The World Health Organization (WHO) has called on governments to strictly regulate nicotine pouches to prevent an imminent epidemic among vulnerable adolescents. These highly addictive products threaten to dismantle decades of global progress in tobacco control if left completely unchecked, health officials warn.

Faced with declining cigarette sales, tobacco companies continuously release new product lines, expanding their portfolios to include vaping products, heated tobacco, and nicotine pouches. While the industry promotes these pouches as tools to help adults quit smoking, public health experts argue that companies deliberately target children to draw in young generations.

According to the WHO’s first-ever report on nicotine pouches, published Friday, retail sales volumes skyrocketed past 23 billion units in 2024, reflecting a 50% increase from the previous year. The global market valuation subsequently approached $7 billion by 2025. Sales are largely driven by North American consumption, with a revenue share of almost 80%. Sweden leads the per person use globally.

Aggressive marketing of nicotine pouches

Only 32 countries and territories, including Canada and Colombia, actively regulate nicotine pouches, while 16 more have banned their sale. Conversely, roughly 160 states currently lack specific regulatory frameworks.

This legislative void enables manufacturers to deploy aggressive marketing tactics with sleek packaging, vast social media influencer campaigns, and candy-inspired flavours without restriction. Digital algorithms promote these deceptive products across platforms heavily frequented by teenagers.

“With nicotine pouches, tobacco companies have added a new item to their menu of addiction,” explained Jorge Alday, director of STOP at Vital Strategies, in a statement to Health Policy Watch, commenting on the report.

‘Harms are well documented’

Sustained nicotine exposure significantly increases cardiovascular risks by stimulating the sympathetic nervous system, explained Ranti Fayokun, author and coordinator of the WHO report, presenting the report on marketing of nicotine pouches. This chemical reaction releases adrenaline, which subsequently elevates heart rates and constricts blood vessels. Crucially, early nicotine exposure damages adolescent brains that are still actively developing.

While a study of various nicotine pouches found a median content of 9.48 milligrams per pouch, toxicological testing reveals extreme chemical concentrations in certain brands, with some tiers reaching up to 150 milligrams of nicotine. If a young child were to ingest these packages, the acute dose could easily prove lethal.

“The harms of nicotine are very well documented,” underscored Vinayak Prasad, unit head of the WHO’s Tobacco Free Initiative.

WHO urges strict regulation and tax increases

To mitigate risks and reduce addiction among adolescents, the WHO insists that policymakers establish strict flavour bans that specifically target youth-oriented options, such as bubble gum and alcohol-inspired varieties like Mojito, Cosmo, and Gin & Tonic. Furthermore, comprehensive advertising restrictions must explicitly prohibit the use of social media influencers and sports sponsorships.

The agency also calls for prominent health warnings and plain packaging to counter the sleek, deceptive designs currently dominating the market, and taxation must increase substantially to reduce overall market affordability, the experts demand. To mitigate the risk of severe dependence, regulators must implement strict caps on the maximum allowable nicotine content per pouch.

States with regulations and prohibitions in place should strictly enforce their existing mandates. Legislative loopholes must be closed that allow synthetic nicotine, as manufacturers increasingly use lab-made nicotine and analogues to evade existing laws.

Health officials emphasise that “nicotine is nicotine”, noting that synthetic variants carry the same addictive properties and must be regulated uniformly alongside tobacco-derived products. “These products are engineered for addiction, and there is a strong need to protect our youth from industry manipulation,” underscored Etienne Krug, director of the Department of Health Determinants, Promotion and Prevention at the WHO.

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Image Credits: WHO, Felix Sassmannshausen/HPW.