A new wave of nicotine products is coming under scrutiny

Senator Chuck Schumer this week called for a crackdown on ZYN, a nicotine pouch that has become increasingly popular in the United States, alongside the rise of so-called Zynfluencers who promote the product online.

National sales of nicotine pouches, which users put in their upper lip, increased dramaticallywith 808 million pouches sold in the first three months of 2022 alone, according to a analysis from four major brands. ZYN, which has quickly built a large footprint in the United States, accounted for the majority of revenue in the analysis.

“These nicotine pouches appear to be targeting young children,” Senator Schumer said, warning that products like ZYN could hook a new generation to nicotine. a 2023 study from the Centers for Disease Control and Prevention found that about 1.5 percent of high school students had used nicotine pouches in the past 30 days.

ZYN says its product is only for consumers aged 21 and over who already use nicotine. “Our marketing practices – which prohibit the use of social media influencers – are aimed at preventing access by minors and set the benchmark for the industry,” a representative for Phillip Morris International, the parent company of the company that produces ZYN, wrote in a statement.

Because ZYN and similar pouches are relatively new, the long-term health effects are not clear, says Minal Patel, senior chief scientist at the American Cancer Society. The risks will largely depend on who uses them and how often. Nicotine pouches are much less harmful than cigarettes, says Jonathan Foulds, professor of public health sciences and psychiatry at Penn State University College of Medicine. So for someone who currently smokes, switching to a pouch can reduce health risks.

But for people who have never used tobacco — especially teens and young adults — experts urge caution.

Newer products like ZYN could “really boost nicotine addiction and nicotine enjoyment,” says Dr. Panagis Galiatsatos, a pulmonologist and critical care physician at Johns Hopkins Medicine. “It's the same problem we face with electronic cigarettes.”

What are nicotine pouches?

Nicotine pouches are small, cushion-like containers containing nicotine salt, which is absorbed through the tissues in the mouth. They often contain flavorings and sweeteners and resemble snus, a type of tobacco pouch popular in Scandinavia. The nicotine in ZYN comes from tobacco leaves. But unlike other nicotine-containing products, such as snus, chewing tobacco and dipZYN and similar pouches do not contain tobacco leaf themselves.

What is known about the risk of nicotine and cancer?

Nicotine is not considered a carcinogen. While cigarette smoking can cause lung and other cancers, and snus has been linked to an increased risk of these gastrointestinal cancersthe cancer risks of tobacco-free nicotine pouches are not yet clear. The bags may contain other carcinogens, said Dr. Patel.

“Most of what we know comes from the nicotine pouch industry,” says Brittney Keller-Hamilton, an assistant professor at the Ohio State University College of Medicine who has studied nicotine pouches. A rare independent study has been looked at 46 bag products in Germany and found that 26 contained compounds known as tobacco-specific nitrosamines that can cause cancer. ZYN nicotine pouches do not contain “any quantifiable levels” of these compounds, a representative said in an email.

Other potential health damage

The nicotine in these bags can be addictive. They are typically sold in the US in strengths of about three or six milligrams; smokers absorb For comparison: about just over one milligram of nicotine from a cigarette.

Teens are especially vulnerable to addiction because their brains are not yet fully developed, Dr. Keller-Hamilton said. “We don't know what the end result is for a young person using nicotine pouches – we don't know if they would just continue using nicotine pouches until they stop, or if they would look for other forms of nicotine that might work faster. nicotine delivery, like a cigarette,” she said.

Brian King, director of the Food and Drug Administration's Center for Tobacco Products, said in a statement that the agency “remains concerned about each tobacco product that can appeal to youth.” (The FDA classifies nicotine pouches as tobacco products.)

Some experts think of nicotine deteriorates the gum tissuewhich could lead to periodontal disease, said Irfan Rahman, a researcher at the University of Rochester Medicine who has studied nicotine pouches.

Nicotine is also possible increase blood sugar levels And increase your heart rate and blood pressure. “It probably has a small but real effect on your cardiovascular risk,” said Dr. Foulds. Nicotine is also possible the walls of the arteries in the heart hardenwhich contributes to heart disease and seizures.

Experts are also concerned about the risks that nicotine pouches pose to pregnant women and their fetuses. Dr. Bendik Brinchmann, a physician and researcher at the National Institute of Public Health and the National Institute of Occupational Health in Norway, said that various studies show that women who use snus during pregnancy are at greater risk of preterm labor and stillbirth, which he suspects are linked to nicotine exposure. These risks could be transferred to tobacco-free nicotine pouches, he said. “My biggest concern is for the young women who could really become addicted to this,” he said.

“Once you start, it's much harder to stop.”