| Cigarettes, as you've probably heard, are bad. And while vaping gets around the problem of carcinogenic smoke, dousing your lungs in toxic chemicals brings risks of its own, health authorities will tell you. Less clear is what happens when you instead spend the day cycling through oral pouches or lozenges that gradually deliver nicotine, the addictive substance in cigarettes and vapes, into your bloodstream. But millions of people are in the process of finding out. Zyn, Phillip Morris International's market-leading brand of tobacco-free nicotine pouches, has roughly tripled its sales in the US since 2022, shipping almost 150 million cans in the third quarter of last year. Each tin contains 15 flavored pouches with as much as 6 mg of nicotine apiece, the equivalent of roughly three cigarettes. (It's a good business, too: PMI estimates that its smoke-free products generate more than twice the gross profits of cigarettes.) The rapid rise of Zyn has been a little flummoxing to researchers and health experts, for whom nicotine has long been a second-order problem. Traditionally, it's the smoking that kills you; nicotine is just the addictive substance that keeps you lighting up. If someone can be persuaded to kick cigarettes, there are patches and gums and brain-training programs ready and waiting to help them shake off the residual nicotine addiction. With tobacco-free pouches, on the other hand, the nicotine is the whole point. That shifts the focus from smoking's blaring dangers of lung cancer and cardiovascular disease to the more diffuse risks of forming a dependence on straight-up nicotine, a substance that no less an authority than Keith Richards said is harder to quit than heroin. "There are a lot of immediate effects of nicotine that can seem pretty ideal," says Jodi Prochaska, a clinical psychologist who specializes in addiction at the Stanford Prevention Research Center. Nicotine is a stimulant that, not unlike caffeine, has demonstrated effects on concentration, memory and appetite suppression. "That all might sound amazing, but it's so transient," Prochaska says. "The half-life is one to two hours, so unless you keep dosing, you're going to feel anxious, unable to concentrate, and irritable. Then you become hooked and need to constantly dose it just to feel normal." The sheer amount of nicotine a pouch user can consume could be cause for alarm in itself. The average user is running through about half a tin in a day, according to the American Lung Association. If each of those pouches is a 6 mg Zyn, that adds up to about as much nicotine as in three packs of cigarettes, a rate of consumption impractical outside of a Mad Men episode.
And because nicotine pouches are so new — the first one made its market debut in the US in 2016 — there's not much data on the long-term risks of sustained exposure to such high levels of nicotine. Many studies, like a recent one from Germany, conclude that while nicotine pouches can lead to notable elevations in heart rate, the risk pales in comparison to the dangers of smoking. The nightmare scenario is that the soaring popularity of nicotine pouches serves as a gateway to old-fashioned cigarettes, said Thomas Carr, policy director at the American Lung Association. Only about a third of pouch users have ever smoked before, Carr says, suggesting few are using them to quit. The fear is that more and more will become so-called dual-users, popping pouches during the workday and then lighting up once the evening comes. "Cigarettes are on the decline, but if this leads to more people smoking — or using any tobacco products — it's going to be a huge problem," he says. — Damian Garde | 
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