Will Llamas, who wasn’t a regular tobacco user, was introduced to Zyn nicotine pouches by a friend. “I had convinced myself, because there wasn’t any tobacco, these were pretty safe,” Llamas from Stamford, Connecticut, said. “I liked how it made me feel. It tasted good. And so I was hooked.”
At 32, Llamas quickly developed an addiction to Zyn, using up to 20 pouches a day. These pouches, available in 3- or 6-milligram doses, come in various flavors like coffee, mint, and citrus. “It gives you a shot of dopamine, so you just feel a little energized, happier, almost focused,” Llamas explained.
Rising Popularity
The popularity of nicotine pouches like Zyn has surged recently. Zyn, a Swedish brand acquired by Philip Morris in 2022, sold over 131 million cans in the first three months of this year, marking an 80% increase from the same period last year.
Last month, a Zyn shortage led to an outcry on social media. Other brands in the market include Rogue, Velo, and On!, marketed as smoke-free, spit-free, and hands-free alternatives to traditional tobacco products.
Perception of Safety
“Usually when you say that something is free of something, it makes it seem less harmful,” stated Tory Spindle, an associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine.
“Our concern is that, well, does that make them more appealing to someone that otherwise would have never tried any tobacco product?”
Balancing Benefits and Risks
Spindle noted that while nicotine pouches could be a better alternative for established tobacco users, “the challenge is, how do you make the products accessible to someone like that, while not inadvertently addicting a new wave of individuals who never would have tried nicotine?”
Philip Morris stated it is “committed to developing products such as Zyn that are scientifically substantiated as a better alternative to continued smoking.”
From Disgust to Dependency
Llamas mentioned trying other smokeless tobacco products but disliked their taste. “It was honestly pretty disgusting, so the benefits weren’t there,” Llamas said. “I was not addicted to those, but these were a whole different beast,” referring to Zyn.
After about a year of using Zyn, Llamas began experiencing gastrointestinal problems, which he now attributes to the nicotine pouches. “I got many tests done. I went to a hospital. I got an ultrasound, I got a colonoscopy, and all they found was that my stomach was inflamed,” he said. After researching his symptoms online, he suspected the pouches were the cause. “I haven’t had stomach issues since the day I quit cold turkey.”
Regret and Reflection
Llamas, who wears an Apple Watch daily, noticed his resting heart rate dropped by 10 beats per minute after quitting the pouches.
“I really wish I had more information when I took my first pouch,” he said. “If I had known that it was going to cause me so many health issues, I wouldn’t have started.”
Evaluating Safety
Dr. Donna Shelley, professor and vice dean for research at the New York University School of Global Public Health, said that while nicotine pouches don’t cause the same health problems as tobacco products, she wouldn’t call them “safe.”
“Some of the negative health effects of the nicotine pouches include gastrointestinal symptoms, like nausea, gum soreness and ulcers, and also some cardiovascular risks like elevated heart rate,” Shelley noted. “We don’t know the full safety profile yet.”
Chemical Concerns
A 2023 study comparing Zyn pouches to smokeless tobacco and nicotine replacement products found that while Zyn doesn’t contain “nitrosamines or some of those real known cancer-causing agents, it does contain some chemicals like formaldehyde that the FDA has said are potentially harmful,” Shelley explained.
Dr. Varisha Parikh, a prosthodontist at Parikh Prosthodontics in Los Angeles, has cautioned about the potential dental health effects of nicotine pouches on social media. “Placing something on your gum tissue for a prolonged period of time, that is a chemical agent, you’re just asking for issues in that area,” she said.
Gum Health Impact
Sydney Cunningham, a 30-year-old from Safford, Arizona, said she developed gum recession from using Zyn. She picked up the habit while pursuing her doctoral degree for an “extra kick” to help her focus and study.
“I put the Zyn pouches in the back of my mouth as far as I can, kind of near the wisdom teeth on the upper side of my mouth,” Cunningham said. “And that is where I’m having these gum issues.”
Targeting Youth and Potential for Lifelong Addiction
Medical experts are particularly concerned that these products are being used not just by adults, but also by kids and teens. “When young people use nicotine, it changes the way their brains work. And what it can then do is set them up for a lifelong addiction to nicotine,” said Judith Gordon, a professor and associate dean for research in the college of nursing at the University of Arizona.
Spindle, who is researching the addictive nature of different flavors of nicotine pouches, said, “they do seem to be pretty heavily marketed to youth.” Vaughan Rees, director of the Center for Global Tobacco Control at Harvard T.H. Chan School of Public Health, added, “The way it’s designed is exactly the sort of thing that makes it easy for adolescents to use and, you know, convenient, concealable.” The various strengths may make the pouches easier to start using, he said. “The way it’s designed may actually encourage use among youth rather than being a viable alternative for an adult smoker.”
Discrepancy in Usage Data
A recent study in the Journal of the American Medical Association found that nicotine pouch use among U.S. adults remains low despite rising sales. However, study co-author Adam Leventhal, director of the Institute for Addiction Science at the University of Southern California, pointed out that the study only focused on adults.
He suggested that underage users might be contributing to the sales increase. “While the study was focused on adults, there are data that have been published, and forthcoming as well, that shows that an appreciable proportion of teens also use nicotine pouches at rates that are higher than what we found for adults,” Leventhal said.
Regulatory Actions and Market Availability
Earlier this year, the FDA issued 119 warnings to retailers selling Zyn to underage kids. “The FDA remains concerned about any tobacco product that may appeal to youth,” an agency spokesperson said. The FDA is currently reviewing the marketing applications for Zyn and other nicotine pouches, though these products continue to be sold in the U.S. Multiple medical organizations have urged the FDA to remove them from the market during the review period.
Last month, Philip Morris suspended online sales of Zyn following questions about compliance with Washington, D.C.’s ban on flavored tobacco. However, the products remain widely available online through other sellers. Philip Morris stated that “Zyn’s marketing is directed toward legal age nicotine users who are 21+.”
