Nicotine pouches an ‘evidence-free zone’

A GP and addiction specialist has expressed significant concern over the rapidly rising popularity of nicotine pouches, particularly among young Australians.
 
Nicotine pouches are small bags containing nicotine and often other ingredients such as sweeteners and flavours.
 
Designed to be placed in the user’s mouth, between the lip and gum, the pouches are gaining popularity for their discreetness and ability to be used in places where vaping and smoking is not allowed, such as gyms and nightclubs.
 
It remains illegal for Australian retailers, such as tobacconists and convenience stores, to supply nicotine pouches, even to customers with a prescription.
 
In June 2024, the ABC reported that 1.3 million nicotine pouches had been seized at the Australian border since January 2024 – a 950% increase from the previous two years.
 
And on Monday in Sydney, the Therapeutic Goods Administration (TGA) seized products worth more than $360,000, including 7000 nicotine pouches and 5000 vapes.
 
‘Nicotine pouches can contain very high nicotine concentrations that have not been assessed in clinical studies, posing potential significant safety risks,’ said the TGA following Monday’s seizure.
 
Chair of RACGP Specific Interests Addiction Medicine, Dr Hester Wilson, told newsGP it is concerning that some people perceive an unregulated nicotine product as a healthier alternative, or as a potential tool to help quit smoking.
 
‘Some influencers are talking about how fabulous pouches are, how safe they are, how healthy they are,’ she said.
 
‘The big issue is, God knows what’s in them, or how they’re manufactured. Are there contaminants in them that are poisonous? What’s the long-term risk – we don’t know anything about them.’
 
Dr Wilson said there is also ‘no evidence’ that nicotine pouches are useful to help people give up smoking, or e-cigarettes.
 
‘We just don’t know. It’s an evidence-free zone,’ she said.
 
‘It’s like we’re doing this experiment on a generation of people, and we’ll know in 40, 50, 60 years’ time what the risk is.’
 
Nicotine pouches can only be imported or supplied in accordance with TGA regulation.
 
However, no nicotine pouches have been evaluated by the TGA for quality, safety or efficacy in Australia, and none are included in the Australian Register of Therapeutic Goods.
 
Dr Wilson questions who is making money out of ‘taking advantage of our physiology’ by creating a new potentially addictive product.
 
‘All the time I’m thinking, “who’s making the nicotine?”,’ she said.
 
‘Who’s making money out of this and looking for new ways to create another generation of nicotine-dependant people that have to use their product?’
 
Dr Wilson said it is important for GPs to reiterate to their patients who are considering trying pouches to quit smoking that ‘we don’t know what’s in them’.
 
‘Absolutely we know tobacco is really bad for you,’ she said. ‘But we don’t have information about this at all. Really, we’re doing a trial of whether this causes harm or not.’
 
Dr Wilson urged doctors to instead suggest other methods, as well as behavioural and psychological support.
 
‘Changing nicotine use is tough,’ she said. ‘So, we’d go patches, we’d go gum, we’d go lozenges – we do whatever it is we need to do to support them. We might even go for the medication called varenicline – that can be really useful as well.
 
‘We’d be looking for behavioural support, psychological supports, helping people, cheering people on, helping them to learn how to change this habit and do things differently.
 
‘Potentially, in someone who’s tried a red-hot go doing those, we might try the nicotine vaping devices that are listed on the TGA, because they’re consistent with the safety standards and they haven’t got a whole heap of additives in them.’
 
Dr Wilson said the evidence around nicotine pouch use in Australia did show that, among young people who are trying them, most do not continue with their use ‘because they taste disgusting’.
 
However, for those who continue using them, once a nicotine dependency is established, ‘you’ll go for whatever is easily available, and that potentially could be smoking’.
 
‘The issue that happens, once you’re dependent on nicotine, is you don’t have free will over it,’ she said.
 
‘It’s got its hooks into you, and then you’ve got to work hard to change that.’
 
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