Nicotine pouches: A wolf in sheep's clothing.

Nicotine pouches are a fast-growing class of tobacco-free nicotine products, marketed for oral absorption and often promoted as cleaner alternatives to traditional tobacco. Regulatory efforts to ban flavors such as menthol have been inconsistent, with the US withdrawal of a proposed menthol ban in 2025 intensifying policy instability and raising concerns over youth use. The aim of this monitoring letter is to examine the development of nicotine pouch markets, regulatory responses, and the need for independent research to guide future policy. Sales of nicotine pouches increased dramatically from their US introduction in 2016, with youth uptake rising alongside aggressive marketing and flavored product availability. ZYN commands nearly 68.7% of the youth market, supported by social media campaigns and influencer endorsement. Despite the FDA's 2025 authorization of select ZYN products, most brands remain unregulated. Research primarily sponsored by industry suggests harm reduction, yet independent studies have found carcinogens and toxic metals in some products, and evidence gaps persist regarding health risks and long-term outcomes. International regulation varies, with France instituting a nationwide ban in 2025, contrasting sharply with the US approach. Nicotine pouches continue to expand in both market reach and youth appeal, driven by flavor options and harm-reduction narratives. Regulatory and scientific oversight remain fragmented, echoing previous challenges faced with e-cigarettes. Coordinated policy action and independent research are urgently needed to prevent a repeat of prior youth and public health concerns.