Rendering Oral Nicotine Pouches Harmless—A Biological Appraisal

Abstract

Since their introduction to the US market in 2016, oral nicotine pouches have grown in popularity. These small fiber pouches of an appealing taste deliver nicotine to the narrow space between the gum and the lip, precisely at the interface of the mucosa of the vestibulum oris and the oral moisture derived from saliva. This delivery mechanism leads to a systemic effect as the substances bypass gastrointestinal enzymatic degradation and the hepatic first-pass effect. While a portion of the nicotine from these products undergoes enzymatic changes in the liver due to the first-pass effect, some nicotine manages to evade this process. The gut environment appears to influence the first-pass effect within the portal circulation system. Despite their ease of use, these products exhibit variability in nicotine levels and concentrations, potentially leading to poisoning and addiction. The increases in use, marketing, and appeal of nicotine pouches have notably elevated their popularity among younger people. However, it is crucial to note that oral nicotine pouches are not risk-free. Given their potential for overdose, a review of medical literature was conducted to explore whether the microbiota could play a role in influencing nicotine overdose among users of oral nicotine pouches.