Oral Nicotine Pouches and Public Health: Evidence from an Updated Scoping Review.

Abstract

Introduction: The popularity of oral nicotine pouches (ONPs) is rising in the US and worldwide. This review provides an update on their potential public health impact.

Methods: We searched six electronic databases for ONP-related empirical studies through September 30, 2025, updating an earlier review. Outcomes included ONP product characteristics, use patterns, beliefs, perceptions, toxicity, sales, and marketing.

Results: We identified 73 new studies published since our previous review (majority conducted in the US; 12 industry-funded). Data from heterogeneous national surveillance sources indicate a slow but steady increase in current ONP use prevalence among youth in 2024, with the National Youth Tobacco Survey (NYTS) reporting 1.8% prevalence among middle and high school students and the Monitoring the Future (MTF) study reporting 2.6% prevalence among 10th and 12th graders. Current use among adults was relatively low in 2022-2023 (0.4%-0.8%), with higher use among ages 18-44 and current tobacco users. US sales have more than tripled between 2021 and 2024. Marketing strategies increasingly emphasize potentially youth-appealing claims, with online and social media as key promotional channels. ONPs generally contain a higher proportion of freebase nicotine than other oral nicotine products and tobacco-containing pouches, with nicotine delivery increasing proportionally with nicotine strength. Nicotine uptake from higher strength ONPs (≥6mg) typically exceeds that from cigarettes in adult smokers, while ONPs consistently score lower in positive subjective ratings than cigarettes. Preliminary evidence from short-term, heterogeneous studies suggests that ONP use can reduce smoking in daily smokers, generally resulting in dual use rather than complete cigarette cessation. ONPs are considerably less toxic than cigarettes, but their long-term health impacts remain understudied.

Conclusions: The review underscores the need for further research on ONP health effects, their efficacy in long-term smoking cessation, and broader public health impact in tobacco-naïve populations.