Last year, Jessica Kent, a doctor working in the department of emergency medicine at the University of Toronto, found herself with an unusual patient. Confused, nauseous, and slumped on the floor of the emergency department, readings showed that his blood pressure had soared to levels far higher than would be expected for an otherwise healthy 21-year-old university student. When medical staff attempted to ask some simple questions, his responses were nonsensical.
But this patient wasn’t drunk or high on narcotics. It would later transpire that these symptoms were the consequence of a binge on nicotine pouches. While studying, the man had used 15 extra-strength pouches in the space of just 12 hours.
It was the second such incidence of nicotine pouch-induced toxicity that Kent had seen, and she felt compelled to publish it as a case study. “My colleagues have observed additional cases, suggesting this may be a growing trend,” she says. “My patient was not aware of the risk of multiple pouch use as he thought it was ‘just nicotine’ which is a common sentiment. But nicotine can induce a spectrum of symptoms, depending on how high the dose is, varying from mild agitation and jitteriness to severe confusion, vomiting, respiratory compromise [a state in which patients are at risk of lung failure] and death.”
Kent suggests it may be too early to tell whether we’re about to see a spike in cases of nicotine toxicity, as has previously been seen with vaping, but use of nicotine pouches is on the rise on both sides of the Atlantic. In January, a new study from King’s College London reported that the number of UK adults using nicotine pouches has doubled in the past four years.
First introduced to the UK in 2019, these pouches have become an enormously popular mass-market alternative to snus, a Swedish tobacco product which comprises finely ground tobacco in a dissolvable pouch, designed to be placed between the lips and gums and absorbed into the mouth. However, snus is subject to a complex legal landscape in this country: buying and selling it is illegal, while being in possession of it for personal use remains within the law.
But what the UK’s teens are using are nicotine pouches, often described as ‘white snus’ or ‘tobacco-free snus’ or often misleadingly described as ‘snus’ for short, circumvent existing regulations as they do not contain tobacco leaves, only flavoured nicotine powder (not to be confused with ‘snuff’ which is powdered tobacco inhaled through the nose).
Research shows that both snus and nicotine pouches have become popular with professional footballers in the UK. A 2024 survey of nearly 700 active players, across the men’s and women’s game, conducted by Loughborough University in partnership with the Professional Footballers’ Association, revealed that nearly one in five male players currently use these products to unwind from the adrenaline of a game or on days off.
However, many reported symptoms of nicotine dependence, including cravings, irritability and restlessness with more than half expressing a desire to quit in the next year.
What exactly are nicotine pouches?
To comply with UK law, nicotine pouches currently commercially available do not contain tobacco. Instead, they contain concentrated nicotine in the form of a flavoured powder, delivered in a pouch made of dissolvable microfibres which can be placed in the mouth.
Marketing and promotional campaigns for these products typically target the young. Last summer, the brand Nordic Spirit partnered with some of the UK’s leading festivals, so they could be being widely handed to your teens without you even knowing.
What’s inside the pouches?
“Unlike [the Swedish] snus, these new [nicotine] pouches do not contain tobacco leaf,” says Sophie Braznell, a researcher at the University of Bath Tobacco Control Research Group. “Inside is a mixture of dehydrated nicotine, water, cellulose, flavours, additives and sweeteners.”
Reports suggest that pouches can contain between 2 and 20mg of nicotine, although trading standards teams across the UK have reported a rise in illegal high-strength versions, some of which claim to contain up to 150mg of nicotine. By comparison, a smoker will typically absorb between 1 and 2mg of nicotine from a single cigarette, although cigarettes also contain a plethora of additional carcinogens and toxic chemicals.
How does it differ from smoking and vaping?
- It’s more discreet
- There is no tobacco, unlike cigarettes
- Nicotine is absorbed between the lip and gum, rather than inhaled through vapour
- There are fewer harmful toxins than cigarettes
What are the side effects?
According to Dr Tory Spindle, an associate professor at Johns Hopkins University School of Medicine, some of the most well-known side effects of using nicotine pouches relate to their impact on oral health.
One review paper published last summer found that users can experience symptoms ranging from:
- A dry mouth
- Gum lesions or blisters
- Unusual jaw sensations
- Some users have reported developing receding gums
“This is likely due to prolonged contact between the pouch and gums,” says Dr Spindle. “It is unclear if these effects are driven solely by nicotine, or if other constituents in the pouches aside from nicotine may be contributing, which is likely the case.”
However Dr Spindle says that the prevalence and severity of side effects depends on the strength of the pouches and how regularly they are used. “There’s other acute adverse effects of nicotine such as nausea, light-headedness, and increased heart rate,” he says. “As with any nicotine product, more frequent use or higher doses exacerbates these concerns.”
How easy is it to become addicted to them?
They can be very addictive by nature of their ease and subtlety of use and because of who they are marketed to.
At February’s NCD Alliance Forum which examined factors contributing to the rising prevalence of chronic diseases, the Global Alliance for Tobacco Control (GATC) cited nicotine pouches as one of a suite of new products developed by the tobacco industry with the potential to drive nicotine addiction among the younger generations.
“We’re really concerned that this is another insidious attempt by the tobacco industry to just keep people addicted, particularly young people,” says Kylie Lindorff, a director at the GATC. “They’re highly flavoured and clearly trying to appeal to children.”
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