As nicotine pouches gain visibility in the United States and other markets, debate around their public-health role has intensified. Much of this discussion has been driven by concern over youth uptake and regulatory uncertainty. However, recent reporting in JAMA highlights a more nuanced picture, one in which several public-health experts recognise that nicotine pouches differ fundamentally from combustible tobacco and may play a role for adults seeking to move away from smoking or vaping.
The question for regulators is not whether nicotine pouches should be scrutinised, they should, but whether policy frameworks reflect relative risk, real-world use patterns, and the growing body of scientific evidence.
What the JAMA Article Reports
The JAMA article examines the rapid rise of nicotine pouches in the US market, noting both increased awareness and growing use among adults. Importantly, the reporting does not frame pouches as risk-free. Instead, it captures expert views that distinguish nicotine itself from the harms of combustion and smoke exposure, which remain the primary drivers of tobacco-related disease.
Several public-health professionals interviewed for the article emphasise that nicotine pouches do not contain many of the carcinogenic chemicals found in cigarettes, and that their use does not involve combustion or inhalation, two critical pathways through which smoking causes cancer, cardiovascular disease, and respiratory harm.
This distinction matters for regulatory decision-making, particularly when nicotine pouches are increasingly grouped with cigarettes in public discourse and proposed policy responses.
Expert Perspectives: Risk Is Not Binary
Among the experts cited in JAMA is Cristine Delnevo, PhD, MPH, Director of the Rutgers Institute for Nicotine and Tobacco Studies and Chair of the FDA’s Tobacco Products Scientific Advisory Committee (TPSAC) since 2021. Her assessment underscores the importance of proportionality.
“As far as the risk profile of a single pouch, it looks more like nicotine gum,” Delnevo said.
This comparison is notable. Nicotine gum has long been approved and recommended as a smoking-cessation aid, and its risk profile is widely understood to be substantially lower than that of combustible tobacco. While nicotine pouches are not therapeutic products, the analogy highlights how nicotine delivery without smoke fundamentally alters exposure and risk.
Other health professionals quoted in the article similarly stress that while nicotine is addictive and not harmless, the absence of combustion and inhalation significantly reduces exposure to the toxicants responsible for most smoking-related disease.
Use Patterns: Who Is Actually Using Nicotine Pouches?
The JAMA reporting also points to emerging data on who is using nicotine pouches and why. Recent surveys indicate that pouch use is common among adults who are trying to quit smoking or vaping, suggesting that these products may serve as a substitute for higher-risk nicotine delivery methods.
This aligns with broader findings across multiple jurisdictions: smoke-free nicotine products tend to be adopted disproportionately by people with prior experience of smoking, rather than by nicotine-naïve individuals. For this population, nicotine pouches may represent an accessible, discreet, and combustion-free alternative, particularly where other cessation tools have not been effective.
From a public-health perspective, this pattern matters. Products that facilitate movement away from smoking, even if they maintain nicotine use, can still deliver net population health benefits when evaluated through a continuum-of-risk lens.
Regulation, Youth Protection, and the Risk of Oversimplification
None of the experts cited in JAMA argues for unregulated access. Youth protection, marketing restrictions, and age-verification measures remain essential. However, the article illustrates the risk of flattening all nicotine products into a single regulatory category, ignoring meaningful differences in harm.
When policy treats smoke-free products as equivalent to cigarettes, it can unintentionally undermine smoking-cessation efforts by removing lower-risk alternatives from the market or discouraging accurate risk communication. This is particularly concerning in light of evidence that many adults already overestimate the risks of non-combustible nicotine products relative to smoking.
A GINN Perspective: Evidence Before Equivalence
For GINN, the takeaway from the JAMA article is not that nicotine pouches are harmless, but that regulation should follow evidence, not assumption.
Public-health experts interviewed by JAMA acknowledge three points that are highly relevant for regulators:
- Nicotine pouches do not expose users to the carcinogenic by-products of combustion found in cigarettes.
- Their risk profile appears closer to established nicotine-replacement products than to smoking.
- They are being used primarily by adults seeking to quit or move away from smoking or vaping.
Effective nicotine policy must be capable of holding these truths simultaneously: protecting young people, acknowledging nicotine’s addictive nature, and preserving pathways for adult smokers to transition away from the most harmful products.
As regulatory frameworks evolve, especially in the US and Europe, the challenge will be to avoid collapsing scientific nuance into blunt policy tools. The evidence highlighted in JAMA suggests that proportionate, risk-based regulation is not a concession, it is a prerequisite for credible public-health strategy.
Source:
JAMA – Nicotine Pouches Are Everywhere. What Does That Mean for Public Health?
https://jamanetwork.com/journals/jama/fullarticle/2843607
