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This August, the Food and Drug Administration (FDA) announced that four flavored nicotine pouches will continue to be sold in stores, at least until further review.
The agency’s latest move is seen as highly problematic by the American Heart Association, the American Lung Association and the American Association of Pediatrics.
The FDA claims its decision is a step toward getting adults to choose a kinder, gentler alternative to cigarettes. But numerous studies have shown that the flavored products appeal mainly to kids, not adults. The pouches may actually prime our youth for future nicotine addiction, whether through e-cigarettes or real ones.
The American Heart Association’s statement includes the following rebuke: The FDA “appears to be ignoring decades of evidence that the tobacco industry has used flavored products and other tactics to attract and addict youth to its harmful products. The tobacco industry cannot be trusted with the health of our nation’s children.”
Kids don’t tend to seek out unflavored nicotine pouches. According to a spokesperson from the American Lung Association (ALA), more than 90 percent of young people who use nicotine pouches use flavored ones.
The FDA just gave the okay to four pouches, including Rich Berry, Cappuccino (two strengths) and Autumn Spice—aware, no doubt, of how appealing these flavors would be to kids.
While smoking has declined among youth, the ALA notes that nicotine pouches “are the only tobacco product that has increased in use among young people over the last five years.”
The nonprofit points to two trends. First, many young adults are using nicotine through e-cigarettes and pouches without ever having smoked cigarettes. And second, many people who try to quit smoking by using other tobacco products end up using more than one at the same time. That’s called “dual” or “poly” tobacco use.
“Both patterns increase harm instead of reducing it,” the ALA further notes. “Starting to use nicotine in any way can raise the chances that someone will smoke in the future. Using more than one tobacco product can also cause greater health risks than using one product alone.”
Dr. David Kutler, a noted otolaryngologist and head and neck surgeon as well as an associate professor of Otolaryngology at Weill Cornell Medicine, says these risks are significant. “With regular use, the chemicals in nicotine pouches produce inflammation and irritation of the gums leading to dental loss and, possibly, an increased risk for oral cancer. Products containing nicotine also increase your heart rate and blood pressure, which can lead to cardiovascular disease with extended use.”
Nonetheless, he adds,“advertisers are promoting these products as a safer alternative to smokeless tobacco and cigarettes and are glossing over these risks.”
Emergency medicine specialist Dr. Brenna Farmer wholeheartedly agrees with Dr. Kutler’s view, saying: “As a safety measure, the companies making these products should not be marketing to underage people. Regulators should be looking to develop public health initiatives that prevent such marketing techniques and create campaigns to highlight the health problems associated with these products.”
Dr. Farmer, an associate professor of Clinical Emergency Medicine and site director at NewYork-Presbyterian Lower Manhattan Hospital’s Emergency Department, has seen the harm they cause first-hand—namely, acute nicotine poisoning.
“Acute nicotine toxicity presents with palpitations, very elevated heart rates, high blood pressure, tremors, nausea, vomiting, stomach cramps and profuse sweating,” she says. “In severe cases, acute nicotine poisoning can cause muscle paralysis, and a person can stop breathing as their respiratory muscles, like the diaphragm, don’t work properly.
“Treatment usually entails supportive care with IV fluids and medications to help calm the tremors,” she explains. “If necessary, the patient will need to be intubated and require a mechanical ventilator to help them breathe.”
Dr. Farmer cites a study from the August 2025 issue of the journal Pediatrics, saying that U.S. poison centers have reported a greater than 700 percent increase in exposures to flavored nicotine pouches from 2020 to 2023. These exposures were seen in children younger than age 6 and resulted in more referrals to the emergency department due to the signs and symptoms of nicotine toxicity than any other nicotine-containing products.
“These exposures happen when nicotine pouches are not stored or discarded properly,” she says, “and in most cases, the exposures are described as toddlers exploring their environment. Safe storage and disposal can prevent these exposures and the need for emergency department or hospital visits.”
And, obviously, reducing their use overall.
“We’ve made enormous progress reducing youth tobacco use. The goal now is to make sure a new generation doesn’t mistake ‘smoke-free’ for ‘risk-free,’” says Dr. Jonathan Avery, attending psychiatrist, professor of Clinical Psychiatry and vice chair for Addiction Psychiatry. “Young people who become dependent on nicotine don’t need shame or scare tactics. They need accurate information, support and help getting free from an addictive drug.”
Find the care you need at Weill Cornell Medicine at weillcornell.org/doctors.
