WHAT ARE THEY?
Tobacco-free oral nicotine products include pouches or dissolvable ‘pearls’, placed between the gum and lip, allowing nicotine to be absorbed. They do not contain tobacco. Tobacco companies produce several brands (e.g., ZYN).
Snus is also a pouch that is placed between the gum and the lip. However, it contains tobacco. It is widely used in Sweden.
Of note, some tobacco-free oral nicotine products have recently started to be marketed as snus e.g. “white snus”, which may cause confusion for consumers. In this article, when we refer to snus, we are referring to the traditional version that contains tobacco.
It is illegal to sell tobacco-free oral nicotine products and snus in Aotearoa New Zealand, however they can be imported for personal use. The New Zealand government has indicted that they are considering making it legal to sell these products.
These products are different to heated tobacco products. You can read more about heated tobacco products here.
CAN THESE PRODUCTS HELP PEOPLE TO STOP SMOKING?
Tobacco-free oral nicotine products can reduce symptoms of nicotine withdrawal. 1-2 However, we currently do not have adequately powered randomised controlled trials that have tested whether tobacco-free oral nicotine products reduce the amount a person smokes or increase their likelihood of stopping smoking. 2,3
Evidence for the efficacy of snus as a smoking cessation aid is mixed. In 2023, meta-analyses of randomised controlled trials found snus did not increase smoking cessation compared with control conditions (placebo or no product, risk ratio (RR) 1.33 [95% CI 0.71 to 2.47]) or nicotine replacement therapy (RR 0.62 [95% CI 0.27 to 1.41]).4 In the same study, meta-analysis of longitudinal data found snus use was associated with an increased likelihood of smoking cessation (RR 1.38 [95% CI 1.05 to 1.82]).4 However, the authors noted that the analysis included studies at high risk of bias. Overall, the authors concluded the evidence supporting snus as a smoking cessation aid was ‘weak’.
Evidence for other smoking cessation products is much stronger, for example data from over 100 trials support Medsafe-approved nicotine replacement therapy (also known as NRT), such gums and lozenges.5,6
WHAT ARE THE RISKS OF THESE PRODUCTS?
Both products contain nicotine, which is addictive.
Because tobacco-free oral nicotine products do not contain tobacco, they are likely to be less physically harmful than cigarettes and snus. That does not mean they are risk-free. Long-term health risks are uncertain and may include nicotine addiction and negative effects on oral health.7,8
While snus has been associated with increased cancer risk (e.g. oesophageal and pancreatic cancer), it is likely to be less physically harmful than cigarettes.9,10
It is possible that these products are used by people who do not smoke, particularly young people, as the marketing of these products is youth-targeted.
LINKS TO MORE DETAILED INFORMATION FROM OUR RESEARCH TEAM
Read about:
- The composition of oral nicotine products here.
- Youth-focussed marketing of oral nicotine products here.
- The evidence for these products as smoking cessation aids here.
Listen to:
Share:
- Click below for a printable bullet point summary about tobacco-free oral nicotine products
- Click below for a printable bullet point summary about snus
REFERENCES
1. Keller-Hamilton B, Alalwan MA, Curran H, et al. 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;119(3):464-75. doi: 10.1111/add.16355.
2. Caldwell B, Burgess C, Crane J. Randomized crossover trial of the acceptability of snus, nicotine gum, and Zonnic therapy for smoking reduction in heavy smokers. Nicotine Tob Res 2010;12(2):179-83. doi: 10.1093/ntr/ntp189.
3. Avila JC, Maglalang DD, Nollen N, et al. 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 doi: 10.1093/ntr/ntae047.
4. Stjepanović D, Phartiyal P, Leung J, et al. Efficacy of smokeless tobacco for smoking cessation: a systematic review and meta-analysis. Tobacco Control 2023;32(6):757-68. doi: 10.1136/tobaccocontrol-2021-057019.
5. Theodoulou A, Chepkin SC, Ye W, et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2023;6(6):CD013308. doi: 10.1002/14651858.CD013308.pub2.
6. Hartmann-Boyce J, Chepkin SC, Ye W, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev 2018;5(5):CD000146. doi: 10.1002/14651858.CD000146.pub5.
7. Ye D, Rahman I. Emerging Oral Nicotine Products and Periodontal Diseases. Int J Dent 2023;2023:9437475. doi: 10.1155/2023/9437475.
8. Jackson JM, Weke A, Holliday R. Nicotine pouches: a review for the dental team. Br Dent J 2023;235(8):643-46. doi: 10.1038/s41415-023-6383-7.
9. Nutt DJ, Phillips LD, Balfour D, et al. Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach. European Addiction Research 2014;20(5):218-25. doi: 10.1159/000360220.
10. Valen H, Becher R, Vist GE, et al. A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco. Int J Cancer 2023;153(12):1942-53. doi: 10.1002/ijc.34643.