Nicotine pouches like Zyn, Velo, and On! have emerged as the latest nicotine delivery trend, particularly among younger demographics. They’re quickly gaining traction; dollar sales of oral nicotine pouches increased by 305% from 2016 to 2020, according to one study. Unlike traditional tobacco products, the small, discreet pouches contain nicotine derived from tobacco but no actual tobacco leaf, so some users view them as a “cleaner” alternative to cigarettes and vaping.
Additionally, in many countries—including the U.S.—the marketing and regulation of nicotine pouches have historically been less strict than cigarettes or vaping devices, contributing to easier youth access and ongoing regulatory uncertainty.
The medical community’s response to nicotine pouches reflects broader questions about harm reduction, youth protection and the role of alternative nicotine products in public health. As these products gain mainstream acceptance and regulatory scrutiny, physicians are navigating how to discuss potential health implications with patients.
Nicotine pouches in teens & young adults
The rise of nicotine pouch use among younger patients has caught many physicians’ attention. The aforementioned study found that among U.S. adolescents and young adults (up to age 24) surveyed from December 2021 to May 2022, 16% had used nicotine pouches at some point, and 12% were current users. The study revealed that current users were more likely to be aged 21 and older, male, and from lower-income backgrounds. Socioeconomic status can dictate access to healthcare, and some nicotine pouch users may not receive health services that would include counseling on nicotine use.
Perhaps most concerning to clinicians is the pattern of concurrent use. The research showed that 73% of current nicotine pouch users also reported current cigarette smoking, suggesting these products may not be replacing traditional nicotine delivery but rather adding to it.
Physicians on Sermo have observed this rise in nicotine pouches firsthand. In a Sermo community poll, 32% said they’ve seen frequent pouch use in the last year, and 31% said young adults (aged 18-24) are the most common user group.
“We’re starting to see more teens using nicotine pouches—often thinking they’re harmless because they’re ‘tobacco-free,'” notes a hematologist on Sermo. Unlike cigarettes or even vaping devices, nicotine pouches can be used virtually anywhere without detection, making it difficult to identify and address problematic use patterns among young people.
“Sweet flavors are attracting first-time users, including teens,” writes a general practice resident on Sermo, speaking to another reason that these products may appeal to younger users. The authors of one study argued that the novel flavors, along with “tobacco free” marketing claims may appeal to young people who’ve never had nicotine before, and ultimately lead to dependence.
Do nicotine pouches contribute to harm reduction or form a new addiction?
The medical community remains divided as to whether nicotine pouches have some benefit as a cigarette cessation tool, or whether they’re solely a new pathway to addiction. This uncertainty reflects the broader challenge of evaluating novel tobacco products without long-term safety data.
Polling reveals that physicians on Sermo are uncertain about nicotine pouches. 43% voted that more research is needed before calling nicotine pouches a harm reduction tool, while 26% responded that pouches may simply replace one addiction with another. Only 18% view the pouches as offering meaningful harm reduction benefits.
Some physicians on Sermo see potential benefits, particularly for patients struggling to quit smoking. “I always recommend starting with pouches to reduce smoking for anesthesia,” shares an anesthesiologist. “Helping people quit smoking is important, and we should use all resources,” echoes a nephrology and internal medicine specialist.
However, many physicians on Sermo express skepticism about the substitution approach. “The use of tobacco substitutes does not eliminate the concept of addiction,” warns a pediatrician. “The promotion of any addictive substance with the risk for harm is always of concern,” adds an OB/GYN.
The challenge for physicians lies in weighing potential benefits for adult smokers against risks for nicotine-naive individuals, particularly young people who might use pouches as an entry point to nicotine addiction rather than an exit strategy from smoking.
Screening gaps and practice adaptation
As nicotine pouch use becomes more prevalent, physicians are adapting their screening practices with varying degrees of urgency and consistency. The current landscape reveals significant gaps in how healthcare providers build rapport and address these products during patient encounters.
Only 22% of surveyed physicians on Sermo said they routinely ask about pouch use during patient visits, while 34% occasionally include these questions in their screening. Another 27% plan to incorporate such questions in the future, but 16% don’t see the need for specific screening about nicotine pouches.
The problem is, these products are relatively new. With an absence of standardized clinical guidance, physicians have taken to Sermo to discuss the best screening practices for this emerging concern.
The question now is whether physicians should adapt their nicotine screening questions to account for different age groups. For younger patients, physicians increasingly recognize the need to ask specifically about nicotine pouches, as traditional tobacco screening questions may miss these products entirely.
For older patients or those with established smoking histories, physicians often incorporate nicotine pouch questions into existing tobacco cessation conversations. However, concurrent use patterns indicate that even patients actively trying to quit smoking may be using pouches alongside cigarettes rather than as replacements.
Comparing nicotine pouch use to vaping and e-cigarettes
Physicians are split as to whether they believe nicotine pouches are more harmful than vaping. A quarter of surveyed Sermo members said they feel more concern about pouches than vaping, while 42% view them as equally concerning. Only 18% consider pouches less concerning than vaping.
Those who are more concerned point out that the pouches are even easier to conceal, which makes them more convenient to users. “Their discreet format makes them easy to hide, especially in settings with nicotine restrictions,” writes an occupational GP on Sermo.
Those who may view pouches as less concerning often point to the absence of inhalation risks. “While likely safer than vaping and certainly safer than smoking, this still represents a highly addictive substance with cardiovascular risks,” writes one general practice physician.
The comparison becomes more complex when considering population-level impacts. While individual health risks may differ between products, the potential for pouches to create new nicotine users and even nicotine poisoning—particularly among youth—represents a significant public health concern that physicians have emphasized on Sermo.
What physicians want next
The Sermo community’s response to nicotine pouches reveals several clear priorities for moving forward. The overwhelming theme is the need for more comprehensive research, standardized clinical guidance, and better educational resources.
“More scientific studies are needed for long term effect of nicotine pouch use,” states an internal medicine physician, echoing a sentiment expressed across specialties. The lack of long-term safety data leaves physicians making clinical recommendations with incomplete information.
Clinical guidance represents another major need. The variation in screening practices and patient counseling approaches suggests that standardized protocols would help ensure consistent care across healthcare settings. This includes guidance on when to recommend pouches for harm reduction versus when to discourage their use entirely.
Patient education materials that accurately communicate both risks and potential benefits represent another crucial need. “I think many patients underestimate the risks,” notes an internal medicine physician on Sermo.
As more information about the implications of nicotine pouches comes to light, you can discuss their potential benefits and harms and screening practices with your peers. Join Sermo to connect with verified physicians around the world.
Common questions about nicotine pouches
What are the side effects of nicotine pouches?
Reported side effects include mouth irritation, nausea, dry mouth, and increased heart rate, though long-term effects remain under study.
Are nicotine pouches harmful to teens?
Yes, nicotine pouches pose addiction risks for teens and may interfere with brain development, making them inappropriate for youth use.
Are nicotine pouches a safe alternative to cigarettes?
While potentially less harmful than cigarette smoking, nicotine pouches still carry addiction risks and cardiovascular effects, and thus are not harmless, making “safe” a misleading term.
What are the dangers of Zyn and other nicotine pouches?
Primary concerns include nicotine addiction, potential cardiovascular effects, mouth irritation, and unknown long-term health consequences.
How are physicians responding to nicotine pouch use in patients?
Physician responses vary widely, from routine screening to minimal awareness, reflecting the need for standardized clinical guidance and more research.
