COLUMBUS, Ga. (WRBL) — Tobacco-free oral nicotine pouches are on the rise and many institutions are still figuring out how to handle it.
Sales of oral nicotine pouch products in the U.S. increased from just over $126 million in 2019 to just over $808 million in 2022.
“It’s on TikTok, it’s on Snapchat, whatever – all social media … and it’s not stigmatized, whereas cigarettes have become kind of taboo,” said Dr. Rebecca Toland, who teaches entry-level addiction courses as an assistant professor of Health Sciences at Columbus State University (CSU).
While the phenomenon can be observed on a local level, it extends nationwide. Large-scale policy changes could be on the way in the coming months and years at educational institutions, as well as within the military.
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WHAT ARE ORAL NICOTINE POUCHES?
WHO IS USING ORAL NICOTINE POUCHES? WHY?
HOW MUCH NICOTINE? IS IT A PROBLEM?
ARE YOUNG ADULTS UNDER 21 USING?
WHAT ARE ORAL NICOTINE POUCHES?
Unlike other smokeless products like snus and snuff which can also come in pouch form, oral nicotine pouches do not contain tobacco. Instead, these products include nicotine salts, sweeteners and other ingredients. Users place the pouches between their lip and gum for up to an hour, then dispose of the pouch. These products are small and slim, so are nearly imperceptible when in use.
Importantly, oral nicotine pouches are not considered a form of nicotine replacement therapy (NRT) used to quit smoking, such as nicotine patches or gums.
WHO IS USING ORAL NICOTINE POUCHES? WHY?
According to Toland, tobacco-free nicotine pouches – including popular brands like Zyn, On! and Velo, amongst others – are becoming increasingly popular amongst young adults in a way that cigarettes and other nicotine-containing products have not.
It is illegal to sell tobacco products to people under the age of 21 in the U.S., and many retailers follow the same regulations for oral nicotine pouches. Official websites for popular brands often include age-verification firewalls or require registration to access their storefronts.
For the holidays, popular accounts like Whiskey Riff, followed by over 650K on Instagram, shared memes about “Zynmas.” These often featured hundreds of oral nicotine pouch containers arranged like Christmas lights or trees. Year-round, countless posts about these products circulate the “For You” pages and feeds of millions of social media users, ranging from ironic humor to advertisements.
Part of the oral nicotine pouch appeal is due to a perceived sense of safety, Toland explained, since these products can provide a nicotine hit without the presence of tobacco, a known carcinogen. Additionally, Toland suspects part of the popularity may come from the variety of flavors available, targeted ads, discretion and availability.
For one 25-year-old Army officer currently working at Fort Moore, Ga., the use of these products – most commonly, Zyn — is ubiquitous among his ranks. The officer, who asked to remain anonymous, estimated at least 75- to 80% of his coworkers, mostly in their 20s but some older, regularly use tobacco-free nicotine pouches.
“If I was to go up to some random guy that I work with and be like, ‘Hey, you got a Zyn on you?’ Nine times out of 10 they’ll get out that little thing that Zyns are in and give me one,” he said.
The officer explained he switched to Zyn products two years ago, partly as a way to quit vaping. He admitted he understands little is known about the effects of long-term usage for either product type.
The non-teeth-staining quality of Zyn relative to other tobacco products and lack of smoke-related side effects were also draws, the officer said.
That, and the fact Zyn and similar products are readily available for purchase at gas stations, grocery stores and more.
“Say you’re leaving the bar at 2 a.m., the gas station’s always open,” said the officer. He continued, “It’s the ease of access of the stuff [that] makes it hard to break because it’s … always right there.”
Although the officer explained he someday hopes to stop using oral nicotine pouches, he hasn’t yet, partly due to the difficulty of nicotine withdrawal symptoms. At this point, he said he would only stop using if his wife found his habit so concerning that she asked him to quit.
By his own estimate, the officer goes through one 15-pouch Zyn container every two days. At about $4 per container, the officer explained his usage of oral nicotine pouches was most concerning to him from a monetary perspective at this time.
HOW MUCH NICOTINE? IS IT A PROBLEM?
Zyn products come in varieties containing either three- or six milligrams of nicotine per pouch. Other brands’ nicotine content ranges from less than two milligrams up to 12 milligrams.
By comparison, a single cigarette contains roughly 12 to 15 milligrams of nicotine, however only 1- to 1.5 milligrams of that is actually absorbed by the user, according to Medical News Today.
Nicotine is the highly addictive chemical from the tobacco plant which makes it difficult to stop smoking, vaping or using any other tobacco products.
In young people, it can be even more addictive, according to Toland. She added social media may be making oral nicotine pouches appeal to populations which may not have otherwise been attracted to nicotine-containing products as they are influenced by peers or icons on social media.
Oral nicotine pouch use could be a slippery slope, Toland explained. If someone runs out of pouches, they might turn to vapes, cigarettes or other tobacco-containing products in order to achieve the effects commonly associated with nicotine use.
In the short term, nicotine can provide a sense of stress- and pain relief, as well as increased focus, according to Medical News Today. It also releases dopamine, which reinforces the desire to keep using nicotine, the site explains.
As use becomes more frequent, people may experience withdrawal when not using nicotine-containing products, Medical News Today states. Over time, users may also experience declines in cognitive abilities, which Toland likened to the brain-fog experienced by long COVID patients.
WHAT ARE INSTITUTIONS DOING?
Although CSU, where Toland is a professor, became a smokeless and tobacco-free campus more than a decade ago, tobacco-free oral nicotine pouches currently fall into a no man’s land of sorts. Since they contain synthesized nicotine without tobacco and are subtle to use, these products are difficult to regulate on campus, Toland said.
But the current lack of regulation did little to mitigate the professor’s concern. She pointed out that these pouches are not regulated by the FDA in the same way as other nicotine-containing products. With little research surrounding long-term usage there could be significant risk, she said.
According to Toland, the products make nicotine poisoning more likely because of their nicotine concentration. She added that she would “almost bet” oral nicotine pouches may come to be associated with mouth-related issues, possibly even cancer, down the road.
From a military standpoint, these products are also a concern. Although policies to-date focus on tobacco-containing products – rather than nicotine products without tobacco – that is soon to change.
In response to an email query, Cory Fitzgerald, the Tobacco Policy Lead with the Defense Centers for Public Health – Aberdeen (DCPH-A), said, “YouCanQuit2, the online DOD [Department of Defense] educational campaign to help service members quit tobacco, is presently updating materials that address electronic cigarettes and synthetic nicotine.”
Fitzgerald also addressed greater concerns voiced at the highest levels of the U.S. military about tobacco use, referring to a joint statement from 2019, which reports “[m]ore than one-third of servicemembers who use tobacco products started after joining the military.”
He added that nicotine pouches are “problematic” since they are marketed as “tobacco-free” because they do not contain leaf tobacco but can still negatively impact the health of users. Fitzgerald stated tobacco and nicotine pouch use is harmful to military members, their units, families and communities as it reduces physical capabilities and increases risk of illness.
He also highlighted that U.S. Surgeon Generals are especially concerned about tobacco and nicotine product use among young people in middle- and high school who may someday become servicemembers.
ARE YOUNG ADULTS UNDER 21 USING?
Middle- and high-schoolers are using oral nicotine pouches.
“I have seen the adolescent age group using those products, and it’s much more common than it would have been in years past,” said Ashley Morgan, a clinician at Columbus’ Pastoral Institute who was most concerned about oral nicotine pouch usage among those aged 16 to 21.
In 2022, the Centers for Disease Control and Prevention (CDC) surveyed U.S. youth and found just over 1% of middle- and high schoolers had used oral nicotine pouches.
In her practice Morgan has worked with multiple young clients dealing with addiction to these products. She worries about nicotine’s ability to cause feelings of anxiety and depression in young adults, despite initial usage causing the opposite effect.
As of now Morgan isn’t sure what will happen in terms of future adolescent nicotine pouch usage. She is, however, nearly certain research will find that young users will become more likely to use nicotine products throughout their lifespans, although not necessarily by smoking.
