American Lung Association Claims that Nicotine Pouches are No Safer than Cigarettes

In light of the FDA's approval yesterday of a pre-market tobacco product application (PMTA) for Zyn nicotine pouches, I did some internet searches to see what tobacco control and health groups are telling the public about the health risks of nicotine pouches compared to cigarettes. The fact that the FDA approved this product indicates that the agency determined that nicotine pouches are much safer than cigarettes. This is one determination the FDA must make before it can approve any PMTA. 

The FDA explicitly stated its conclusion that Zyn nicotine pouches are safer than cigarettes: "Among several key considerations, the agency’s evaluation showed that, due to substantially lower amounts of harmful constituents than cigarettes and most smokeless tobacco products, such as moist snuff and snus, the authorized products pose lower risk of cancer and other serious health conditions than such products. The applicant also provided evidence from a study showing that a substantial proportion of adults who use cigarette and/or smokeless tobacco products completely switched to the newly authorized nicotine pouch products."

Because nicotine pouches contain no tobacco, do not involve combustion, and do not even involve heating, they do not produce either smoke or vapor. Therefore, they are probably one of the safest forms, if not the safest form, of nicotine intake. Obviously, there is no comparison between the safety of nicotine pouch use compared to that of cigarette smoking. Nicotine pouch use is unequivocally much safer than smoking.

However, that fact did not stop the American Lung Association from publicly claiming that nicotine pouches are no safer than cigarettes, which is another way of saying that cigarette smoking is no more hazardous than using a nicotine pouch - a preposterous and damaging statement on its face.

Here is exactly what the American Lung Association claims:

"Because of their smokeless, odorless features, many people believe that these nicotine pouches are a safer alternative to cigarettes. But don’t be fooled. A 2022 study of 44 nicotine pouch products found that 26 of the samples contained cancer-causing chemicals and several other chemicals such as: ammonia, chromium, formaldehyde, nickel, pH adjusters, and nicotine salt."

The Rest of the Story

The basis of the American Lung Association's claim that nicotine pouch use is no safer than smoking is this 2022 study which indeed detected tobacco-specific nitrosamines (carcinogens) in 26 of 44 nicotine pouches studied. However, what the American Lung Association is not informing the public is that the levels of nitrosamines detected in nicotine pouches were extremely low -- essentially trace levels -- and that these levels are two orders of magnitude lower than the nitrosamine levels in some brands of nicotine gum, which the American Lung Association heavily endorses.

The level of nitrosamines detected in nicotine pouches that did have detectable levels typically were in the 0.5ng to 3ng range. The absolute highest level detected in any of the pouches was 13ng. 

In contrast, nicotine gum has been found to contain levels of tobacco-specific nitrosamines as high as 380ng per gram of gum. Conservatively assuming that a piece of nicotine gum weighs one gram, the nitrosamine content of this brand of nicotine gum is 380ng. 

Since the highest nitrosamine level detected in nicotine pouches was 13ng, this means that the level of these carcinogens in this nicotine gum brand is 29 times higher than the nicotine pouch with the highest level of nitrosamines. Most of the nicotine pouches had no detectable nitrosamines, and most of the pouches that did have nitrosamines detectable had levels of no more than 3ng. This means that nicotine gum may have carcinogen levels that are as much as 127 times higher than most nicotine pouches with detectable nitrosamine levels. Of course, the level of nitrosamines in nicotine gum is infinitely higher than its level in 18 of the nicotine pouches tested.

Clearly, the American Lung Association is outright lying to the American public. There is no evidence to support its claim that smoking is no more hazardous than using a nicotine pouch. And there is abundant evidence that smoking is much more hazardous than using a nicotine pouch. Moreover, the study which the American Lung Association cites to back up its claim actually demonstrates that nicotine pouches have far lower levels of tobacco-specific nitrosamines than nicotine gum!

This would be an almost laughable misrepresentation of the truth were it not for the fact that the American Lung Association's false information may very plausibly deter smokers who might otherwise switch to nicotine pouches from quitting smoking.

This is a huge favor to the cigarette industry. Nicotine pouches--because of their drastically lower health risks than cigarettes--pose an existential threat to the cigarette industry. But not if the American Lung Association has its way. 

The rest of the story is that the American Lung Association is lying to the public and they are doing so in a way that is helping to protect the profits of cigarette companies, deter smokers from quitting, and boosting sales of deadly cigarettes, which means more lung disease. 

Yes, the American Lung Association's irresponsible reporting of the relative health effects of nicotine pouches compared to cigarettes may well result in increasing lung disease in the population.