Nicotine pouches are gaining in popularity with teens

Teen use of nicotine pouches appears to be rising, even as vaping and other tobacco products drop in popularity.

These small microfiber pouches contain powdered nicotine with flavorings and other substances and are placed along a user’s gums, where the nicotine can be directly absorbed into the blood stream, according to the U.S. Centers for Disease Control and Prevention.

Use of pouches in the 12 months during 2023-2024 reported by 10th and 12th graders rose from 2.4 percent to 4.6 percent, according to a study published April 30, 2025, in JAMA Network Open. Lifetime use climbed from 3 percent to 5.4 percent, the same study said. It also found the number of teens using both vaping and pouches increased.

This new data indicates the growth in popularity of nicotine pouches is quite recent, as only a few months before, the 2024 National Youth Tobacco Survey reported that 1.8 percent of respondents said they used nicotine pouches. Despite that relatively small number, pouches were the second-most used tobacco product, behind e-cigarettes at 5.9 percent, the Centers for Disease Control and Prevention (CDC) said in an Oct. 17, 2024 release. The CDC also reported that overall use of tobacco products by middle and high school students had dipped to the lowest point in 25 years.

By comparison, in 2019, about 32 percent of Massachusetts high school students said they had vaped (inhaling an aerosol, usually containing nicotine, through an electronic cigarette) in the past 30 days, and 51.2 percent said they had tried it, according to the state Department of Public Health.

The tobacco industry changes its products as smoking becomes less popular, and flavored products are generally aimed at younger users, said Jeffrey J. Spillane, MD, FACS, a general and thoracic surgeon with Cape Cod Healthcare, who has a particular interest in tobacco use in adolescents and teens. Pouches may be the industry’s latest fad targeting youth.

“The issue with it is, nicotine is highly addictive,” he said. “Nicotine is as addictive as heroin – very addictive,” and a known carcinogen.

Known Effects

Both the short- and long-term health effects of using nicotine pouches needs more study, the CDC says. What is known is, in adolescents, nicotine can:

• Hurt brain development up to age 25, and injure portions of the brain employed in learning, attention, impulse control and mood.
• Possibly make them more susceptible to other addictions.
• Quickly cause symptoms of addiction, whether or not there’s regular use of tobacco products.

Also, nicotine can harm pregnant women and is poisonous to developing fetuses, according to the CDC.

As a thoracic surgeon, Dr. Spillane has seen the results of smoking and vaping, and stressed he is not an expert on nicotine pouches, which aren’t inhaled. What bodily damage results from use of these pouches probably won’t be known for 20-30 years, he said.

Recent FDA Approval

Nicotine pouches became available in the U.S. in 2016. Some brands use nicotine derived from tobacco, but often it’s laboratory-made, and marketed as “tobacco-free.” None contain tobacco leaf, and they vary in the amounts of nicotine they contain. Pouches retail online for around $4 or $5 a can and contain 25 pieces.

On Jan. 16, 2025, the federal Food and Drug Administration approved the marketing of 20 such products sold under the brand name ZYN, saying they contained fewer harmful substances than most cigarettes and smokeless tobacco products, such as snus (pouches of tobacco powder placed in between lip and gums) and snuff (tobacco powder that is snorted). The FDA also said the products’ potential benefit to tobacco users outweighs the potential risks to society, including to youth, citing the 2024 National Youth Tobacco Survey, which reported only 1.8 percent of middle and high school respondents said they used nicotine pouches.

The FDA authorization did not apply to any other brands of nicotine pouches, and it said ZYN products should only be marketed to people 21 and older.

Young People and Trends

Today’s teens and people in their early 20s know smoking causes lung and other cancers, and so they may avoid cigarettes, Dr. Spillane said. Similarly, they consider chewing tobacco gross and linked to mouth and throat cancers. Nicotine pouches are new, don’t contain tobacco, don’t require users to spit out juice or exhale smoke or vapor, and are easily concealed in the mouth. Young people may consider them a healthier and more clandestine alternative to tobacco, he said.

“The pandemic definitely helped decrease teen vape use,” he said. “Massachusetts and other states passed flavored vape bans.”

Dr. Spillane estimated nicotine pouch use is higher among adults around 25 years old than teens, and they use it to deal with anxiety. He estimated a quarter to a third of that age group use tobacco or nicotine products.

“These kids are under stress,” he said. “The reason I’m interested in this at all, is because of the issue of anxiety and mental health. There’s no doubt that this is a very stressed generation.”