Cochrane Database Syst Rev

Evidence for oral nicotine pouches in tobacco cessation remains weak

October 28, 2025

Current evidence doesn't support oral nicotine pouches (ONPs) as a proven cessation aid for cigarettes or other tobacco/nicotine products. Short-term safety appears acceptable, but efficacy is unclear and inferior to e-cigarettes.

Study details: This Cochrane systematic review included four small randomized trials (N = 284; all in smokers) conducted in the U.S. and New Zealand. Comparisons included ONPs vs. no intervention, e-cigarettes, snus (a pouch of powdered tobacco leaves placed under the lip), and nicotine replacement therapy, as well as higher- vs. lower-dose ONP. All studies were short-term (≥4 weeks), with most at high risk of bias.

Results: Smoking abstinence may be slightly higher with ONPs vs. no intervention, but the evidence is very uncertain (risk ratio [RR], 1.58; 95% confidence interval [CI], 0.07–35.32; very low certainty). ONPs may be less effective than e-cigarettes for cessation (RR, 0.25; 95% CI, 0.03–2.02; low certainty). No serious adverse events were reported. Biomarker data suggest possible reductions in tobacco-specific nitrosamines and carboxyhemoglobin with ONPs, but findings are imprecise. No data were available for ONP use in cessation of non-cigarette tobacco/nicotine products or for population-level prevalence outcomes.

Source:

Hartmann-Boyce J, et al. (2025, February 13). Cochrane Database Syst Rev. Oral nicotine pouches for cessation or reduction of use of other tobacco or nicotine products. https://pmc.ncbi.nlm.nih.gov/articles/PMC11822881/