Experts concerned over health effects of high-dose nicotine pouches as sales soar in UK

Walk into any corner shop and you’ll see them: colourful tins stacked beside the chewing gum, boasting flavours from frosty berry and lime storm to something called Tomorrowland. Welcome to nicotine pouches – the tobacco industry’s latest diversification strategy. Marketed as “tobacco-free” but packed with nicotine, these small sachets promise a discreet buzz. Sales are rapidly climbing, and UK ministers are considering tighter rules. But are they helping smokers to quit – or hooking a new generation on nicotine? And what else are they doing to people’s health? Nicotine pouches are different from snus – a moist tobacco paste – and vapes, which deliver nicotine via inhalation. These small white sachets contain purified nicotine powder, fillers such as cellulose, plus artificial sweeteners and flavourings. You tuck one under your upper lip, where it mingles with saliva and delivers a rapid hit of nicotine through the oral lining – along with a blast of sweet minty or fruity flavour. They’ve been on UK shelves since about 2019, and are already big business: 92m units were sold in 2022, and sales grew 55% in 2023 – a shift some put down to revamped marketing. “Initially, they were a bit dull-looking, and in the last few years they’ve become very colourful and interestingly packaged, clearly not only appealing to a middle-aged person who smokes, but targeting other, younger age groups,” said Prof Leonie Brose of King’s College London’s nicotine research group. Related: Influencers and freebies: Big Tobacco’s push to sell nicotine pouches in UK Recent research by the group suggests that the share of UK adults who have tried them doubled between 2020 and 2024 to 5.4%, although just 1% use them regularly. Youth use is at a similar level, but awareness may be growing. In a study published this week in Addiction, researchers at the Scottish Centre for Social Research ran focus groups with 14- to 16-year-olds in four schools. Pupils were well aware of nicotine pouches, describing them as easy to access and discreet to use, with some reporting nicotine rushes, sickness or fainting. Teachers, by contrast, were mostly unaware that pupils were using them at all. These findings echo those seen elsewhere. A recent review by Dr Nargiz Travis at Georgetown University in Washington DC and colleagues found that between 35% and 42% of US adolescents and young adults were aware of pouches, and 9-21% of non-tobacco users said they would consider trying them. Health concerns centre on two things: nicotine and the flavourings and sweeteners inside pouches. Nicotine itself doesn’t cause cancer, but it’s a powerful stimulant and highly addictive. “When nicotine receptors are activated, this mediates the release of dopamine in the brain’s reward pathways,” said Prof Barbara Sahakian, a neuroscientist at the University of Cambridge. Pouch nicotine levels range from 1.8mg up to 97.5mg – far higher than the 2-4mg found in nicotine gum. “Even more concerning is that in addition to the total nicotine content being high, they have a very high proportion of freebase nicotine, which facilitates faster delivery into the bloodstream,” said Travis. “This makes them even more effective in delivering higher levels of nicotine compared to cigarettes.” Related: What are nicotine pouches, and are they actually better for you than cigarettes? One fear is that, once hooked, users may transition to more harmful nicotine products – especially as many wrongly believe that it is the nicotine in cigarettes that causes cancer and other diseases. “A key concern is that, because of the misperception that it’s all the same, people will move on to different products that are much more harmful,” said Brose. Young people may be especially vulnerable: their brains have more nicotine receptors in reward-related areas, and animal studies suggest that nicotine exposure during adolescence might increase later use of other drugs or trigger mood or attention issues. “It is especially worrying that children and adolescents are using these nicotine pouches, as their brains are still in development,” said Sahakian. “It is not known what the effects of these nicotine pouches are on the developing brain.” Addiction aside, pouch users report gum irritation and stomach upsets. Nicotine also raises the heart rate and constricts blood vessels, which could be risky for those with heart conditions. But nicotine is not the only concern. Lab studies suggest pouch extracts may trigger stronger toxic and inflammatory effects in human cells than pure nicotine alone – with flavourings the leading suspect – although the implications for human health are still unclear. “We found that in some brands, the amount of artificial flavouring actually increases with nicotine strength – likely to mask harshness and facilitate use,” said Travis. On the other hand, most experts agree that pouches are likely to be significantly less harmful than smoking and could even offer benefits if they help smokers quit. Cigarette smoke contains about 7,000 chemicals, many of them toxic or carcinogenic, whereas pouches typically contain about 180. Crucially, they involve no combustion – eliminating the most dangerous compounds entirely. “We need to remember that cigarettes are sold everywhere completely legally, and they kill 70,000 people a year in England. This doesn’t mean I’m a fan of pouches, but we shouldn’t lose sight of the main enemy,” said Brose. Evidence that pouches help people quit smoking is still thin. A recent Cochrane review found no serious short-term health harms of nicotine pouches in people who smoked, but concluded there are no robust long-term trials showing that they improve quit rates. The real concern is about their use in never-smokers. “A lot of the challenge in regulating in this space is recognising you have a reduced-risk product, but not a risk-free product,” said Prof Jamie Hartmann-Boyce at the University of Massachusetts in Amherst, who led the Cochrane review. “So how do we make sure it’s helping the people it can help, and isn’t harming the people who wouldn’t have otherwise used tobacco or nicotine?” Earlier this week, the UK government announced plans to ban sales of nicotine pouches to under-18s, cap nicotine levels and limit flavours, as part of its wider tobacco and vapes bill. Most experts welcome the move, but restricting flavours may not be straightforward. Brose points to the example of menthol-flavoured cigarettes: even though they are banned for sale in the UK, “a recent study found that when people were asked to smell and use cigarettes, they could very clearly identify some that tasted of menthol,” she said. “So, even when you take out a flavour, you can achieve a similar sensation with different things.” One workaround could be changing flavour labels to something more factual and less fun. “Calling something unicorn vomit or gummy bear, no matter what it tastes like, is clearly youth-oriented,” said Hartmann-Boyce. “You could have gummy bear flavour but call it R-22, and that’s not necessarily going to appeal to young people in the same way.” Standardised or plain packaging could also help. Dr Eve Taylor, Brose’s colleague at King’s College London, recently studied the impact of standardised packaging and toned-down flavour names on adults’ interest in pouches and their perception of harm. Her team found little impact – encouraging news if policymakers want to deter young people without reducing their appeal to adult smokers. The aim, say researchers, is to ensure pouches remain available for those who might benefit, while stopping them looking like sweets. Because, while those pastel tins by the till might seem harmless, they are engineered to deliver one of the most addictive drugs we know. The challenge now is ensuring they do not hook a whole new generation.