Are Your Adolescent Patients Using Oral Nicotine Pouches?

Jennifer Middleton, MD, MPH
Posted on January 29, 2024

Last week, Chuck Schumer, the U.S. Senate Majority Leader, called for the U.S. Food and Drug Administration (FDA) to investigate companies that produce oral nicotine pouches. The most well-known oral nicotine patch product in the United States is Zyn, which Schumer alleges is targeting U.S. youth to addict their still-forming brains to nicotine products. Although many in Congress expressed disinterest in tackling this topic (it is an election year in the United States and alienating Gen Z Zyn users could backfire), family physicians should be aware of the growing prevalence of these products’ use in teens and young adults.

Sales of oral nicotine pouches such as Zyn, On!, and Velo have more than quadrupled in the United States since 2019. The pouches contain nicotine—but no tobacco (unlike snus)—and come in a variety of flavors, including mint, cinnamon, and fruit. The small, soft pouches are tucked between the cheek and gum and are discreet. Fewer members of the generally risk-averse Gen Z have smoked cigarettes compared with other generations, and these products may appeal, with a texture and use similar to the candy and gummies they are familar with. Because oral nicotine patches do not contain tobacco, they are likely safer than carcinogen-riddled tobacco products, but they have also yet to be studied regarding long-term effects; mouth soreness and mouth ulcers have been reported in a small number of users to date. The most dangerous known risk of using these products, especially in teens and young adults, is the exposure to nicotine:

Teens are particularly vulnerable to addiction, because their brains aren’t fully developed... “We don’t know what the end result of what a young person using nicotine pouches is — we don’t know if they would just stay using nicotine pouches until they quit, or if they start seeking other forms of nicotine that might have faster nicotine delivery, like a cigarette."

Family physicians should screen adolescents and young adults for the use of any nicotine-containing product, including oral nicotine pouches, vaping, and disposable e-cigarettes. We can nonjudgmentally inform them of the risks and unknowns about these products and provide guidance if they wish to quit. The AFP By Topic on Tobacco Use and Dependence includes several useful references, including an article, “Reducing Tobacco Use in Adolescents,” and a Cochrane review, “Behavorial Interventions for Tobacco Cessation.” Nicotine is the addictive substance in all of these products, and both of these AFP pieces pertain to users of oral nicotine pouches. Finally, we can contact our representatives in Congress (find yours here) and let them know that marketing candy-flavored nicotine products to teenagers is unacceptable—regardless of whether it’s an election year.