Smokeless Tobacco - Pouches (not snus)

This page is for referencing the possible benefits of Smokeless tobacco - Pouches (not Snus) AND tobacco free nicotine pouches.

Tobacco Free Nicotine Pouches - Studies, Surveys, Papers

2024: The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review

• ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users, although key data are mainly available from industry-funded studies. Data from independent research is critically needed.
  • Citation: Nargiz Travis, Kenneth E Warner, Maciej L Goniewicz, Hayoung Oh, Radhika Ranganathan, Rafael Meza, Jamie Hartmann-Boyce, David T Levy, The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review, Nicotine & Tobacco Research, 2024;, ntae131, https://doi.org/10.1093/ntr/ntae131
    • Acknowledgment: This work was supported by the National Cancer Institute (NCI) and Food and Drug Administration (FDA) grant U54CA229974. All authors declare no conflict of interest. MLG received a research grant from Pfizer and served as a member of the scientific advisory board of Johnson & Johnson.

2024: Using pod based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: A pilot randomized controlled trial

• This study provides novel evidence that e-cigarettes and nicotine pouches can be a harm reduction tool for individuals with lower SES who smoke and are not willing to quit smoking, contributing to reducing tobacco-related disparities in this population.
  • Citation: Avila JC, Maglalang DD, Nollen N, Lee SC, Suh R, Malone M, Binjrajka U, Ahluwalia JS. Using pod based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: A pilot randomized controlled trial. Nicotine Tob Res. 2024 Mar 6:ntae047. doi: 10.1093/ntr/ntae047. Epub ahead of print. PMID: 38447095.
    • Acknowledgment: Funding and COI paywalled

2024 Evaluating the Role of Nicotine Stereoisomer on Nicotine Pouch Abuse Liability: A Randomized Crossover Trial

• "Implications: Little is known about the effects of racemic (vs. S-) nicotine in humans. In a sample of adults who smoke cigarettes, we identified that oral nicotine pouches containing racemic nicotine exposed participants to less nicotine than oral nicotine pouches containing only S-nicotine, but both types of oral nicotine pouches held similar, moderate appeal. Additional research evaluating the roles that flavorings, total nicotine concentration, and freebase nicotine play in the abuse liability of oral nicotine pouches would inform comprehensive product regulations to support public health."
  • Citation: Keller-Hamilton B, Curran H, Alalwan M, Hinton A, Brinkman MC, El-Hellani A, Wagener TL, Chrzan K, Atkinson L, Suraapaneni S, Mays D. Evaluating the Role of Nicotine Stereoisomer on Nicotine Pouch Abuse Liability: A Randomized Crossover Trial. Nicotine Tob Res. 2024 May 7:ntae079. doi: 10.1093/ntr/ntae079. Epub ahead of print. PMID: 38713545.
    • Acknowledgment: Grants: U54CA287392/DA/NIDA NIH HHS/United States, CA/NCI NIH HHS/United States

2024 Evaluating the effects of nicotine concentration on the appeal and nicotine delivery of oral nicotine pouches among rural and Appalachian adults who smoke cigarettes: A randomized cross-over study

• "Conclusions: Among adult smokers, using 6-mg nicotine concentration oral nicotine pouches (ONPs) was associated with greater plasma nicotine delivery at 30 minutes than 3-mg ONPs or cigarettes, but neither ONP relieved craving symptoms at 5 minutes as strongly as a cigarette. Accelerating the speed of nicotine delivery in ONPs might increase their misuse liability relative to cigarettes."
  • Citation: Keller-Hamilton B, Alalwan MA, Curran H, Hinton A, Long L, Chrzan K, Wagener TL, Atkinson L, Suraapaneni S, Mays D. Evaluating the effects of nicotine concentration on the appeal and nicotine delivery of oral nicotine pouches among rural and Appalachian adults who smoke cigarettes: A randomized cross-over study. Addiction. 2024 Mar;119(3):464-475. doi: 10.1111/add.16355. Epub 2023 Nov 14. PMID: 37964431; PMCID: PMC10872395.
    • Acknowledgment: This study was funded by the Addiction Innovation Fund at The Ohio State University's College of Public Health. This research was also partially supported by The Ohio State University Comprehensive Cancer Center—The James and the National Cancer Institute of the National Institutes of Health (grant number P30CA016058). BKH was supported by grant number K01DA055696 from the National Institute on Drug Abuse. BKH, AH, TLW, and DM were supported by grant number U54CA287392 from the National Cancer Institute. The sponsors had no role in the study design; in the collection, analysis or interpretation of the data; in the writing of the report; or in the decision to submit the manuscript for publication.

2023: Nicotine pouches: a review for the dental team

• Nicotine pouches are a new product that the dental professional should be aware of, particularly in smokers and ex-smokers. They are likely to have a relatively low-risk profile, similar to other forms of orally administered nicotine; however, the prolonged and regular use may give increased risk of local oral problems. Further research is required.
  • Citation: M. Jackson, J., Weke, A. & Holliday, R. Nicotine pouches: a review for the dental team. Br Dent J 235, 643–646 (2023). https://doi.org/10.1038/s41415-023-6383-7
    • Acknowledgment: The authors declare no conflicts of interest. (Source of funding?)

2022: Nicotine products relative risk assessment: an updated systematic review and meta-analysis [version 2; peer review: 1 approved, 1 approved with reservations] Previously titled: Nicotine products relative risk assessment: a systematic review and meta-analysis

• In this update, 70 new studies were added to the synthesis, making a total of 123 studies included. All combustible tobacco products score between 40 and 100, with bidis and smokeless (rest of world) also in this range. All other products have a combined risk score of 10 or less, including U.S. chewing tobacco, U.S. dipping tobacco, snus, heat-not-burn tobacco, electronic cigarettes, non-tobacco pouches and nicotine replacement therapy.
  • Citation: Murkett R, Rugh M and Ding B. Nicotine products relative risk assessment: an updated systematic review and meta-analysis [version 2; peer review: 1 approved, 1 approved with reservations]. F1000Research 2022, 9:1225 (https://doi.org/10.12688/f1000research.26762.2)
    • Acknowledgement: The research presented was produced with the help of a grant from the Foundation for a Smoke-Free World, Inc. (FSFW), an independent, US non-profit 501(c)(3) grantmaking organization with the purpose of improving global health by ending smoking in this generation. The contents, selection, and presentation of facts, as well as any opinions expressed herein, are the sole responsibility of the authors and under no circumstances should they be regarded as reflecting the positions of FSFW. FSFW accepts charitable gifts from PMI Global Services Inc. (PMI); under FSFW’s Bylaws and Pledge Agreement with PMI, FSFW is independent from PMI and the tobacco industry.

2021: A Randomised Study to Investigate the Nicotine Pharmacokinetics of Oral Nicotine Pouches and a Combustible Cigarette

• NPs (Nicotine Pouches) can provide nicotine in amounts sufficient to replicate cigarette smokers' nicotine uptake following a switch from conventional cigarettes to these potentially less harmful NP products.
  • Citation: McEwan, M., Azzopardi, D., Gale, N. et al. A Randomised Study to Investigate the Nicotine Pharmacokinetics of Oral Nicotine Pouches and a Combustible Cigarette. Eur J Drug Metab Pharmacokinet (2021). doi.org/10.1007/s13318-021-00742-9
    • Acknowledgement: All authors are current employees of British American Tobacco (Investments) Limited except JM who is an employee of RAI Services Company and IMF who is a consultant contracted by British American Tobacco (Investments) Limited.

2020: Initial Information on a Novel Nicotine Product

• Nonusers of tobacco had very little interest in ZYN. Smokeless tobacco users are not only more interested and likely to buy ZYN than other tobacco users, they were the largest group of regular users.
• The first assessment of a new nicotine product, ZYN, suggests that current and former tobacco users may perceive ZYN as a reduced‐risk product. ZYN potentially could be used as a smoking/tobacco‐cessation aid based on reasons of current users.
• PDF Version
• Brad Rodu’s Blog: First Study of ZYN, A Novel Consumer Nicotine Product
  • Citation: Plurphanswat, N., Hughes, J. R., Fagerström, K., & Rodu, B. (2020). Initial Information on a Novel Nicotine Product. The American Journal on Addictions. doi:10.1111/ajad.13020
    • Acknowledgment: Drs Plurphanswat and Rodu were supported by unrestricted grants from tobacco manufacturers to the University of Louisville and by the Kentucky Research Challenge Trust Fund. Neither author has any financial or other personal relationship with the sponsors. Dr Hughes has received consulting and speaking fees from several companies that develop or market pharmacological and behavioral treatments for smoking cessation or harm reduction and from several non‐ profit organizations that promote tobacco control. He has recently received consulting fees from Swedish Match, Altria, and Philip Morris International to assist their efforts to develop less‐risky tobacco products. Dr Fagerström has received consulting and speaking fees from many companies that develop or market pharmacological and behavioral treatments for smoking cessation. He currently receives consulting fees from Swedish Match and has received fees in the past from Philip Morris International and BAT to assist their efforts to develop less‐risky tobacco products.

2020: Pharmacokinetic Comparison of a Novel Non-tobacco-Based Nicotine Pouch (ZYN) With Conventional, Tobacco-Based Swedish Snus and American Moist Snuff

• The two higher doses of ZYN (6 and 8 mg) deliver nicotine as quickly and to a similar extent as existing smokeless products, with no significant adverse effects.
• PDF Full Version
  • Citation: Lunell E, Fagerström K, Hughes J, Pendrill R. Pharmacokinetic Comparison of a Novel Non-tobacco-Based Nicotine Pouch (ZYN) With Conventional, Tobacco-Based Swedish Snus and American Moist Snuff. Nicotine Tob Res. 2020 Oct 8;22(10):1757-1763. doi: 10.1093/ntr/ntaa068. PMID: 32319528.
    • Acknowledgement: The present study was funded by Swedish Match AB, Stockholm, Sweden. The funder developed the protocol and an independent CRO conducted the studies. The funder has provided data, figures and tables, but has in no way approved the manuscript. Dr Lunell has received grants from Swedish Match for a number of clinical trials on nicotine and tobacco products. He has not received any consulting fees from Swedish Match or any other tobacco company. Dr Pendrill is a Research Scientist at Swedish Match. Dr Fagerström has received consulting fees from many companies that develop or market pharmaceutical and behavioral treatments for smoking cessation. He currently receives consulting fees from Swedish Match and has received fees in the past from BAT and PMI to assist their development of less-risky tobacco products. Dr Hughes has received consulting and speaking fees from several companies that develop or market pharmacological and behavioral treatments for smoking cessation or harm reduction and from several non-profit organizations that promote tobacco control. He currently receives consulting fees from the pharmaceutical company Achieve. He also receives fees from the tobacco companies of Swedish Match, Altria and Philip Morris International to assist their efforts to develop less risky tobacco products.

2020: An approach for the extract generation and toxicological assessment of tobacco-free ‘modern’ oral nicotine pouches

• This study demonstrates that tobacco-free nicotine pouches are significantly less biologically active than an equivalent reference Swedish-style snus product. Future product usage studies, pharmacokinetics and clinical studies will provide further data to substantiate the reduced risk potential of tobacco-free modern oral nicotine pouches (MOP).
  • Citation: Bishop E, East N, Bozhilova S, Santopietro S, Smart D, Taylor M, Meredith S, Baxter A, Breheny D, Thorne D, Gaca M, An approach for the extract generation and toxicological assessment of tobacco-free ‘modern’ oral nicotine pouches, Food and Chemical Toxicology, Volume 145, 2020, 111713, ISSN 0278-6915, doi.org/10.1016/j.fct.2020.111713.
    • Acknowledgement: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: BAT funded the project and all authors were employees of BAT at the time of the study conduct. LYFT tobacco-free modern oral nicotine pouches are manufactured and supplied by BAT.

Articles, Blogs, Videos (Tobacco and Tobacco Free Pouches)

2022: Nicotine Pouch Use Is on the Rise

• "Nicotine pouches are one of the fastest growing nicotine delivery products in the United States. There are a variety of reasons why people are using these small sacks full of nicotine and other ingredients, including as a substitute for cigarette smoking."

2021 Blog: Can Nicotine Pouches Alleviate Harm Reduction Hurdles in Emerging Markets?

• Compares cost in various countries to other forms of tobacco Harm Reduction Products.
• There is a significant role for nicotine pouches in tobacco harm reduction in Emerging Markets, particularly in countries where oral tobacco use is prevalent.
• In theory, regulators should look more favourably on the category, but this has not proven to be the case. In part, the industry needs to take a more proactive approach and engage with regulators and local stakeholders, where appropriate, before launching new products.
• Nicotine pouches don't require consumers to buy often prohibitively expensive devices. Still, relatively high current production costs make it challenging to earn the returns needed to facilitate meaningful investment in many developing countries. Over time, this could be addressed by a combination of appropriate excise-tax regimes and reduced input costs.

2019: US endorses tobacco pouches as less risky than cigarettes

• For the first time, U.S. health regulators have judged a type of smokeless tobacco to be less harmful than cigarettes, a decision that could open the door to other less risky options for smokers. The milestone announcement on Tuesday makes Swedish Match tobacco pouches the first so-called reduced-risk tobacco product ever sanctioned by the Food and Drug Administration.
• FDA Press Release: FDA grants first-ever modified risk orders to eight smokeless tobacco products

Tobacco Pouches - Studies, Surveys, Papers

• Please see SLT (Smokeless Tobacco) page for more details

Suggested studies/articles to add to this page