A new, independently conducted clinical study in Experimental and Clinical Psychopharmacology offers rare, high-quality evidence on how oral nicotine pouches perform for people who already use smokeless tobacco (SLT) and why nicotine content is the hinge on which substitution success turns.
What the study asked and why it matters
Alisha Eversole and colleagues at Virginia Commonwealth University examined the physiological and subjective effects of one pouch brand (“on!”; 2, 4, and 8 mg labeled nicotine) compared with participants’ own-brand SLT. Crucially, this was not an industry-funded trial. For harm-reduction policy, the question is practical: do pouches with sufficient nicotine actually suppress abstinence symptoms and deliver nicotine in a way that can replace higher-risk SLT?
How the study worked
Twenty-four daily SLT users completed four lab sessions in Richmond, Virginia, each with two 30-minute administration periods. Sessions were randomized across four conditions: 2 mg pouch, 4 mg pouch, 8 mg pouch, and the participant’s own SLT. Researchers measured plasma nicotine, heart rate, and validated subjective scales for craving, withdrawal, and product effects. They also used behavioral economic purchase tasks to test whether pouches function as substitutes for SLT.
The headline finding
Nicotine content drove both delivery and relief of withdrawal. The 8 mg pouch produced nicotine exposure and craving suppression that did not differ meaningfully from participants’ own SLT on several measures. The 4 mg pouch performed in the expected middle ground. The 2 mg pouch consistently under-delivered nicotine and reduced abstinence symptoms less effectively than the 4 mg, 8 mg, or SLT.
In some individuals, the 8 mg pouch delivered more nicotine than their own SLT, underscoring notable variability across users and products. Still, at the group level, 4 mg and 8 mg pouches reliably increased plasma nicotine and reduced craving; 2 mg did not.
What people felt, not just what the blood showed
Across conditions, craving and urges dropped after use, but reductions were clearly weaker with 2 mg. Light-headedness rose transiently only with 8 mg during the first use period, consistent with a stronger pharmacologic effect. Taste and “liking” scores were higher for participants’ own SLT than for the unflavoured pouches used in the trial, a reminder that flavor and sensory profile also shape acceptance and persistence.
Will people buy pouches instead of SLT?
In hypothetical purchasing tasks, pouches functioned as substitutes for SLT regardless of nicotine level, suggesting commercial feasibility. However, the authors note these tasks were exploratory, and real-world purchasing studies are still needed.
What this means for regulation and harm reduction
Three practical implications stand out:
- Set content with purpose. If pouches are to replace higher-risk SLT for dependent users, lower strengths (e.g., 2 mg) may be insufficient to suppress withdrawal and can fail as substitutes. Regimes that cap products too low may undermine harm-reduction potential.
- Mind the upper bound. For some users, high-strength pouches can exceed their SLT nicotine exposure. Policymakers should pair upper limits with clear labeling so adult consumers can choose appropriate strengths without unintentionally increasing dependence.
- Standards beyond nicotine. Acceptance is influenced by sensory qualities (flavor, mouthfeel, pH, perceived harshness). Product standards should encompass quality, consistency, and child-resistant packaging, alongside nicotine content.
Important caveats
This was a small, controlled lab study of adult daily SLT users (mostly men). Results may not generalize to other populations, brands, flavors, or naturalistic settings. The pouches tested were unflavoured; many consumers use mint or wintergreen, which may affect liking and adherence. The study did not weigh pouch nicotine before/after use, so individual extraction differences remain a question for follow-up work.
GINN’s view
For adult SLT users who won’t quit nicotine outright, orally delivered, tobacco-free pouches with adequate nicotine content can plausibly reduce risk by substituting away from nitrosamine-rich products. The VCU data provide independent, lab-grade confirmation that nicotine strength is the key lever: too low, and pouches don’t work; appropriately set, and they can meaningfully suppress abstinence symptoms and match SLT nicotine delivery.
Regulators should differentiate products by risk and function. Policies that recognize dose-response realities, pairing minimum effective strengths for switching with sensible upper limits, rigorous quality standards, clear adult-only access, and truthful communication are most likely to translate the science into real-world harm reduction.
