(opens in new tab)Nicotine pouches are small sachets that are placed between the upper lip and gum, allowing direct absorption of nicotine into the bloodstream.
Nicotine pouches, which contain nicotine extracted from tobacco leaf or chemically synthesized, entered the US market in 2014.1 Nicotine pouches include various flavors (eg, tobacco, menthol, mint, citrus) and flavor descriptors such as “cool” and “chill.” The US Food and Drug Administration has not approved use of nicotine pouches for any therapeutic indication but currently allows marketing of 26 nicotine pouch products (3-9 mg of nicotine per pouch). Higher-strength nicotine pouches (eg, 20 mg) are sold in the US illegally.
How Common Is Nicotine Pouch Use?
More than 1 billion nicotine pouches were sold in the US in 2024. In 2023, approximately 2.7% of US adults reported ever using nicotine pouches, and 0.4% reported current use. In 2024, 2.6% of 10th and 12th graders in the US reported nicotine pouch use in the prior 30 days. Nicotine pouch use is more common among people who currently or formerly used other tobacco products, and among males, non-Hispanic White individuals, and people living in rural areas.
What Are Possible Harms of Nicotine Pouch Use?
Trace amounts of substances that promote cancer (carcinogens) have been detected in some nicotine pouches, although at lower levels than cigarettes and smokeless oral tobacco products such as chewing tobacco and snus (smokeless tobacco placed under the upper lip). Nicotine pouch use can cause oral problems. In a survey of adults using nicotine pouches, approximately half developed mouth lesions (patches, lumps, abrasions), more than one-third reported mouth soreness, and about 20% had a sore throat. People often develop nicotine dependence that causes cravings and can lead to use of nicotine pouches with electronic cigarettes (e-cigarettes), cigarettes, or both. The long-term health consequences of nicotine pouches, including effects on the oral and cardiovascular systems, and the risk of cancer, are unknown.
Nicotine pouch use can cause blood nicotine levels that are similar to or higher than with e-cigarettes and cigarette smoking, although achieving peak nicotine levels takes longer with nicotine pouches (20-65 minutes) compared with smoking cigarettes (5-8 minutes). Compared with e-cigarettes, nicotine pouches avoid the risk of inhaling e-cigarette flavorings, heavy metals, heated carrier liquids, and other byproducts, but are more likely to cause oral adverse effects. Nicotine pouches have not been shown to improve smoking cessation outcomes, but they reduce exposure to many smoking-related carcinogens among adults who completely switch from smoking cigarettes.
Based on data from the National Poison Data System for 2010 to 2023, accidental nicotine ingestions occurred among 134 663 US children younger than age 6 years, with serious outcomes in 1.2%. Although nicotine pouches accounted for only 1.4% of accidental nicotine ingestions, the number of cases increased more than 7-fold from 2020 to 2023, and these cases were associated with higher likelihood of serious medical outcomes compared with all other types of nicotine and tobacco products combined.
Although there are currently no published studies about treatment of nicotine dependence from nicotine pouches, effective treatments for nicotine addiction include brief advice, counseling, and medications (such as varenicline or nicotine replacement therapy).
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Article Information
Published Online: July 30, 2026. doi:10.1001/jama.2026.12580
Conflict of Interest Disclosures: None reported.
Additional Information: GPT 4.1 (OpenAI) generated a draft of the manuscript on June 11, 2026, following an editor-developed prompt. The final manuscript was prepared by Dr Walter, who takes full responsibility for the content.
Reference
Piasecki TM, Piper ME, Kathuria H. Nicotine pouches. JAMA. Published online July 30, 2026. doi:10.1001/jama.2026.11806
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