What to Know About Nicotine Pouches and Cancer Risk

They’re smokeless, don’t contain tobacco, and are available all over the place. But are nicotine pouches really safe?

The connection between smoking and cancer has been known for decades. But it may take years to know how dangerous newer products, such as nicotine pouches, may be. As these pouches grow more popular, especially among young people, you may be wondering if they’re as much of a health risk as cigarettes. Knowing some details about how they work and what they do can help clear up any misconceptions you might have.

Tobacco and nicotine: The basics

Tobacco is a plant. Nicotine is the drug inside it. The tobacco plant has very large leaves. Its dried leaves are used to make cigarettes, cigars, and smokeless tobacco. Some e-cigarettes and other products also include tobacco, nicotine, and additional harmful chemicals.

Nicotine is one of the harmful chemicals naturally found in the tobacco plant. It can be extracted from tobacco plants or made in a lab. It’s widely considered the major addictive substance that makes people use tobacco products. Nicotine causes the release of dopamine, a chemical that our brains send out when we feel pleasure. Dopamine can also improve a person’s focus and help them feel more alert.

However, nicotine products often include other harmful substances that can cause serious health issues. Since nicotine products can be both harmful and addictive, the Food and Drug Administration (FDA) classifies all of them as “tobacco products.” However, even FDA-approved products aren’t free from risks. Nicotine is highly addictive in any form, including pouches.

What are nicotine pouches?

Nicotine pouches are small, dissolvable packets about the size of a piece of gum. They contain nicotine powder. They’re placed between the gums and the lip. As the powder dissolves, it’s absorbed into the lining of the gums and cheek, then enters the bloodstream.

In 2025, the FDA approved marketing for nicotine pouches in the United States. Companies that make these products can now advertise them. The FDA has found nicotine pouches have fewer risks for serious health conditions than cigarette smoking does. However, the FDA warns that pouches can be addictive, may include other harmful chemicals, and carry serious health risks.

“Nicotine pouches don’t have tobacco leaf in them. But they do have nicotine, which is addictive. They may also contain harmful chemicals like formaldehyde, or heavy metals like nickel or chromium,” said Kedar Kirtane, MD, an American Society of Clinical Oncology (ASCO) expert and medical oncologist at Moffitt Cancer Center.

The amount of nicotine in each pouch varies depending on the brand and strength. In the United States, nicotine pouches typically contain between 1.5 and 12 milligrams of nicotine.

Because they don’t actually contain tobacco, nicotine pouches may be viewed as safer than smoking cigarettes, using smokeless tobacco, or vaping. But research has shown that a pouch with 6 milligrams of nicotine can deliver more nicotine to the blood after 30 minutes than smoking just one cigarette.

Who uses nicotine pouches?

Though most users are adults over 25, studies show that use of pouches is rising quickly among teens and young adults. According to the 2024 National Youth Tobacco Survey, nicotine pouches are the second most used tobacco product among high school students. Flavored options for pouches may be one of the reasons why younger users like them.

Overall use is fairly low. Among U.S. adults, only 2.9% report having ever tried a nicotine pouch. Former and current tobacco users are most likely to use pouches. Research also shows higher usage among males and non-Hispanic White people.

Do nicotine pouches help people quit smoking?

Current and former tobacco users report using nicotine pouches when trying to cut back on other nicotine products. But Dr. Kirtane cautions against using pouches as a tool to quit smoking. “Just because the FDA authorizes a product does not mean it’s safe. It just means that these products can be marketed under certain guidelines. Nicotine should be avoided,” he said.

Do nicotine pouches increase cancer risk?

The short answer is that we don’t know yet. Because nicotine pouches are newer products, there is limited research on their effects.

“Long-term data is going to be really important. We don’t know the lasting effects on the kids who are now exposing themselves to nicotine pouches. If there is true toxic harm, we’re going to see that years from now. We may start seeing more and more patients with oral cavity cancers,” Dr. Kirtane said.

What’s certain is the negative impact of nicotine on oral and dental health, cardiovascular disease risk, and cancer risk. Nicotine pouches could also act as a gateway to smoking or using other tobacco products with known links to cancer.

“Although pouches may expose you to slightly fewer carcinogens than smoking, they’re not harmless,” Dr. Kirtane said. “As a head and neck oncologist, the biggest thing I worry about is oral health. You place the pouch between your gum and your lip. This can irritate your oral membrane lining. Constantly doing that is risky if there are carcinogens present.”

Other potential side effects of nicotine pouches

Aside from raising cancer risk, nicotine in any form can affect your health in the following ways.

Oral health:

• Gum irritation and recession
• Tooth decay and cavities
• Dry or sore mouth

Cardiovascular health:

• Increased heart rate and blood pressure
• Greater risk of heart disease and stroke
• Damage to blood vessels

General symptoms:

• Nausea
• Headaches
• Dizziness
• Hiccups
• Upset stomach
• Mental health concerns, including depression and anxiety

Dr. Kirtane is a member of ASCO’s Patient Information Advisory Committee.