By Global Institute for Novel Nicotine (GINN)
The South Australian Government’s ban on nicotine pouches, coupled with alarmist media narratives, distorts public understanding of these products. The recent article, “Everything You Need to Know About Nicotine Pouches,” presents nicotine pouches as a serious public health threat without properly assessing their risk profile compared to combustible tobacco or other nicotine replacement therapies (NRTs). While concerns over youth access are valid, misrepresenting the science behind nicotine pouches undermines their potential role in harm reduction for adult smokers.
Health Risks: A Scientific Perspective
The article presents nicotine pouches as dangerous, with unsubstantiated claims about their health risks. It ignores the well-established fact that nicotine pouches, like other smoke-free alternatives, eliminate the most harmful elements of tobacco consumption—combustion, tar, and carbon monoxide. Numerous studies confirm that the primary cause of smoking-related disease is the inhalation of burnt tobacco and associated carcinogens, not nicotine itself. The Royal College of Physicians has stated that while nicotine is addictive, it is not the cause of smoking-related cancers, lung disease, or heart disease when used in non-combustible forms (Royal College of Physicians, 2016).
The article also fails to recognize the New Zealand Dental Association position, which explicitly states that nicotine pouches are a substantially lower-risk product compared to cigarette smoking and chewing tobacco. The NZDA position paper highlights that there is no reported evidence linking nicotine pouches to an increased risk of oral disease, cancer, dental caries, or periodontal disease (NZDA, 2024). The British Dental Journal review on nicotine pouches further confirms that they contain significantly fewer toxic compounds than traditional smokeless tobacco products such as snus (Jackson et al., 2023).
Expert Perspectives
Dr. Colin Mendelsohn, a leading Australian tobacco treatment specialist, has criticized the moral panic surrounding nicotine pouches. He argues that fear-driven opposition to these products is not based on scientific evidence and risks undermining harm reduction efforts. In a recent commentary, Dr. Mendelsohn stated:
“The moral panic about nicotine pouches is driven by ignorance and ideology rather than science. Nicotine pouches are a far safer alternative to smoking and should be regulated responsibly rather than banned” (The Daily Telegraph, 2024).
Addressing Dr. McMullen’s Claims on Cardiovascular Risks
Dr. Danielle McMullen, Australian Medical Association president, claims that nicotine pouches contribute to heart issues and anxiety due to nicotine’s effects on heart rate and blood pressure. However, her argument misrepresents nicotine’s actual role in smoking-related cardiovascular disease.
Scientific evidence establishes that the primary cardiovascular risks from smoking arise not from nicotine, but from carbon monoxide exposure and oxidative stress caused by combustion. The Cochrane Library and British Medical Journal confirm that nicotine replacement therapy (NRT) is widely regarded as safe, even for individuals with pre-existing cardiovascular conditions (Hartmann-Boyce et al., 2018).
By conflating nicotine’s temporary physiological effects with long-term smoking-related cardiovascular disease, McMullen’s claims mislead the public. Nicotine’s impact on heart rate is comparable to that of caffeine and is not responsible for the severe cardiovascular risks associated with smoking (Benowitz & Burbank, 2016).
Oral Health Risks: Addressing Dr. Corbin Barry’s Assertions
The article cites Dr. Corbin Barry, who argues that nicotine pouches contribute to gum disease, bone fragility, and poor healing. However, there is no clinical evidence supporting these claims.
Unlike smokeless tobacco, nicotine pouches do not contain carcinogenic tobacco-specific nitrosamines, which are the primary contributors to oral cancer and gum disease in users of products like chewing tobacco and snus. The British Dental Journal notes that nicotine pouches contain significantly fewer toxic compounds than snus or smokeless tobacco and that the primary concern is minor gum irritation, which is comparable to effects seen with nicotine gum and lozenges (Jackson et al., 2023).
Further, the New Zealand Dental Association position states that nicotine pouches pose no increased risk for oral disease, including dental caries and periodontal disease (NZDA, 2024). If Dr. Barry is concerned about gum irritation, he should also warn against nicotine gum and lozenges, which are globally endorsed for smoking cessation.
Short-Term Side Effects vs. Long-Term Risks of Smoking
The article highlights minor side effects such as gum irritation, nausea, and dry mouth while failing to acknowledge that these effects are common with all nicotine replacement therapies. A systematic review of nicotine replacement therapies found that mild irritation, occasional hiccups, and nausea are frequently reported in users of nicotine gum and lozenges, yet these products are widely accepted as effective cessation tools (Hartmann-Boyce et al., 2018).
By contrast, smoking is responsible for severe and often fatal conditions, including lung cancer, emphysema, chronic obstructive pulmonary disease (COPD), cardiovascular disease, and stroke. Nicotine pouches do not contain the toxic substances that contribute to these diseases.
Nicotine Pouches and Smoking Cessation
The assertion that nicotine pouches are not intended for smoking cessation contradicts growing evidence that they can aid smokers in reducing or quitting cigarette consumption. The Cochrane Review is currently evaluating the effectiveness of nicotine pouches for smoking cessation (Cochrane, 2024).
A study in Nicotine & Tobacco Research found that nicotine pouches deliver nicotine levels comparable to medically approved nicotine replacement products, making them a viable alternative for smokers (Hecht et al., 2020).
Regulation and Enforcement Challenges
The article discusses the recent ban in South Australia without addressing the failures of prohibition-based approaches. Australia’s experience with vaping bans has already demonstrated that prohibiting reduced-risk nicotine products leads to an unregulated black market, poor quality control, and increased access for youth. Instead of imposing outright bans, governments should focus on effective regulation that includes clear age restrictions, product standards, and responsible marketing oversight.
Australia intercepted 9 million nicotine pouches last year, showing strong consumer demand. This mirrors the situation with vaping, where despite regulatory restrictions, illicit sales continue to thrive. A better approach would be to develop a regulated framework that ensures product safety while preventing youth access, as seen in countries that have successfully implemented harm reduction policies.
Keeping the Focus on the Real Issue—Helping Smokers Quit
The media’s focus on minor side effects of nicotine pouches while ignoring the overwhelming evidence of the dangers of smoking is a disservice to public health. Nicotine pouches should be regulated responsibly, not banned outright.
The concerns raised in the media about gum irritation and nausea mirror those of existing nicotine replacement therapies, which are globally endorsed as effective smoking cessation tools. Rather than banning products that reduce harm, policymakers should prioritize strategies that help smokers transition away from combustible tobacco.
Tobacco harm reduction has consistently been shown to save lives. The focus should remain on transitioning smokers away from deadly combustible cigarettes, not fear-mongering over nicotine alternatives that have the potential to prevent smoking-related disease.
Instead of prohibiting nicotine pouches and pushing consumers toward unregulated, illicit products or continued smoking, Australia should consider regulating them responsibly and integrating them into a comprehensive harm reduction strategy.
The real enemy is combustible tobacco, not harm reduction tools. Let’s not lose sight of that.
