What's the ZYN nicotine trend—and how should doctors prepare for bad outcomes?
Key Takeaways
Nicotine pouches, seen as safer alternatives, still carry health risks due to nicotine addiction.
While seen as a potential aid for quitting cigarettes, their effectiveness is unclear, and risks like gum disease persist.
Nicotine pouches have become widely popular in the last few years, with some public health experts likening them to the “new vaping.” You tuck the Chiclet-sized tobacco-free pouches under your lip, and over the course of an hour, nicotine is gradually released, providing a feel-good buzz.[]
One product, ZYN, has become massively popular in the US and the United Kingdom. It claims to be “smoke-free, spit-free, and hands-free.” It’s all over TikTok and has received attention from people like Tucker Carlson and Joe Rogan.[][]
Surveys have shown that many people believe the pouches are a safer alternative to vape pens and cigarettes. While the pouches don’t contain tobacco—a plant used in cigarettes, chews, dip, and cigars—which causes chronic diseases like cancer and heart disease, public health experts argue that this does not mean the pouches come without risk, especially for young people.[][]
Nicotine is not a carcinogen, but it’s highly addictive and has the potential to trigger a cascade of negative health consequences. “Nicotine is a stimulant drug that has addicting potential, and its use is always of concern regardless of route delivered,” Theodore John Strange, MD, Chairman of Medicine at Staten Island University Hospital, tells MDLinx.[][]
The health effects of nicotine
With vaping, nicotine quickly hits the bloodstream via inhalation. When someone sucks on a nicotine pouch, on the other hand, the drug reaches the bloodstream more slowly via the oral mucosa. Once absorbed, nicotine causes the brain to release dopamine, a neurotransmitter that elicits feelings of reward and pleasure.[]
Ingesting nicotine this way comes with its own set of concerns. “Absorption through the mouth over time is concerning because it maintains nicotine levels in the body and could lead to addiction and potentially the desire or need for more or higher doses,” says Vincent Mase, MD, FACS, a thoracic surgeon at Yale Cancer Center and Assistant Professor of Surgery at Yale School of Medicine.
The short- and long-term health effects associated with tobacco-free nicotine pouches are unclear, as the products are relatively new and became popular quickly. As a result, the research is relatively limited. That said, nicotine use, in general, is known to cause many health issues. For example, regular exposure to nicotine is linked to a greater risk of cardiovascular, respiratory, and gastrointestinal disorders. The drug can also impair the immune system, hindering the body’s ability to fight infections and diseases and have harmful effects on reproductive health.[] [][]
The risks go on: Nicotine causes oxidative stress and cell damage and can potentially trigger changes to DNA that could lead to cancer. Some researchers suspect that the pouches could, over time, damage the gums or other parts of the mouth they regularly touch.[]
The risks “include increasing heart rate and potential risk of heart disease exacerbation like acute MI, local placement in the mouth causing ulcerations, tooth decay, gum issues, and possible oral cancer risk,” says Dr. Strange. And although more benign than, say, heart disease, nicotine pouches, in the short-term, may cause nausea, hiccups, oral soreness, or irritation, research suggests.[]
Nicotine pouches are highly addictive
Many people, including teens, are using ZYN pouches as an entry into other types of nicotine use, according to Bonnie Halpern-Felsher, PhD, a professor of pediatrics at Stanford Medicine who studies tobacco use among teens and adolescents. “There is the question of whether one goes from ZYN pouches to other forms of nicotine— e-cigarettes or cigarettes—to get even more nicotine hit if one is addictive,” says Dr. Halpern-Felsher.[]
ZYN pouches contain 3 to 6 milligrams of nicotine, which, according to Dr. Halpern-Felsher, is less than a pack of cigarettes and less than most e-cigarettes. Many people, however, use more than a pouch a day. “Any nicotine [use] is risky, but certainly using more than one pouch a day would make me worried,” she says. Nicotine changes the brain, making people susceptible to addiction. “Nicotine is nicotine, and no matter the form, nicotine is addictive and harmful to the developing brain,” Dr. Halpern-Felsher adds.
If someone became addicted and were to stop using the pouches suddenly, they’d be at risk of developing withdrawal symptoms. Because nicotine causes the brain to release dopamine, the sudden deprivation of the feel-good neurotransmitter can cause people to feel depressed, frustrated, and irritable.[]
“The use of any stimulant drug is never healthy, and physicians should always talk to patients about trying to stop or cut back on daily use to avoid the potential side effects, despite the [fact that the] route that ZYN is delivered [via] may be overall ‘safer’ as it relates to the respiratory health risks,” says Dr. Strange.
Nicotine pouches may be helpful in very specific cases
The one potential benefit of the tobacco-free pouches is that they might be able to curb some people’s addiction to cigarettes—if people who frequently smoke completely give up cigarettes and switch to the pouches. The efficacy of this method, however, is not well understood. “Their effectiveness and safety for this purpose requires more extensive research, and the trade-off of trying to reduce the harmful effects of tobacco smoke while accepting the risk of gum disease, tooth decay, and potential head and neck cancers are still not completely understood,” says Dr. Mase.
One recent study found that the pouches aren’t actually all that effective at nixing people’s cigarette cravings. The reason for this, researchers suspect, is because smoking leads to an immediate surge of nicotine in the blood, quelling the craving, whereas it takes 30 minutes to an hour to hit peak effectiveness in pouch form.[].
Still, some models predict that tobacco-free nicotine pouches, when used as a harm-reduction tool, could slightly reduce mortality linked to cigarette smoking. That said, the best way to quit smoking cigarettes or using e-cigarettes is to use therapy and nicotine replacement patches rather than pouches, says Dr. Halpern-Felsher.[]
Dr. Mase says that doctors should discuss the risks and uncertainties associated with nicotine pouches, highlighting addiction potential and the lack of long-term safety data. “Patients should be aware of the risks of nicotine dependency and the benefits of quitting nicotine altogether,” he says.