NBC News
Will Llamas was not a regular tobacco user when a friend introduced him to Zyn nicotine pouches.
“I was convinced that since they didn’t contain tobacco, they were pretty safe,” explains Llamas, of Stamford, Connecticut. “I liked the way they felt. They tasted good. And so I was hooked.”
Llamas, 32, quickly became addicted to Zyn, eventually consuming up to 20 packets a day. The pouches come in 3- or 6-milligram doses of nicotine in a variety of flavors, including coffee, mint and citrus.
“It gives you a hit of dopamine, you feel more energetic, happier, almost focused,” says Llamas.
Nicotine pouches like Zyn have surged in popularity in recent years. Zyn, a Swedish brand, was acquired by Philip Morris in 2022, and more than 131 million units were sold in the first three months of this year, up 80% from the same period last year. Last month, a shortage of Zyn sparked an outcry on social media. Other products include Rogue, Velo and On! Most are marketed as smoke-free, non-hand-held and non-drooling alternatives to cigarettes.
“Typically, when you say something is free of something, it makes it seem less harmful,” says Tory Spindle, an associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine in Baltimore. “Our concern is, well, does that make them more attractive to someone who otherwise would never have tried any tobacco product?”
While Spindle said nicotine pouches — which users stick between their lip and gum and then throw away — could serve as a better alternative for those who already use tobacco, “the challenge is, how do you make products accessible to these types of users, while not hooking in customers who otherwise might never have tried nicotine?”
In a statement, Philip Morris said it is “committed to developing products like Zyn that are scientifically proven to be a better alternative to continuing to smoke.”
Llamas said he had tried other smokeless tobacco products but didn’t like the taste.
“Honestly, it was pretty unpleasant, so the benefits weren’t there,” Llamas says. “However, after a year of using Zyn, he started experiencing gastrointestinal problems, which he now attributes to the nicotine pouches.
“I had a lot of tests done. I went to the hospital. They did an ultrasound and a colonoscopy, and all they found was that I had a swollen stomach,” she explains. After researching her symptoms on the Internet, she thought the source of her problems might be the bags. “I haven’t had any stomach problems since the day I quit cold turkey.”
Llamas wears an Apple Watch every day and said the device detected that his resting heart rate dropped by 10 beats per minute after he stopped using the bags.
“I really wish I had had more information when I took my first bag,” she said. “If I had known it was going to cause me so many health problems, I wouldn’t have started.”
Negative health effects
Dr. Donna Shelley, a professor and vice dean for research at New York University’s School of Global Public Health, said that while nicotine pouches do not cause the same health problems as tobacco products, she would not call them “safe.”
“Some of the negative health effects of nicotine pouches include gastrointestinal symptoms such as nausea, sore gums and ulcers, and also some cardiovascular risks such as increased heart rate,” said Shelley, who researches tobacco control, adding: “We don’t yet know the full safety profile.”
A 2023 study comparing Zyn pouches to smokeless tobacco and nicotine replacement products found that while Zyn does not contain “nitrosamines or some of those known actual cancer-causing agents, it does contain some chemicals like formaldehyde that the FDA has said are potentially harmful,” it said. Dr. Varisha Parikh, a prosthodontist at Parikh Prosthodontics in Los Angeles, has warned about the potential dental health effects of nicotine pouches on social media.
“Putting something on the gum tissue for a prolonged period of time, which is a chemical agent, you’re just asking for problems in that area,” he says.
Sydney Cunningham said she has receding gums from using Zyn. The 30-year-old from Safford, Arizona, picked up the habit while studying for her doctorate because she “wanted an extra boost” to help her focus and study for exams.
“I put the Zyn sachets in the back of my mouth, as close to my wisdom teeth as possible, at the top,” Cunningham explains. “And that’s where I’m having these gum problems.”
One of the biggest concerns for medical experts is that these products are not only used by adults, but also by children and adolescents.
“When young people use nicotine, it changes the way their brains function. And what that can do is set them up for a lifelong addiction to nicotine,” said Judith Gordon, a professor and associate dean for research at the University of Arizona College of Nursing.
Spindle, who studies the addictiveness of different flavors of nicotine pouches, says that “they seem to be very targeted at young people.”
“The way they’re designed is exactly the kind of thing that makes it easy for teens to use and, you know, it’s convenient and concealable,” said Vaughan Rees, director of the Center for Global Tobacco Control at Harvard’s T.H. Chan School of Public Health. The different strengths may make it easier to start using the pouches, he added. “The way it’s designed may actually encourage youth use rather than being a viable alternative for an adult smoker.”
A study published Wednesday in the Journal of the American Medical Association found that nicotine pouch use among U.S. adults remains low despite rising sales.
However, the study focused only on adults, according to Adam Leventhal, a co-author of the study and director of the Institute for Addiction Sciences at the University of Southern California. It’s possible, he said, that the increase in sales is due to underage users. “Although the study focused on adults, there is published and forthcoming data showing that a significant proportion of adolescents also use nicotine pouches at rates higher than adults,” Leventhal said.
Earlier this year, the FDA issued 119 warnings to retailers selling Zyn to minors.
“The FDA remains concerned about any tobacco product that may appeal to youth,” an agency spokesperson said in a statement.
The FDA is reviewing marketing applications for Zyn and other nicotine pouches, though it has allowed the products to be sold in the United States in the meantime. Several medical organizations have asked the FDA to remove them from the market during the review period.
Last month, Phillip Morris suspended online sales of Zyn after raising questions about whether it violated Washington DC’s ban on selling flavored tobacco. But the products remain available online through other sellers.
In a statement, Philip Morris said that “Zyn is marketed to nicotine consumers aged 21 and older.” It has been six months since Llamas quit smoking, but he says he still has cravings.
“I don’t know if they will ever go away,” she said. Quitting smoking was difficult, she added, because she used a bag of Zyn for almost every activity.
“So I had to relearn how to like these activities and my body has to create its own dopamine,” Llamas added. “So going to the gym, driving, being at work. All of these things I had to relearn how to enjoy.”
