Nicotine pouches: The latest trend getting kids hooked

As concerted efforts to curb the rates of teens vaping in Australia roll out, young people have already moved onto the next trend – with nicotine pouch use on the rise.
 
So, what exactly are these products and should GPs now be including them in their advice on vaping or smoking cessation?
 
Nicotine pouches come in small teabag-like bags, often sold in small colourful tins. They do not contain tobacco, but instead consist of plant-derived or synthetic nicotine as well as sweeteners and flavours.
 
Placed between the lip and gum, the product in the pouch dissolves in the mouth and is absorbed into the bloodstream.
 
Recent research, published this week in the international Drug and Alcohol Dependence journal, details the patterns of nicotine pouch use among young Australians.
 
The study, which surveyed responses from a cohort aged 16–39 years, shows awareness of the product was reported by 77% of participants, lifetime use by 26%, and past 30-day use by 19%.
 
‘Research on the harms associated with nicotine pouches is in its infancy, with most studies to date conducted by tobacco companies or researchers funded by tobacco companies or their subsidiaries,’ the study states.
 
Chair of RACGP Specific Interests Addiction Medicine Dr Hester Wilson told newsGP there is no doubt this new product trend, particularly among teens, is increasingly becoming an issue.
 
‘It’s certainly been a question that’s been asked by some young people that I have seen, but also some of the young people in my life, they’ve been talking about it,’ she said.
 
‘It’s another shift to get around the laws, I suspect the vaping laws, so once again we are in the same situation we were with vaping, and we don’t know what the risks are.’
 
Legislation cutting off the retail sale of vapes in Australia passed through the Senate in June this year, aimed at restricting advertising, packaging and flavours for vapes.
 
Unregulated and without any quality control, Dr Wilson says there are several added risk factors with pouches.
 
‘It’s highly discrete, it doesn’t have a smell,’ she said.
 
‘There could be variable amounts of nicotine, from no nicotine to massive doses.’
 
The Therapeutic Goods Administration (TGA) says it is ‘aware of the rising profile of nicotine pouches in Australia‘.
 
‘Particularly the promotion of nicotine pouches as an aid to support smoking or vaping cessation,’ it says.
 
‘No nicotine pouches have been evaluated by us for quality, safety or efficacy in Australia.’
 
According to the TGA, consumers can import nicotine pouches under the Personal Importation Scheme with a valid prescription from an Australian-registered medical practitioner.
 
Although they are illegal to sell without medical supervision, retailers are commonly being caught flouting the law.
 
In August, 10,000 nicotine pouches were seized in an enforcement operation from tobacconists in Queensland.
 
As it might be some time before legislative reform catches up to the tobacco industry’s latest product reinvention, Dr Wilson says GPs should step in now and include advice on the pouches when talking to patients about cessation.
 
‘We must ensure that young people get credible, evidence-based information and they’re not depending on an Instagram influencer or a person that absolutely has a conflict of interest, because they’re going to make money,’ she said.
 
‘We really need to be making sure that young people have got the information about the nicotine replacement products that we do know what the risks are if they want to quit, rather than going for something where we don’t know about the quality and we don’t know about the risks of any of those substances.’
 
She said that young people are often very open to these kinds of conversations.
 
‘I see it in the conversations that I have with the young people in my life, they don’t like the idea of being manipulated,’ she said.
 
‘They don’t like it that they’re being lied to, and they don’t like the sense of being dependent or being addicted to something.’
 
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