The rise of nicotine bags: a new challenge for public health?
Source: Dr Becky Freeman (United Kingdom)
For decades, it has been widely recognized that smoking is extremely harmful and that quitting, or never starting, is one of the most effective actions to protect your health. Governments around the world have taken comprehensive steps to marginalize smoking, making it less socially acceptable and exposing its dangers as a deadly addiction.
High tobacco taxes, graphic visual warnings on packets, smoking bans in workplaces, and an end to glamorous cigarette advertising campaigns have all helped reduce smoking rates. According to the Office for National Statistics, in the UK, 12,9% of the adult population currently smokes, down from around 30% in the early 1990s, a significant reduction. Tobacco control policies have undoubtedly been a public health success.
However, nicotine addiction remains a lucrative business. The tobacco industry did not disappear silently but instead began manufacturing and marketing a new generation of products primarily targeting young people. Disposable and flavored e-cigarettes, heated tobacco products, and now, the industry's latest innovative development: nicotine pouches.
Nicotine pouches are typically sold in small, round plastic containers that fit easily in a pocket or purse. The pouches themselves look like tiny tea bags and contain plant fibers, sugars, flavorings and of course nicotine. This nicotine can be synthesized in the laboratory or extracted directly from the tobacco plant. The pouches come in a wide range of flavors, from fruits and berries to candy and even cocktails, and in various nicotine strengths, some containing more nicotine than a typical cigarette.
The small pockets are placed between the lip and gum so users can absorb the nicotine orally. Once all the nicotine is absorbed, users simply remove the pouch and replace it with a new one. The pouches are very discreet, smell good and, unlike some oral tobacco products like chewing tobacco, do not require users to spit out the used product.
Although the pouches are a relatively new product, they are very similar to Scandinavian “snus”. However, while snus contains tobacco, the pouches do not. This distinction is important because it often allows pouches to escape the strict regulations applicable to tobacco products and cigarettes.
This lack of regulation means that pouches, unlike cigarettes, can be legally sold to under-18s in the UK. Other countries, such as the United States, have already taken steps to ban pouches outright or restrict their sale to adults only.
What are the health risks associated with nicotine pouches?
Although nicotine pouches are growing in popularity globally, there is little data to assess their health risks, given that they have only recently been on the market. Nevertheless, the World Health Organization recommends a precautionary approach to the sale and promotion of pouches, prioritizing the health of young people.
We know that the use of pouches results in exposure to toxic nicotine, which can lead to nicotine addiction and potentially encourage the use of other products such as e-cigarettes or traditional cigarettes. In addition to addiction, nicotine has negative effects on the brain development of adolescents, particularly on learning abilities. In large doses, nicotine can cause dizziness, headaches, nausea, and abdominal cramps, especially in people who have never been exposed to nicotine before.
Comparing the health effects of nicotine pouches, e-cigarettes and tobacco products and judging some products “safer” than others can be tempting. However, with more than 85% of the UK population not smoking at all, there are no health benefits if young people who have never smoked start using pouches. Additionally, there is currently no evidence to suggest that pouches are an effective way to quit smoking or vaping. Instead, smokers or vapers could simply use pouches in situations where they cannot smoke or vape, such as on an airplane, at school or at work, thereby increasing their total nicotine consumption.
The global cigarette market is controlled by a handful of multinationals, and two of the biggest players, British American Tobacco and Philip Morris International, manufacture and market nicotine pouches. In a manner reminiscent of old cigarette advertisements, pouches are promoted through motorsport, celebrity endorsements and various lifestyle marketing techniques. The tobacco industry has proven its great skill in marketing harmful and addictive products to young people, and with so few restrictions on the promotion and sale of pouches, there is a real danger that pouch use and addiction to nicotine are increasing rapidly among young people.
