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Don¡¯t be deceived: Nicotine pouches are not totally safe

The tobacco industry¡¯s recent launch of nicotine pouches caught many of us by surprise. These products are made from cellulose fibers infused with nicotine. Manufacturers say they are better at delivering nicotine than tobacco. They also claim that since no tobacco leaf is present, they¡¯re not as harmful.  

The problem with that assertion is that up to half the nicotine used in these products may still be derived from tobacco plants. According to the Food and Drug Administration (FDA), a product can contain as little as 50% synthetic nicotine and still be labeled as ¡°synthetic.¡±  

Manufacturers say the tobacco-derived nicotine used in their products is purified or synthetic, but purifying nicotine derived from tobacco enough to reach medicinal levels is expensive. To qualify for medicinal status, as in products like the patch, lozenges or gum, nicotine has to be 99.9% pure.  

That¡¯s why the FDA¡¯s pre-marketing authorization only allows nicotine pouches to be marketed as a ¡°modified risk tobacco product.¡± The manufacturers know that the tobacco-derived nicotine in their products is not pure enough to qualify for medicinal status. Otherwise, they would have applied for that designation, using the same mechanism/criteria that apply to the patch, lozenges and gum.  

Now, nicotine pouch manufacturers must keep collecting data as a part of the authorization process to determine what their long-term effects are. They are likely to be less harmful than 100% tobacco-based nicotine products. But we won¡¯t know the exact level of harm for certain until we have years of accumulated data to analyze. 

¡®Snus,¡¯ you lose

Another smokeless tobacco form to be aware of is ¡°snus.¡± Pronounced ¡°snoose,¡± this powdered tobacco product originally came from Sweden, where a company devised a new technology for processing tobacco plants.  

Instead of harvesting the leaves and hanging them up to dry for days/weeks, they created a method of drying them out almost immediately. This eliminated the fermentation process caused by bacteria, which is responsible for 80% of the carcinogens found in dried tobacco.  

The hope was that this new technology might also reduce the number of cancer diagnoses linked to smokeless tobacco. Swedish studies have determined that cancer rates were lower among snus users than they were among smokers. But the rate of pancreatic cancer among people using snus was higher than in the control group of non-tobacco product users.  

Even so, the American tobacco industry tried to mimic snus by putting regular loose snuff in a pouch and calling it by the same name. That caused a lot of confusion among smokeless tobacco users. Then, the tobacco industry switched tactics. Within a year of the FDA granting the original Swedish product a ¡°modified risk¡± designation, the tobacco industry bought it out. They did the same thing a few years ago when they purchased the most popular e-cigarette maker at the time.  

Damage caused by dipping and chewing may be permanent

Whenever patients ask me about how damaging smokeless tobacco is, I tell them all the same thing: it really depends. If you¡¯ve already lost teeth and underlying bone structure due to the use of smokeless tobacco products, then that is not reversible. Similarly, once your gums have receded beyond a certain point, it¡¯s impossible to bring them back up.  

But if all you have right now is a little gum irritation, you might be able to fully recover if you stop dipping and chewing tobacco. There may be no long-term damage if you¡¯ve only been using smokeless tobacco products for a few weeks or months. The probability of long-term damage is much higher if you¡¯ve been using it for years and years. 

But as with smoking, the body starts seeing benefits almost immediately when you stop using these products. Call 1-800-784-8669 or text QUIT to 47848 for help quitting.

Cancer patients may also enroll for free in?MD Anderson¡¯s Tobacco Research and Treatment Program. If you are not an MD Anderson patient, but would still like to particpate in one of our studies, please visit Tobacco-Related Studies.

., is medical director of the Tobacco Research and Treatment Program at MD Anderson.

 or call 1-877-632-6789.