We’ve known for decades that smoking is incredibly harmful and that quitting smoking, or never starting in the first place, is one of the single most effective things you can do to protect your health.
Governments around the world have taken comprehensive action to push smoking out of the circle of normal and socially acceptable behaviours and to expose it for what it truly is: a deadly addiction.
High tobacco taxes, graphic visual warnings on packages, bans on smoking in workplaces, and the end of glamorous cigarette advertising campaigns have all played a part in bringing smoking rates down.
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According to the Office For National Statistics, in the UK, 12.9 per cent of the adult population currently smokes. This compares to about 30 per cent in the early 1990s, a significant reduction. Tobacco control has without doubt been a public health success story.
But nicotine addiction is also very big business. The tobacco industry has not quietly faded into the background, but instead is manufacturing and marketing a whole new generation of products aimed primarily at young people. Flavoured, disposable e-cigarettes or vapes, heated tobacco products, and now the industry’s latest novel product development: nicotine pouches.
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Nicotine pouches are typically sold in small, round, plastic containers that fit easily into a pocket or purse. The pouches themselves look like miniature teabags and are filled with plant fibres that act as a filler, sugars, flavours, and of course nicotine.
The nicotine can be either manufactured synthetically in a lab or extracted directly from a tobacco plant. Pouches come in a wide range of flavours from fruits and berries to sweets and even cocktails. They also come in a variety of nicotine concentrations, with some pouches containing more nicotine than a typical cigarette.
The small pouches are placed between the lip and the gum so that users can absorb the nicotine in their mouths. Once all the nicotine has all been absorbed, users simply remove the pouch and replace it with another one. Pouches are very discreet, smell pleasant and unlike some oral tobacco products such as chewing tobacco, do not cause users to spit out the used product like cowboys in old Western movies.
While pouches are a relatively new product, they are very similar to Scandinavian ‘snus’. But whereas snus contains tobacco, pouches do not. This distinction is important, as it means pouches often slip through regulatory black holes such that the laws and rules that apply to tobacco products and cigarettes, don’t apply to pouches.
This lack of regulation means that pouches, unlike cigarettes, can be legally sold to people under the age of 18 in the UK. Other countries, like the US, have already taken the move to outright ban pouches or have restricted their availability to adults only.
What do we know about the health risks of pouches?
While nicotine pouches are rising in popularity globally, as they have only been on the market a short time there is not much data available to assess their risks to health. Noting this, the World Health Organisation does, however, recommend a precautionary approach to allowing the sale and promotion of pouches that prioritise the health of young people.
We do know that using pouches results in exposure to toxic nicotine, which can lead to nicotine addiction and may also encourage and facilitate the use of other products like vapes or cigarettes.
In addition to addiction, nicotine has negative effects on adolescent brain development, including on learning outcomes. In high doses, nicotine may cause dizziness, headache, nausea and abdominal cramps, especially among people who have never been exposed to nicotine before.
It can be tempting to try to compare the health effects of nicotine pouches, vapes, and tobacco products and deem some products ‘safer’ than others. But with over 85 per cent of the UK population not smoking at all, there are no health benefits to be gained if young people who have never, and would never have, smoked start using pouches.
There is also no evidence currently available to suggest that pouches are an effective aid to quitting either smoking or vaping. Instead of quitting, people who smoke or vape may just use pouches during occasions when they can’t readily smoke and vape, like on a plane, at school, or at work, and so end up consuming more nicotine.
The global cigarette business is controlled by just a handful of multi-national companies, and two of the biggest players, British American Tobacco, and Philip Morris International, manufacture and market nicotine pouches. In a way reminiscent of old cigarette ads, pouches are being promoted through motorsport, celebrity endorsements, and various lifestyle marketing techniques.
The tobacco industry has proven itself highly adept at marketing harmful and addictive products to young people, and with so few limits on the promotion and sale of pouches, there is a real danger that pouch use, and nicotine addiction, could rapidly increase among young people.
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