Nicotine delivery from and user reactions to nicotine pouches compared to cigarettes

Rationale Limited data exist on the potential of nicotine pouches to help smokers quit. Objectives To examine nicotine delivery from and user reactions to a popular nicotine pouch. Methods Twenty smokers provided data after overnight abstinence, first after smoking a cigarette and then, a week or more later, after using 9 mg nicotine ZYN pouch. Blood samples were collected before and 2, 4, 6, 8, 10 and 30 min (and also 60 min in the pouch condition) after starting product use. Participants also rated their urges to smoke at 5, 10, 15 and 30 minutes, and provided ratings of pouch characteristics at the end of the session. Results Pouches delivered nicotine more slowly than cigarettes (Tmax 30 min vs. 6 min, z =-3.93, p < 0.001), though nicotine levels from pouches reached 13 ng/ml within 10 min. Cmax was higher than from cigarettes (27.9 vs. 19.5 ng/ml, t (19) =-2.17, p = 0.043). Both products had the same effect on reducing urges to smoke over 30 min although cigarettes were more effective at 5 min. With pouches, urges to smoke remained low at 60 min. Pouches were rated as delivering more nicotine and being less pleasant than cigarettes; but as effective and as fast in reducing urges to smoke. Three participants who were light smokers experienced nausea and one vomited. Conclusions The initial appeal of pouches to smokers is likely to be more limited than the appeal of products that resemble smoking more closely, and ZYN pouches with 9 mg of nicotine may be too strong for light smokers. However, in terms of nicotine delivery and effects on urges to smoke, pouches have good potential to provide effective replacement for smoking.