What parents need to know about nicotine pouches that have drawn concerns in Canada

B.C. to restrict access to Zonnic pouches B.C.'s premier announced Zonnic nicotine pouches will only be available at pharmacy counters in efforts to deter children from using them.

Nicotine pouches with candy-like flavours have captured the attention of health advocates and government officials who fear youth may become addicted to them in Canada.

In the United States, sales have soared for Zyn, a tobacco-free nicotine pouch made by Philip Morris, with about 350 million cans that have shipped in 2023, CNN reported.

While Philip Morris says Zyn isn't available in Canada, the B.C. government last Wednesday announced new regulations to make it harder for minors to buy Zonnic, another brand of nicotine pouches sold by Imperial Tobacco Canada since October.

The new regulations require the nicotine pouches to be sold behind a pharmacy counter rather than on convenience store shelves. Each Zonnic pouch has four milligrams of nicotine, which is the same amount of nicotine typically absorbed by a person who smokes three to four cigarettes. The pouches are sold in flavours such as tropic breeze, chill mint and berry frost.

B.C. Health Minister Adrian Dix said experts are concerned about the "youth appeal" of Zonnic's colourful packaging and marketing, and the "concerning trend" of youth using smoking cessation products recreationally.

Canada approved Zonnic's sale in July 2023 as a licensed natural health product for nicotine replacement therapy, meaning there are no restrictions on who can buy it and minors could buy them legally, Dix and health advocates noted.

"Their distribution needs to be limited and targeted to those looking to lessen their dependency on nicotine, not create new addictions, especially among young people," Dix said at a news conference last week.

Health Canada said it is working on regulatory and policy measures to prevent youth from accessing nicotine products.

"Health Canada is aware of and shares the concerns expressed by health care professionals about the potential for youth access to Zonnic nicotine pouches," Tammy Jarbeau, spokesperson for Health Canada, said in an email to CTVNews.ca.

She didn't provide details on the planned measures.

In response to concerns about the products being used by youth, Eric Gagnon, vice-president of corporate and regulatory affairs for Imperial Tobacco Canada, said Zonnic is marketed and sold the same way as any other cessation product in Canada.

"Imperial Tobacco Canada (ITCAN) firmly agrees that minors should not be able to purchase nicotine products," Gagnon said in an email to CTVNews.ca. "Claiming that youth can access ZONNIC nicotine pouches in BC is completely inaccurate. We have gone above and beyond by contractually requiring that retailers store and display the products behind the counter in convenience stores and gas stations and obtain proof of age from their customers before being able to purchase ZONNIC."

Amid mounting fears about the products' possible effects on youth, health advocates interviewed by CTVNews.ca offered their advice for parents about the nicotine pouches.

What are nicotine pouches?

Placed between the cheek and gum, the small tobacco-free pouches release nicotine with the aim of helping people become less addicted to smoking.

Though the pouches aren't candy, Cynthia Callard, executive director of Physicians for a Smoke-Free Canada in Ottawa, said she believes there's a "high risk" children will try them once they've seen or heard about them.

"The products smell delicious," said Callard in a phone interview with CTVNews.ca. "They smell very much like the gums and candies that children like."

Callard advises parents to be aware of the risks regarding nicotine pouches.

"I think parents should know that there are new products to look out for," Callard said. "And because they are new and different, young people may not have received any kind of warning about them in their school education systems, or on television, or even from family members. So children are particularly vulnerable, because they haven't encountered these products before."

Smoking and vaping

Laurie Zawertailo, a senior scientist at the addictions program at the Centre for Addiction and Mental Health (CAMH) in Toronto, said the pouches contain nicotine and flavourings, not tobacco.

"They are meant as a nicotine replacement (similar to nicotine gum or lozenge) for people wanting to quit or cut down on their smoking," Zawertailo said in an email to CTVNews.ca. "If you do not smoke, you should not use any nicotine-containing product."

Nicotine is a stimulant drug that acts on brain receptors to increase dopamine release, Zawertailo said. "This means that products that contain nicotine can produce dependence where a person can feel withdrawal effects and strong urges to use the nicotine product," she explained.

Smoking tobacco is the fastest route for nicotine to reach the brain so it is more addictive, followed by vaping, she said.

"Using nicotine pouches will result in much slower delivery to the brain because the nicotine is absorbed into the bloodstream through the tissue in the cheek and not via the lungs," Zawertailo said. "In this respect, at least from a pharmacological perspective, the risk of abuse and dependence on nicotine pouches should be similar to nicotine gum or lozenge – in other words, low."

What are the concerns?

Despite what Zawertailo calls a "lower" risk of addiction to nicotine pouches compared to smoking, she said it's "probably not negligible. The more you use the greater the risk."

Flory Doucas, co-director and spokesperson for the Quebec Coalition for Tobacco Control in Montreal, said nicotine is harmful to kids whose brains are still developing.

"What is certain is that they are addictive as they contain enough nicotine to be able to fulfill a smoker's cravings for nicotine," Doucas said in an email to CTVNews.ca. "The neurological impacts are that nicotine makes them more likely to engage in other risky behaviours and this makes them more likely to become addicted to other drugs as well. … So, there is this concern that pouches serve as an on-ramp to other nicotine products and cigarettes."

But Doucas said no long-term data exists on the impact of "sustained and regular use" of the nicotine pouches. "The health effects remain largely unknown," she said.

Manuel Arango, director of policy and advocacy at Heart and Stroke Foundation in Ottawa, said there are plenty of studies about nicotine showing that long-term use can affect memory, learning and academics, as well as raise blood pressure and the risk for heart disease.

"Nicotine is a highly addictive and problematic substance if used over the long term," Arango said in a phone interview with CTVNews.ca. "It's got a whole host of problems and issues. … Kids are at risk because their brains are still developing. And a product like this can really harm them."

Arango said some research findings have raised concerns that "nicotine may be a tumour promoter for cancer," although the studies are inconclusive.

While Prabhat Jha said nicotine pouches are not safe and long-term use of nicotine can cause diabetes, the professor and chair in global health and epidemiology at the Dalla Lana School of Public Health at the University of Toronto said the products are effective for their intended purpose of helping people to quit smoking.

"We know unequivocally that cigarettes are an order of magnitude more harmful than vaping/nicotine pouches," Jha said in an email to CTVNews.ca. "But we also know that vaping/nicotine pouches are not zero risk."

Jha questions whether nicotine pouches would be a gateway to cigarettes. He said studies have found that youth vaping has mostly been a substitute for cigarettes rather than a gateway.

Nicotine pouches and kids

Callard says it's difficult to know if kids are using them. She said people tuck them inside their mouth between their teeth and gums.

"So it looks like someone has a piece of gum in their mouth. You wouldn't really know it. It can be used very discreetly, virtually invisibly," Callard said. "A lot of kids are going to be very experienced at hiding that from their parents. … Children, however, may have a reaction to them, because they (the pouches) have quite a bit of nicotine in them."

Zawertailo said nicotine is toxic at high doses, especially in people who do not smoke and aren't tolerant to the effects of nicotine.

"Signs of nicotine toxicity include dizziness, nausea, vomiting, sweating, diarrhea," she said. "All nicotine products should be kept away from children and pets."

How popular are they?

While health advocates aren't aware of statistics showing the popularity of the products in Canada, Arango said parents have been complaining about the problem to his organization.

"They're very popular ... if you did a survey of parents, you would find that there would be a lot of parents saying that they're very concerned because they have found nicotine pouches being used by their kids," he explained.

Health advocates said the concern about possible addictions is real.

"It would be worrisome to wait … before reining in industry, because it might mean thousands and thousands of kids become addicted to them," Doucas said, comparing the situation to when Ottawa restricted the promotion of vaping products in places youth can access in 2020.

Ottawa's move came amid research showing teen vaping was becoming popular in Canada, The Canadian Press reported.

"That is what happened with vaping, and explained why the tighter federal regulations on advertising came in 2020, some 2 years after the nicotine vaping products become legal in Canada and the youth craze that followed," Doucas said.

Callard said she thinks the main reason they're popular is because they're new and different.

"And it kind of could easily become like the 'Fidgets Spinner of nicotine' – something that becomes a fad," she said. "They're attractive, it's got cool little cans."

Why Canada approved Zonnic

Tammy Jarbeau of Health Canada said the government approved Zonnic as a natural health product for smoking cessation for adults 18 years and older.

"It was authorized in July 2023 based on the evidence supporting its safety, efficacy, and quality as a nicotine replacement therapy for use by adults only, who are looking to stop smoking," Jarbeau said in an email to CTVNews.ca.

She said nicotine replacement therapies require "directions for use and risk statements" to help consumers "make informed choices."

"Heath Canada dictates that labels and advertisements prominently display information indicating that the products are intended only for smoking cessation in adults aged 18 years and older who are regular smokers," she explained.

While the federal government regulates the classification of nicotine products, Jarbeau said provinces and territories regulate the sale. "Provinces and territories are encouraged to explore measures to restrict access in their jurisdictions, similar to what British Columbia has recently announced, while the federal government assesses regulatory and policy options that may be implemented at the federal level," she said.

With files from CTVNews.ca Writer Dorcas Marfo and CTVNewsVancouver.ca Reporter Kaija Jussinoja

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