What is an Oral Nicotine Pouch?

Oral nicotine pouches(ONPs) contain a powder made of nicotine, flavorings, and other additives. They are placed between the cheek and gum to allow the powder to dissolve, and the nicotine is absorbed through the gums or lining of the mouth (see here for more details). Many people do not know that products like ONPs have nicotine in them, since they look like a pack of gum or candy (Figure 1).

ONPs are advertised as being tobacco-free since they do not contain leaves from the tobacco plant. However, this is misleading because they still contain nicotine, a chemical made from tobacco leaves. A synthetic form of nicotine can also be produced in a lab.

Why is Nicotine so Bad?

The structure of nicotine is the same as acetylcholine, which is a type of communication molecule called a neurotransmitter, naturally present in the body. Each neurotransmitter has a specific protein that it binds to, called a receptor. The binding of a neurotransmitter to its receptor is similar to a key connecting with a lock (Figure 2). When acetylcholine binds to its receptor, it increases brain activity such that messages are sent to various parts of the body. Nicotine, therefore, acts as a stimulant, meaning it can make people feel more alert, awake, or energetic. Depending on the amount of nicotine a person is exposed to, it can also increase a person’s focus or talkativeness, or decrease their appetite. Too much nicotine can make people sick, and can lead to headaches, stomachaches, anxiety, and dizziness. Nicotine also plays a role in memory and learning.

Since the nicotine in ONPs is rapidly absorbed into the body, effects typically only last 30 min or less—which often leads people to use ONPs frequently. After repeated use, the brain’s receptors get used to nicotine flooding the brain. When the nicotine is gone, such as when someone tries to stop using ONPs, those empty receptors can cause the brain to feel the effects of withdrawal. Withdrawal symptoms can include irritability, difficulty concentrating, trouble sleeping, or intense cravings to use nicotine again. Nicotine can be addictive, especially for teenagers and young adults whose brains are still developing. Because nicotine is addictive and leads to withdrawal symptoms, it can be hard to stop using ONPs. In 2024, almost 500,000 students reported that they were currently using nicotine pouches, with more than 20% of those students reporting daily use.

How do ONPs Compare to Other Nicotine Products?

Cigarettes can range in nicotine content, but the body typically absorbs a little more than 1 mg of nicotine from one cigarette. Therefore, one pack of 20 cigarettes results in about 22–36 mg of nicotine absorbed into the body. Studies have shown that even smoking one cigarette per day can put you at an increased risk for death [1].

ONPs can also have varied nicotine content. The most common ONPs are labeled as having 3–15 mg of nicotine per pouch, but some ONPs can contain up to 65 mg nicotine in a single pouch! The body absorbs roughly 1 mg of nicotine from a 6 mg-labeled nicotine pouch. This means that people who use a full tin (commonly consisting of 15 pouches) of 6 mg-labeled ONPs could be exposed to more nicotine in a single day than what is present in a full pack of cigarettes (Figure 3). Furthermore, in a 2021 survey of over 20,000 middle and high school students, over 50% used ONPs along with another tobacco product, potentially leading to very high levels of nicotine consumed [2].

While ONPs do not contain some of the harmful chemicals found in cigarettes, they still contain additional chemicals such as nitrosamines that can increase a person’s risk of cancer. In a study examining 44 different ONPs, 26 of those products had nitrosamines in them [3].

Why do People Use ONPs?

ONP manufacturers are using some of the same tactics as e-cigarette companies to get young people hooked on their products, including marketing ONPs as a method to help people quit smoking. Advertisements featuring young people and appealing flavors, like strawberry, grape, or orange, have led to many teenagers using e-cigarettes or ONPs as their first nicotine product. Out of those who have tried ONPs, eight in 10 have used flavored pouches [4]. In a study looking at the marketing campaigns of the five biggest ONP brands, 40% of the ads for VELO included young people, and 35% of the ads for ZYN featured young people [5].

ONPs are also being marketed as discreet, meaning they can be used easily without being seen. They come in small containers, do not produce smoke or vape, and unlike prior chewing tobacco products, ONPs do not require spitting. You may have even seen #Zynfluencers on TikTok talking about “Zynning” and glamorizing using ZYN to other young people. These social media accounts often do not talk about the harms of ONP use, and sometimes they say things that are actually false. In reality, ONPs can cause gum irritation, mouth lesions, a sore throat, nausea and stomachache, as well as nicotine addiction [6].

Flavored ONPs often appeal to young people. In a study done in 2024, nearly 88% of middle and high school students used flavored e-cigarettes, and research on ONPs demonstrates similar findings—most young people are attracted to flavored ONPs, not unflavored products [7]. Many cities and states have banned flavored tobacco products from being sold. Unfortunately, some ONP manufacturers try to hide the nicotine taste in their products by adding artificial sweeteners instead of flavors. By using synthetic sweeteners, ONP companies claim they do not have a “characteristic flavor”, and they argue that the rules of the flavor ban do not apply. Common “flavor ban approved” products of ZYN include ZYN Smooth and ZYN Chill, which are advertised as unflavored but widely recognized as still being sweetened or having a cooling effect.

How can People Quit Using Nicotine?

Quitting nicotine can be tough, but the U.S. Food and Drug Administration has approved medications to help people stop using nicotine, such as nicotine patches and nicotine gum or lozenges. These medicines are called nicotine replacement therapy and they can be helpful for people of any age. Nicotine replacement therapy does not contain the toxic products and chemicals present in ONPs. Instead, these products deliver nicotine in a safe way, so that people trying to quit do not have withdrawal symptoms. Replacement therapy helps people use less and less nicotine over time, alongside help from a doctor. Other medications, such as varenicline, which is a pill, can also be used to help young people quit using nicotine [8].

In summary, ONPs contain harmful chemicals and can contain high levels of nicotine, which is incredibly addictive. If you or someone you know would like more information about how to quit using nicotine, ask a parent, teacher, counselor, or your doctor!

Glossary

Oral Nicotine Pouches: ↑ A pouch placed between the cheek and gums, consisting of nicotine, flavorings, and other additives.

Nicotine: ↑ An addictive chemical that is naturally produced in tobacco plants and binds to acetylcholine receptors, acting like a stimulant in the body.

Acetylcholine: ↑ A neurotransmitter, or communication molecule, that plays an important role in processes involved in memory, thinking, and movement.

Neurotransmitters: ↑ Communication molecules in the body that signal by binding to receptors, like a lock and a key.

Withdrawal: ↑ Unpleasant physical or mental effects one feels when stopping usage of a substance the body has become used to.

E-cigarettes: ↑ Also known as vapes; battery-operated devices that heat a liquid containing nicotine and other additives, producing a gas that can be inhaled.

Nicotine Replacement Therapy: ↑ Treatment consisting of nicotine patches, gum and lozenges used to help one to stop using nicotine.

Conflict of Interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

AI Tool Statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

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