoid these products.
“These are not risk-free products,” she says.
Request an appointment at MD Anderson online or call 1-877-632-6789.
These are not risk-free products.
Jennifer Cofer, Dr.P.H.
Executive Director, EndTobacco™