After an intense hour of playing, Kim has just returned home from a badminton match. The 29-year-old photojournalism student from Aarhus, Denmark, wants to relax and not think about anything. So he places a small bag in the corner of his upper lip. It is a nicotine pouch—a product wrapped in a cellulose film. It contains nicotine, the psychoactive, tobacco-free white powder made from dehydrated derivatives of the tobacco plant or produced synthetically. Just 10 seconds later, he feels the tingling sensation in his fingertips that signals he is about to enter his desired state of ease.
You smoke cigarettes, you chew tobacco—but you simply “park” the nicotine pouches between your lip and gum. Anywhere from 10 seconds to 15 minutes later, they lose their tingling effects, leaving only the remaining flavour. Using the pouch is a kind of self-care for Kim. Despite seeking respite from the stressors and intensity of the day, he knows that—scientifically speaking—the nicotine is only increasing his heart rate.
For 22-year-old Danish student Kasper, using the pouches is part of what he describes as a ritual. “It takes you a minute to quickly put it in and a minute to get it out. You take a break and get back to work,” he explains. Kasper can use five or six pouches over eight hours during a full day of studying. “It’s just something to help with the distractions,” Kasper admits. “I’ll get distracted by that feeling rather than quickly jumping on Facebook. Which might just be swapping one addiction for another.”
Notorious as a highly addictive substance in cigarettes, nicotine is a neurotoxic chemical compound derived from the tobacco plant. When consumed, nicotine mimics a native neurotransmission chemical called acetylcholine, according to the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), an independent committee of the European Commission. Acetylcholine activates receptors in the brain that are important for attention, memory, and cognitive processing functions. Nicotine, once ingested, swamps these same receptors within seconds, providing almost instantaneous effects to the consumer— resulting in the “tingling” sensation Kim describes. These receptors are found in nearly every region of the brain, and nicotine has the power to change the central nervous system, developing tolerance over time and leading to physical dependency.
The effect of nicotine pouches partially depends on their potency, ranging from three to 17 milligrams of nicotine per pouch. A cigarette contains approximately 10 mg of nicotine, but less than a tenth—between 1.1 and 1.8 mg—is inhaled. “The pouches are way stronger than a cigarette,” Kim, previously a cigarette smoker for 10 years, says from experience. “At the beginning, I got sick from it. The first time I tried it I had to vomit.”
After trying another pouch some years later, he warmed to the sensation. “You reach a point where you don’t get sick. And it’s just okay. This is cool,” Kim comments. Rituals, as Kasper suggests, can be confused with habits. But as Kim admits, depending on the strength of the pouch and frequency of use, it can be tough to control your urge.
The pouches are colloquially called “snus” here in Denmark, referring to a similar pouch tobacco product that dates back to early 18th-century Sweden. Swedish snus is now illegal in all European Union countries, except for Sweden, because its contents can cause cancer. According to the University of Bath, transnational tobacco companies have been interested in nicotine pouches since the early 2000s and began selling the products in Europe in 2018.
Scandinavia is currently the largest market for nicotine pouch use. Among all smoke-free alternatives, pouches are the fastest growing sector in the region, according to Swedish Match—the producer of the nicotine pouch brand ZYN.
No more “image problems”
With tolerance built over time, some people use the pouches to satisfy a desire, while others use them as an accompaniment to other vices such as alcohol. Walking around city centre bars in Aarhus on a Friday night, one can see cans of nicotine pouches openly placed on the tables alongside empty glasses and bottles of beer. “If you’re sitting at a bar and feeling a little peckish, you grab peanuts,” says Kasper, drawing a comparison. “The more you drink, the hungrier you get, and there are peanuts sitting right in front of you.” A study published in Psychology of Addictive Behaviors confirmed that drinking alcohol can induce cravings for nicotine and suggested that it increases the positive sensations the user feels with nicotine products as well.
There is an undeniable negative stigma associated with tobacco products, and younger generations have grown up seeing it as increasingly taboo. Public smoking in Denmark was banned in 2007 and all advertising for such products has been prohibited since a legal amendment in 2020. The Nordic country is also considering a historic law change which would ban the sale of cigarettes and nicotine products for people born after 2010. Meanwhile, cartons of cigarettes display graphic bodily traumas potentially caused by smoking and are tucked behind a black plastic curtain in stores, hidden from shoppers’ view.
Nicotine pouches are presented by their manufacturers and sellers as a healthier lifestyle choice because they contain primarily pure nicotine and no carcinogens. The nicotine in the pouches is often combined with sweeteners and flavours. Considered a major popularity factor, some countries like Denmark have begun to regulate flavour options to dissuade young people from using the pouches. To Kim, the pure nicotine makes the pouches an elegant cousin to the uglier members of the tobacco product family like cigarettes and chewing tobacco. He describes the nicotine pouches as “clean, white and without smell,” whereas people who chew tobacco can be seen, he says, “with black saliva running down their teeth.”
The pouches are also often promoted as “modern” non-smoking alternatives that can go anywhere and be taken anytime. They are sold in a little can with an internal pocket on the lid, a repository for used, discarded pouches. The cans travel freely through trains, buses, airports and onto planes, tucked snugly in a purse or pocket. The individual pouches are also discreet—they do not exude an aroma and their placement in the upper lip is for the most part indiscernible to the observer. This near invisibility became a mounting concern for teachers and parents as young Danes, some of the heaviest consumers, used pouches during class. The trend prompted the Danish government to update its legislation in 2021 to ban the use of nicotine pouches during school hours. Educational campaigns in schools complement this, but only a long-term evaluation will tell us whether the ban is effective.
Convenient, cheap, and viral
Kasper remembers being drunk at a party and unable to go outside to enjoy his occasional cigarette. That is how he tried his first pouch. “If you’re sitting down at a party and can’t get outside, you just open the lid, take a pouch out and put it in your upper lip,” Kasper says. He recalls watching friends finish entire packs of pouches in the same sitting as one beer.
The pouches are not only designed for immediate and repetitive use—their convenience also lies in their price and accessibility. They are sold as an everyday commodity in any store. There is also no specific tax on these products—unlike tobacco goods—and all legislative proposals to introduce such a fee are still pending. For now, the pouches remain cheaper than tobacco. A can with 15-20 nicotine pouches in Denmark costs roughly 40 DKK, approximately five euros, while the cheapest pack of cigarettes goes for 50 DKK, almost seven euros. To the manufacturers, cigarettes only guarantee a revenue of 10% of the price, roughly 12 DKK, while profit for a pack of nicotine pouches can reach up to 30 DKK, or 75%.
“So it is a much better product for manufacturers to sell,” says Niels Them Kjær, project manager for tobacco prevention at the Danish Cancer Society. “Of course, they want to use their marketing budget to promote these products to young people,” Kjær concludes.
Legally, nicotine pouches can only be purchased by someone 18 or older. Still, a 2022 report by the National Institute of Public Health and the University of Southern Denmark found that almost 29% of 15 to 17-year-old respondents had used smokeless nicotine products in 2021, which included nicotine pouches.
Additionally, The Danish Health Institute confirmed a troubling trend to Danish national broadcaster DR: young Danes were lodging the pouches in bodily cavities, like the foreskin or rectum, sometimes when drunk and for fun. In 2021, 100 health organisations from 53 countries—among them the Danish Cancer Society, Switzerland’s OxySuisse, the Italian Society of Tobaccology and multiple organisations from France and Belgium—signed a letter to the United States Food and Drug Administration as a globally recognised public health institute. The letter addressed the major social media companies in the United States—Facebook, Instagram, Tik Tok and Twitter—to “end the promotion of nicotine pouches on their platforms.” The report highlighted how tobacco companies target young audiences, particularly on social media. The hashtag #YouveGotVelo, promoting nicotine pouches by a brand called Velo, now has paid ads posted by Instagram influencers, some with millions of followers. It seems that with nicotine pouches, the tobacco industry has found a new strategy—or perhaps the perfect recipe—to keep a foothold in society.
A health concern, not a priority
While humans ingest, the environment suffers. Even though nicotine pouches come in a can that functions as a trash bin, the little white bags are tossed onto the streets alongside glitter and cigarette butts in Denmark. They are clustered in the corners of the bus station, clumped in the trash containers at school, lined up like ants on the pavement, and spread throughout the grass like fertiliser beads.
According to the Truth Initiative, a nonprofit health organisation striving to make nicotine addiction a thing of the past, research has shown that organic compounds leftover from cigarette butts—which include nicotine—harm fish and microorganisms living in our waters. A study by the University of Exeter and the Norwegian Institute for Water Research measured the effect of nicotine exposure on ragworms—which play a central role in marine ecosystems in many parts of the world. Being exposed to the toxicant affected their natural behaviour, such as inhibiting their ability to burrow in sediment for shelter. The worms are commonly eaten by fish and birds, possibly spreading the harmful substance.
Though no official research has been published yet on the impact of nicotine pouches on the environment, it is reasonable to assume that this product, so often seen lining Danish streets, could make its way to the ocean.
Most Danish consumers, Kasper thinks, do use the lid to dispose of their pouches. The fact that you can still see so many pouches littered on the ground, he suggests, speaks to the magnitude of consumers. Despite the drug’s popularity, the long-term use of nicotine pouches remains understudied amidst other competing substances known to cause adverse health effects. Kjær confirms that nicotine pouches have not been proven to cause cancer.
The Centre for Alcohol and Drug Research at Aarhus University—a unique interdisciplinary research institution founded in 1993 to study the relationships between drugs and alcohol—is not currently conducting any studies on the pouches despite their addictive traits or their association with alcohol. Manufacturers do not seem to be worried. “Smoke-free nicotine products have been widely used in Sweden for more than 50 years,” says Inger Schroll-Fleischer, director of Nikotinbranchen (The Nicotine Industry). This lobbying organisation represents manufacturers of smoke-free nicotine products in Denmark. “Due to this long-term Nordic experience, we have detailed knowledge on nicotine’s long-term effect on the human body,” Schroll-Fleischer states.
While this does not mean that their use should be encouraged or that they are the “healthier” alternative they are marketed to be, nicotine pouches are not a prioritised concern for the Danish Cancer Society’s agenda either. In the absence of long-term research studies proving adverse health effects, the opinions of nicotine lobbyists and health experts vary. “To many smokers, nicotine pouches are a realistic way to quit cigarettes and continue to consume nicotine,” claims Schroll-Fleischer. Kjær disagrees with the statement. “I haven’t seen any reports that this is used for smoking cessation,” he says. “It’s not that you go from cigarettes to nicotine pouches,” says Kjær, describing the incentive for young Danes. “You go from nothing to nicotine pouches because it’s not allowed to smoke at home or on school premises.”
But Kjær recognises a silver lining: “As long as the tobacco industry uses all the money on marketing nicotine pouches, I’m in paradise because they don’t market cigarettes. So I’m not really worried about the development.” He hopes that if tobacco-free products substitute cigarettes, “there will be less cancer in Denmark.”