Tins of Zyn nicotine pouches. Users place the small, tobacco-free pouches between the upper lip and gum, where nicotine is absorbed directly into the bloodstream. It bypasses the lungs but still has concerning health effects.
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Walk into any gas station, convenience store or locker room in America today and you are likely to see a colorful tin of Zyn, VELO or another brand. Small, discreet and available in flavors ranging from citrus to cinnamon, nicotine pouches are one of the fastest-growing consumer products. Monthly sales rose more than 200% from January 2023 to April 2025, climbing from $145 million to nearly $447 million.
Alongside the rapid sales growth, a growing body of research is raising questions about the safety of using nicotine pouches. Here are seven things to know about their health effects.
Nicotine pouches are small, tea-bag-like sachets containing a powder mixture of nicotine salts, plant-based fibers, flavorings and pH adjusters. Users tuck them between the upper lip and gum for anywhere from 15 minutes to an hour. There is no smoking, no vapor and no tobacco. Nicotine dissolves through the pouch material and is absorbed across the oral mucosa into the bloodstream.
The delivery mechanism is what sets pouches apart from both cigarettes and e-cigarettes. Cigarettes use tobacco, generating carcinogens like tar, carbon monoxide and benzene. They kill nearly 500,000 Americans per year. Vaping heats a nicotine-containing liquid to produce an aerosol which is inhaled into the lungs.
The short answer is yes. Nicotine is highly addictive. The nicotine is absorbed through the oral mucosa into the bloodstream where it reaches the brain. There, it causes the release of a variety of neurotransmitters triggering reward pathways that give users a “high.”
Regular users develop a tolerance to nicotine as they become desensitized to the drug. Over time, users start to require nicotine primarily to avoid the withdrawal symptoms (i.e. irritability, restlessness, dysphoria , poor concentration and increased hunger), rather than achieving the euphoric effects.
Pouches are a highly efficient delivery vehicle for nicotine. The pH adjusters enhance nicotine absorption and accelerate its entry into the bloodstream, satisfying cravings and, in turn, sustaining dependence. The discreet, spitless format lowers barriers to frequent use throughout the day.
Zyn is sold in 3 mg, 6 mg and 9mg strengths in the U.S. Research has shown that a 6 mg pouch delivers more nicotine to the bloodstream after 30 minutes than smoking a cigarette. Some brands offer considerably higher concentrations.
Research has found that nicotine content in some products exceeds what is stated on the label. Certain pouches can even contain close to 50 mg of nicotine: a dose that could cause toxicity in children or adults with low nicotine tolerance.
Nicotine pouches entered the U.S. market in 2016. No longitudinal studies yet follow pouch users over the decades required to measure cancer incidence. Authorization by the Food and Drug Administration (FDA) was based on the fact that pouches contain substantially fewer carcinogens than combustible tobacco, not on evidence they don't impact cancer risk.
Some nicotine pouches contain trace amounts of tobacco-specific nitrosamines (TSNAs) which are recognized carcinogens. Some products have also tested positive for formaldehyde and heavy metals including nickel and chromium. The American Cancer Society has noted that placing a pouch against delicate oral tissue for extended periods creates repeated chemical exposure: what oncologists call a "pattern of concern."
Setting aside cancer, the mechanical and chemical effects of nicotine pouches on the mouth are well-documented. Holding a pouch against gum tissue causes direct irritation and inflammation. Nicotine pouch users may develop oral mucosal white lesions in the areas where pouches are regularly placed.
Nicotine is also a vasoconstrictor, narrowing blood vessels and reducing blood flow to the gum. This impairs the delivery of oxygen and nutrients, compromising the gum tissue’s ability to fight infection and heal. This may accelerate gum disease and contribute to gingivitis and periodontitis.
Chronic pouch placement in the same location has been associated with gingival recession: a pulling back of the gum from the tooth that exposes the root, increases sensitivity and raises the risk of tooth decay. Nicotine also suppresses saliva production, which plays a role in neutralizing acids and protecting tooth enamel.
In 2025, the American Heart Association issued a policy statement on smokeless oral nicotine products concluding they are addictive and carry potential adverse effects on heart health. However, it did acknowledge that specific long-term outcome data were limited. This shouldn't be seen as reassuring but rather reflects how new the products are.
Yet what is established is that nicotine in any form raises blood pressure, increases heart rate and constricts blood vessels. For healthy users, these acute effects may be modest. But for people with hypertension, coronary heart disease or a history of stroke, the repeated stress of regular nicotine use is clinically significant.
Nicotine pouches are now the second most commonly used tobacco product among American youth, behind e-cigarettes. The 2024 National Youth Tobacco Survey found approximately 480,000 middle and high school students reporting being current users, and among those more than 22% report daily use.
Data from the Monitoring the Future study documented a doubling of use among 10th and 12th graders in a single year, from 1.3% in 2023 to 2.6% in 2024. Zyn was the brand used by more than 84% of those who reported pouch use in the past month.
This is alarming because the adolescent brain continues developing until approximately age 25. Nicotine can disrupt circuits governing attention, learning, mood and impulse control.
The strongest argument for nicotine pouches is their potential role in tobacco harm reduction. FDA’s authorization was partly grounded in evidence that some adult smokers had switched completely from cigarettes to pouches. Studies have shown that switching to nicotine pouches can substitute for cigarettes.
The issue is that switching is not the norm. Many users continue to smoke while using pouches. Among youth and young adults using pouches, the CDC Foundation reports that the vast majority also use at least one other tobacco product.
Ultimately, nicotine pouches like Zyn, VELO and others occupy a complicated position in the public health landscape. They are almost certainly less harmful than cigarettes. Long-term heart and cancer risks are unknown while the oral risk and immediate heart effects are real. Nicotine dependence is highly likely with regular use.
For adult smokers seeking to step away from cigarettes or e-cigarettes, pouches may represent a viable harm reduction option. For everyone else, and especially for adolescents, the evidence is clear: these products carry genuine health risks.
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