Nowadays, there are multiple products presented as less harmful alternatives to traditional cigarettes. This is the case of heated tobacco, flavored 'vapes', and nicotine pouches, the latter, despite having existed for almost a decade, are increasingly popular in the United States of America (USA).

For example, the leading brand in the market, Zyn, registered sales of 350 million cans, with about 15 pouches each, in 2023, a 62% increase compared to the previous year, announced Philip Morrris International, the group responsible for the brand and many other tobacco products, in February, according to CNN International.

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This is a product only available to people over 21 years old, but it has reached people of all ages, especially Generation Z. For example, in the USA, it has become very popular among university students, something that happens in Miami, according to The Miami Student.

In addition to all this, on social networks, especially on TikTok and Instagram, there is a new type of unofficial influencer for these nicotine products. They have been dubbed as 'Zynfluencers' and the hashtag includes hundreds of videos.

Generally, these pouches contain different amounts of nicotine, between three and six milligrams (mg), but some brands may contain more than 28 milligrams. A cigarette contains, on average, between eight mg and 20 mg of nicotine, of which only one to two mg are effectively absorbed.

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These nicotine pouches are a product available only in the United States and Sweden, at least for now. Even so, Lifesyle ao Minuto spoke with Sofia Ravara, a pulmonologist from the Smoking Commission of the Portuguese Pneumology Society and a professor at the University of Beira Interior, in Covilhã, about the popularity and potential risks that nicotine pouches pose to health.

How do these nicotine pouches work?

Nicotine pouches, bags or pearls are oral nicotine products that do not contain tobacco. They are similar to tobacco pouches (called snus), as they are made to be placed between the lip and the gum. However, nicotine pouches do not contain fresh tobacco leaves, but rather a form of dehydrated nicotine that does not need to be kept cold.

The pouches also usually contain cellulose or vegetable fibers, flavorings and sweeteners. Nicotine is absorbed into the bloodstream through the abundant blood vessels in the oral mucosa, and some of it can be swallowed and absorbed in the intestine.

These are not new products: similar oral pouches containing tobacco have been available in Sweden and the United States for many years, but they are banned in the European Union (EU).

Oral nicotine use may cause cardiovascular disease, diabetes, impair oral health and normal fetal development, as well as have a very negative impact on brain development

Why are they placed in the mouth, and more specifically, in the gums?

They are made to be placed and kept for minutes to hours between the lip and the gum, without being chewed, in order to release nicotine quickly and continuously, through the abundant blood vessels in the oral mucosa.

She is a pulmonologist from the Smoking Commission of the Portuguese Pneumology Society© Sofia Ravra

What kind of health hazards can they pose?

There is indirect suggestive evidence, through studies conducted on the effects of nicotine and oral tobacco on human health, that oral nicotine use may cause cardiovascular disease, diabetes, impair oral health and normal fetal development, as well as have a very negative impact on brain development, especially in the fetus, children and adolescents, causing cognitive changes, difficulty concentrating and learning, and school performance, anxiety and behavioral changes.

Do they contain high amounts of nicotine? Is it safe?

Yes, they contain high amounts of nicotine. The pouches are oral nicotine products. The absorption of nicotine in the oral mucosa is rapid and greatly facilitated by the abundance of blood vessels in the mouth, and by the addition of flavors, sweeteners and other additives, often incorporated into nicotine pouches.

On the other hand, part of the nicotine is swallowed (ingested) and absorbed in the intestine, reinforcing the concentration in the blood and brain continuously, throughout the day. The development of new forms of nicotine (synthetic, nicotine salts, freebase nicotine) has also greatly increased the addictive potential of new nicotine products.

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Thus, nicotine pouches are very easily addictive, especially in children, adolescents and young people, leading to repeated and regular consumption, and also opening a path for these vulnerable populations to experiment with other tobacco and nicotine products, and psychoactive substances, such as cannabis, etc.

As nicotine absorbed orally is very addictive, it promotes regular consumption for years or decades: this medium/long-term consumption may have harmful effects on health, causing disease, disability and premature mortality. In short, it is not safe to use nicotine pouches.

What are the consequences of nicotine addiction?

Addiction leads to repeated and regular consumption over years or decades, making it difficult for nicotine users to quit. Medium/long-term consumption may have harmful effects on health, causing disease, disability and premature mortality. On the other hand, experimentation and use of the pouches opens a path for children, adolescents and young people to experiment with other tobacco and nicotine products, and psychoactive substances, such as cannabis, etc.

The only healthy alternative to tobacco and nicotine consumption is not to consume any tobacco or nicotine products

Is it possible that they are a healthier alternative to traditional tobacco and the new nicotine products that have appeared on the market?

There is no safe consumption of tobacco or nicotine. The only healthy alternative to tobacco and nicotine consumption is not to consume any tobacco or nicotine products.

All products, including the latest ones, such as electronic cigarettes, shisha or water pipe, heated tobacco, and nicotine pouches, are addictive, leading to regular consumption for years or decades, and consequently may cause disease, disability an>