The evidence surrounding oral nicotine pouches has expanded rapidly. Questions that only a few years ago were being considered using a relatively small body of research can now be examined across studies covering product characteristics, nicotine delivery, toxicant exposure, patterns of use, smoking behaviour, marketing and consumer perceptions. For regulators, this expanding evidence base creates an opportunity to move beyond assumptions and develop policies that respond more closely to what the research actually shows.
A new updated scoping review published in Nicotine & Tobacco Research on 6 September 2026 provides one of the latest assessments of this evolving field. Researchers identified 73 new empirical studies published since their previous review, with the updated search covering evidence through September 2025. Most of the newly identified studies were conducted in the United States, and 12 were industry-funded. The substantial increase in available research illustrates how quickly the evidence base has developed, although important uncertainties remain.
A More Developed Picture of Nicotine Pouches
The updated review examined evidence relating to nicotine pouch characteristics, patterns of use, consumer perceptions, toxicity, sales and marketing. Overall, the literature provides a more detailed picture of the category than was available when earlier regulatory discussions began.
One important finding is that nicotine pouches appear to expose users to substantially fewer toxicants than combustible cigarettes. This is relevant when considering relative risk, particularly for adults who smoke and may use pouches as an alternative to cigarettes. However, lower toxicant exposure should not be interpreted as evidence of no risk. Long-term health outcomes remain insufficiently studied, and the authors identify this as an important area for continued research.
The distinction is important for proportionate regulation. Evidence can support differentiation between combustible and non-combustible products without requiring regulators to assume that newer nicotine products are harmless.
Nicotine Delivery Deserves Regulatory Attention
The evidence around nicotine delivery has also become more detailed. The review found that nicotine pouches generally contain a higher proportion of freebase nicotine than other oral nicotine products and tobacco-containing pouches, while nicotine delivery increases with product strength. In studies involving adults who smoke, some higher-strength pouches containing 6 mg or more produced nicotine uptake that could exceed that from cigarettes, although pouches consistently received lower positive subjective ratings than cigarettes.
For regulators, this suggests that the number printed on a pouch is only part of the product-standard question. Nicotine content, formulation and resulting delivery can all influence exposure and consumer experience. If governments introduce product-strength standards, those standards should therefore be informed by how products actually deliver nicotine rather than relying solely on broad product categories.
Further independent research would help establish which product characteristics are most useful for regulatory assessment and where appropriate limits should sit.
Smoking Reduction Is Not the Same as Complete Switching
The review also examined how nicotine pouch use relates to cigarette smoking. Preliminary evidence from short-term and heterogeneous studies suggests that pouch use can reduce cigarette consumption among some adults who smoke. However, dual use remained more common than complete cigarette cessation.
This distinction matters because reducing cigarette consumption and completely replacing cigarettes are different outcomes. The potential harm-reduction value of a non-combustible product depends substantially on what it replaces and whether combustible use continues.
The current evidence also does not establish nicotine pouches as an effective long-term smoking-cessation treatment. Longer-term research is needed to understand whether people who initially use both products eventually switch completely, continue dual use or return to exclusive smoking.
Public-health communication should reflect these differences rather than treating cigarette reduction, complete switching and smoking cessation as interchangeable outcomes.
Youth Use Requires Continued Monitoring
Youth uptake remains an important regulatory concern. The review identified a gradual increase in current nicotine pouch use among young people in US surveillance data. In 2024, the National Youth Tobacco Survey reported current use among 1.8% of middle and high school students, while Monitoring the Future reported 2.6% among 10th and 12th graders.
These findings support continued surveillance and strong measures to discourage youth uptake. They also demonstrate why regulators should distinguish between different populations when assessing the public-health impact of nicotine pouches. Initiation among a young person or someone who has never used nicotine presents a different policy question from use by an adult who would otherwise continue smoking cigarettes.
Youth protection and harm reduction therefore do not need to be competing objectives. A regulatory framework can restrict youth access and inappropriate marketing while maintaining accurate information about differences in product risk for adults who smoke.
Marketing Is Becoming Part of the Evidence Base
The updated review also identifies online and social media as increasingly important channels for nicotine pouch marketing, with some research raising concerns about messaging that may appeal to younger audiences.
This strengthens the case for responsible marketing standards alongside age restrictions and product regulation. Regulators need to consider how nicotine pouches are presented, which audiences are likely to encounter promotional content and whether claims accurately communicate product characteristics and risks.
Effective regulation should protect young people without preventing accurate communication to adults about the differences between combustible and non-combustible products.
Important Questions Remain Unanswered
The rapid growth of research should not be mistaken for a complete evidence base. Long-term health outcomes remain uncertain, evidence concerning sustained complete switching from cigarettes is limited, and more research is needed on the population-level consequences of nicotine pouch use among people who previously did not use nicotine.
The literature is also geographically uneven. Much of the newly identified research comes from the United States, so patterns of use, marketing and consumer behaviour should not automatically be assumed to apply across other countries and regulatory environments.
A scoping review is primarily designed to map the available evidence rather than provide definitive estimates of every health or behavioural effect. The addition of 73 studies therefore represents meaningful progress, but it does not resolve every question facing policymakers.
Regulation Should Evolve With the Evidence
For GINN, the most important lesson from the updated review is that nicotine pouch regulation should evolve alongside the evidence.
Research now provides a stronger basis for understanding product characteristics, nicotine delivery, toxicant exposure, patterns of use and emerging youth trends. It also reinforces the need for appropriate product standards, responsible marketing, age restrictions and continued market surveillance. At the same time, significant uncertainties remain around long-term health outcomes and sustained switching from cigarettes.
This is where proportionate regulation becomes particularly important. Policymakers should be prepared to strengthen safeguards when evidence identifies genuine risks, recognise meaningful differences between products when the evidence supports them, and continue gathering data where uncertainty remains.
The nicotine pouch evidence base is no longer where it was several years ago, and it will continue to develop. Effective regulation should neither move ahead of the science nor remain anchored to assumptions formed when substantially less evidence was available.
Source
Travis N, Warner KE, Hartmann-Boyce J, Goniewicz ML, Ma C, Meza R, Levy DT. Oral Nicotine Pouches and Public Health: Evidence from an Updated Scoping Review. Nicotine & Tobacco Research. Published 6 September 2026.
