Oral Nicotine Products: Nicotine Pouches

What are nicotine pouches?

A nicotine pouch is a small gauze-like bag filled with a powder that contains nicotine. The pouch is placed against the gums for up to an hour. The nicotine is absorbed into the bloodstream through the blood vessels that line the mouth. It is distributed throughout the body, including the brain.

A tobacco company’s flavoured nicotine pouch, Zonnic, was authorized for sale as a nicotine replacement therapy product (stop smoking aid). Each pouch contains 4 mg of nicotine; this amount is usually recommended for adults who smoke 25 or more cigarettes a day who want to quit smoking.

To help prevent harms to youth from nicotine replacement therapies, nicotine pouches are to be sold only by a pharmacist or an individual working under the supervision of a pharmacist, and to be kept behind the pharmacy counter.

What is tobacco-free nicotine?

Nicotine is a toxic and highly addictive chemical found in the tobacco plant. “Tobacco-free” nicotine refers to synthetic nicotine created in a lab, or nicotine extracted from tobacco. “Tobacco free” forms of nicotine are still toxic and highly addictive.

Unauthorized nicotine pouches, such as Zyn, may also be available in Canada. Unauthorized products may contain excess amounts of nicotine or include other harmful ingredients not listed on the product label.

Sesh+ Gum is another flavoured nicotine product that is widely available. Each piece contains 2 or 4 mg of nicotine. Other oral nicotine products are expected to be approved.

Nicotine pouches are not harmless.

Short-term adverse effects of nicotine pouches include nausea, hiccups, and soreness or irritation in the mouth.¹ Long-term health effects of nicotine pouches use are still unknown.

Excessive amounts of nicotine can cause symptoms of nicotine poisoning include nausea, vomiting, upset stomach, severe heartburn, fatigue, severe headache, dizziness, cold sweats, weakness, fainting, blurred vision, mental confusion, irregular heartbeat, palpitations, chest pain, breathing problems, and in significant dosage, death.

Nicotine causes addiction.

Nicotine causes the release of dopamine, a feel-good chemical in the brain. This initial effect wears off, leaving the brain craving more. Over time, it may be necessary to use more nicotine more often to get any feel-good effect or to make withdrawal symptoms go away.

The brain adapts to the extra dopamine and begins to produce less of it naturally. Eventually the person using nicotine has difficulty creating natural sensations of pleasure without nicotine.

Although at first, nicotine activates receptors in the brain, it eventually causes them to become less responsive which increases tolerance. As receptors become less responsive, the brain adjusts by creating more of these receptors. This means the brain ends up with more receptors that crave more nicotine.

Nicotine addiction is extremely powerful and is hard to quit. Young people can develop a nicotine addiction with a lower level of exposure than adults.

Exposure to nicotine harms brain development.

The brain is in development until about age 25. Nicotine changes how the brain develops, leading to problems with memory and concentration, impulse control, and behaviour.² Exposure to nicotine in adolescence can also cause mood disorders³, worsen symptoms of anxiety⁴ and depression⁵ and cause learning problems⁶. It may also contribute to future tobacco use⁷ and increase the risk of other substance use disorders³.

Have ongoing conversations with youth about nicotine.

Many of the same resources and tips for speaking to youth about smoking and vaping can be used for any nicotine product.

•    Not an Experiment
•    Conversation Starters About Vaping
•    Talking To Children and Youth About Substances

Tobacco industry tactics target youth.

Zonnic is owned by a tobacco company. They claim the product is not intended for those under 18, yet the company’s original ads featured young people in a variety of fun or social situations.  

The tobacco industry has a history of unethical practices and marketing tactics, including using social media influencers to target youth.

To ensure future profits, the industry’s goal is to recruit lifelong consumers by pulling them into an addiction and keeping people addicted to nicotine. Like vaping, nicotine pouches are an opportunity for companies to expand their share of the nicotine market.

Nicotine pouches are authorized only to help adults quit smoking.

Health Canada reminds consumers that nicotine pouches should not be used recreationally, by people who don't smoke, by people under the age of 18, or by others at risk of nicotine's toxic effects.

Consumers should only use authorized nicotine pouches as directed. Authorized nicotine pouches have an eight-digit NPN on the label. If you use nicotine pouches and have health concerns, contact your health care provider. Report adverse events or complaints to Health Canada.

What can teens do if they want to quit or cut down on smoking or vaping?

Nicotine replacement therapies may not be suitable for young people. Refer them to:

References

1. Sparrock, L., Phan, L., Chen-Sankey, J., Hacker, K., Ajith, A., Jewett, B., & Choi, K. (2023). Nicotine Pouch: Awareness, Beliefs, Use, and Susceptibility among Current Tobacco Users in the United States, 2021. International Journal of Environmental Research and Public Health, 20(3), 2050. doi.org/10.3390/ijerph20032050.

2. England, L.J., Bunnell, R.E., Pechacek, T.F., Tong, V.T. and McAfee, T.A. (2015). Nicotine and the developing human: A neglected element in the electronic cigarette debate. American Journal of Preventive Medicine, 49(2), pp.286-293.

3. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2016). E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. https://www.cdc.gov/tobacco/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf.

4. Kutlu, M.G., Gould, T.J. Nicotine modulations of fear memories and anxiety: Implications for learning and anxiety disorders. Biochemical Published Online First. 2015. https://pubmed.ncbi.nlm.nih.gov/26231942/.

5. Lechner, W.V., Janssen, T., Kahler, C.W., et al. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Preventative Medicine. 2017. https://pubmed.ncbi.nlm.nih.gov/28024859/.

6. Augenstein JA, Smaldone AM, Usseglio J, Bruzzese JM. Electronic cigarette use and academic performance among adolescents and young adults: A scoping review. Acad Pediatr. Published online September 23, 2023:S1876-2859(23)00363-7.

7. National Institute on Drug Abuse (NIDA). (2022). Tobacco, Nicotine, and E-Cigarettes Research Report. www.nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/how-many-adolescents-use-tobacco.