By Author
  By Title
  By Keywords

April 2023, Volume 73, Issue 4

Student's Corner

Nicotine Pouches: A Guilt-Free addiction path?

Ume Habiba  ( 4th Year MBBS Student, Dow Medical College, Karachi, Pakistan. )
Syed Muhammad Moaaz Bin Sultan  ( 4th Year MBBS Student, Dow Medical College, Karachi, Pakistan. )
Radeyah Waseem  ( 4th Year MBBS Student, Dow Medical College, Karachi, Pakistan. )

Madam, Nicotine Pouch (NP) is an oral, non-combustible white bearing, comparable to snuff, packed with a nicotine-containing powder, artificial flavourings, and plant-based fibers.1 It predominantly targets adult smokers as an innovative smoking cessation product since it does not contain tobacco leaves. Despite the claim, it is yet to be established if NPs do assist smokers in the transition from smoking cigarettes to employing a less detrimental nicotine source. Tempting packaging and flavourings, undefined addiction hazard warnings, and unscrupulous marketing strategies are notable speculations for its accentuating popularity amongst youngsters, who have become the central audience of manufacturers.2 Marketing campaigns employ social media influencers, target the population present at concerts and sporting events, and offer free samples, immensely intriguing the young, non-smoking community to engross in nicotine and tobacco dependence that is accountable for an annual loss of around 8 million lives globally.3 Nicotine Pouches have been introduced in Pakistan under the name ‘Velo’ and are gaining popularity across the nation.

Nicotine pouches are yet to be defined as an NRT by the FDA. Similar to other NRTs, it has a propensity to cause nicotine addiction, a higher risk of developing oral diseases, gastrointestinal disorders, hiccups, etc. The direct propensity of nicotine to cause a plethora of cancers is also into question.4 Nicotine pouches are also reputed as being teratogenic and detrimental to brain development up to 25 years of age. Another alarming breakthrough is the rationale that the harm reduction rhetoric can be perceived as a strategic tactical counter-act to evolving policies in tobacco control rather than an honest undertaking to reduce damage. Around 2018, Russia and a few Eastern European countries reported selling pouches of elevated strengths (>20 mg/ pouch) as an imperative for yearning for relief, leading to their cessation in Russia.1

A rise in sales was noted from 2016 to 2020 in the USA from 163,178 units to 45,965,455 units, each unit comprising 15-20 pouches.5 This exponential rise in sales is alarming for countries like Pakistan where tobacco use is responsible for more than 163,600 deaths in 20176 and a major contributory factor of tax collection.7 It is high time to limit access to these products by scrutiny of business records to impede misuse, as the consumer survey by product innovation nominates velo as the best product of the year. 8 An unimpeachable regulatory authority is in question to contemplate the safety, buying barriers, product reliability, dose administration, marketing strategies, and health monitoring to augment the envisioned benefits and prevent any future mishaps.


Disclaimer: None.


Conflict of interest: None.


Funding disclosure: None.




Submission completion date: 09-08-2022


Acceptance date: 17-11-2022




1.      Patwardhan S, Fagerström K. The New Nicotine Pouch Category: A Tobacco Harm Reduction Tool?. Nicotine Tob Res 2021; 24: 623-5.

2.      Salokannel M, Ollila E. Snus and snus-like nicotine products moving across Nordic borders: Can laws protect young people? Nordic Studies on Alcohol and Drugs 2021; 38: 540-54.

3.      New products, old tricks? Concerns Big Tobacco is targeting youngsters. The Bureau of Investigative Journalism (en-GB). [Online] 2022 [cited 2022 June 19]. Available from: URL:

4.      Grando SA. Connections of nicotine to cancer. Nat Rev Cancer 2014; 14: 419-29.

5.      Marynak KL, Wang X, Borowiecki M, Kim Y, Tynan MA, Emery S, et al. Nicotine Pouch Unit Sales in the US, 2016-2020. JAMA 2021; 326: 566-8.

6.      Tobacco control cell, NHSR&C division, government of Pakistan. [Online] [Cited 2022 Oct 28]. Available from: URL: http://www.tcc.

7.      Pakistan government imposes PKR 36 billion tax on cigarettes [Online] 2022 [Cited 2022 Oct 28]. Available from: URL:

8.      Velo. About Velo [Online] [Cited 2022 Oct 28]. Available from: URL:

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: