A new Cochrane systematic review has examined whether oral nicotine pouches can help people stop smoking, vaping, or using other forms of tobacco. While early evidence is promising in showing lower toxicant exposure, the review concludes that more data is needed to determine their long-term impact on cessation outcomes.
What the Review Found
The Cochrane team analysed four studies involving 284 adult smokers, conducted between 2006 and 2023.
Participants averaged 14–23 cigarettes per day, and most were aged between 34 and 50. Three of the four studies were independently funded, while one received support from a tobacco manufacturer.
Results showed mixed findings:
- Quit rates: Two small studies could not confirm whether nicotine pouches improved quit success compared to no intervention or continued smoking.
- Comparisons with vaping: Quit rates appeared lower among pouch users compared with nicotine e-cigarette users, though evidence was limited.
- Safety: Across three studies reporting adverse events, no serious health harms occurred in any group.
- Toxicant exposure: Biomarker data indicate a clear reduction in harmful chemicals compared with smoking. NNAL, a key marker of tobacco-specific carcinogen exposure, was significantly lower in people using nicotine pouches than in those who continued smoking. Similarly, carboxyhaemoglobin levels, a measure of carbon monoxide exposure, were much lower among pouch users.
What It Means for Harm Reduction
While the evidence base remains small, the review adds to a growing body of research suggesting that nicotine pouches substantially reduce exposure to harmful substances compared to smoking.
However, Cochrane emphasizes that larger, longer-term trials are needed to determine how effective pouches are for helping smokers quit entirely, and how they compare to existing nicotine replacement therapies (NRTs) or e-cigarettes.
GINN’s Perspective
At GINN, we view the Cochrane review as an essential milestone in advancing evidence-based nicotine policy.
The absence of serious health harms and the marked reduction in toxicant exposure reinforce that nicotine pouches can play a valuable role in tobacco harm reduction, particularly for adults who would otherwise continue smoking.
However, the review also highlights a critical need: more independent, high-quality clinical research to assess long-term outcomes and inform proportionate regulation.
As the market grows, policymakers must ensure that product standards, accurate labelling, and adult access are prioritised, without restricting innovation that can save lives.
In Summary
- Nicotine pouches reduce toxicant exposure compared to smoking.
- Serious health harms were not observed in any study.
- More research is needed to measure long-term cessation success.
- Regulation and education must evolve alongside emerging evidence.
GINN welcomes this review as another step toward aligning science, policy, and public health in the shared goal of reducing smoking-related harm worldwide.
