Physiological and subjective effects of an oral nicotine pouch in people who use smokeless tobacco

Abstract

Nicotine pouches (NPs) contain no tobacco leaf but instead are filled with nicotine powder, flavorants, and pH adjusters. There are very few independent (i.e., non-industry-funded/affiliated) studies regarding the effects of NPs. The purpose of this industry-independent study is to examine NP effects in people who use smokeless tobacco (SLT). Twenty-four participants completed four sessions that included three NP conditions (2, 4, and 8 mg labeled total nicotine content; "on!" brand, Altria, Richmond, Virginia) and participants' own brand (OB) SLT. Participants completed two 30-min administration periods per session, and outcomes included plasma nicotine concentration as well as subjective and behavioral economic measures. Results indicate that the 8 mg NP did not differ significantly from OB across physiological and subjective measures; the 4 mg NP differed from OB and 8 mg on some measures, and the 2 mg NP reliably delivered less nicotine and reduced abstinence symptoms less effectively when compared to OB and the 8 mg NP. Study results offer preliminary support for the notion that higher nicotine content NPs may substitute for SLT in people who use SLT regularly, while lower nicotine content NPs may not. Overall, labeled nicotine content influences the nicotine delivery and abstinence symptom suppression of "on!" brand NP, and nicotine content and delivery should be considered when assessing the individual and public health impact of NP regulations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Figure 1.

Mean data (± SEM) for plasma nicotine concentration across conditions (Panel A; n = 22) and for the Hughes-Hatsukami “Craving a dip/nicotine” item, (Panel B; n = 23). Participants completed two, 30-minute administrations (shaded gray) in four conditions (2 mg, upside-down triangle symbol; 4 mg, square symbol; 8 mg, right-side-up triangle symbol; OB, circle symbol). Filled symbols indicate a significant difference from pre-use plasma nicotine concentration (same condition). Asterisk (*) indicates significant difference from OB at same time point. Pound sign (#) indicates significant difference from 8 mg at same time point. Plus sign (+) indicates significant difference from 4 mg at same time point. All ps < .05; Tukey’s HSD.