Oral Nicotine Pouches and the Emerging Addiction Crisis Among Youth in Pakistan: A Perspective.

Background and Aims: Oral nicotine pouches (ONPs) are smokeless, flavored products marketed as safer alternatives to cigarettes, but their rapid uptake among adolescents has raised serious public health concerns. This Perspective examines the emerging use of ONPs among youth in Pakistan, the marketing and regulatory environment driving their spread, and the policy responses needed to prevent a new wave of nicotine addiction. Methods: We synthesized recent peer-reviewed evidence, including national survey and point-of-sale data from Pakistan, alongside international literature on ONP use, marketing, and adolescent nicotine addiction, to characterize the scale of the problem and identify regulatory gaps. Results: ONPs are widely available across Pakistan, which has become the third-largest market globally for the leading brand, Velo. Products are sold cheaply, in youth-oriented flavors, and are often displayed near schools and alongside confectionery; some retailers sell to minors. National data show that more children report using e-cigarettes and nicotine pouches than conventional cigarettes, yet public awareness of ONP content and risks remains low. Adolescents are neurobiologically vulnerable to nicotine addiction, and ONPs may act as a gateway to long-term dependence rather than a cessation aid. Critically, ONPs are not legally classified as tobacco products in Pakistan and therefore fall outside existing tobacco-control legislation. Conclusion: Urgent, dedicated regulatory action is needed-including age verification, advertising bans, retail-zoning restrictions, mandatory health warnings, surveillance, and public-awareness campaigns-to prevent ONPs from addicting a new generation of Pakistani youth.