Snus and nicotine pouches

Snus and nicotine pouches are nicotine products used by placing loose snus or a pouch between the upper lip and the gum. Nicotine is absorbed into the bloodstream through the oral mucosa. The size of the pouches varies, as does the amount of nicotine they contain. Most commonly, snus contains 7–8 mg/g of nicotine, but the strongest products can have significantly higher levels. [1] [2] The nicotine content in nicotine pouches is similar, though in some cases it can be higher than in snus. [3]

Legal status: The sale of tobacco snus is banned in all EU countries except Sweden. In Finland, up to one kilogram can be imported, but only for personal use. Ordering snus online is prohibited. Import and possession by individuals under 18 years of age is also prohibited. [4]

As of early 2025, tobacco-free nicotine pouches fall into a legal grey area in Finland. The Parliament is reviewing a government bill that would regulate nicotine pouches similarly to cigarettes—requiring a retail sales license and bringing them under tobacco tax. [5]

How does it work?

Nicotine is absorbed through the oral mucosa into the bloodstream. Compared to cigarettes, nicotine from snus or pouches is absorbed more slowly, but the blood nicotine level stays elevated for a longer period. [6] The amount of absorbed nicotine depends on how long the product remains in the mouth.

There is a great deal of individual variation in how nicotine is absorbed and how strongly it affects the user. [7] Genetics play a role in how strongly nicotine stimulates the nervous system and how long its effects last. [8]

Perceived effects: Like other nicotine products, snus and nicotine pouches may act as a stimulant or a relaxant, depending on the user and their mental state. In moments of nervousness, nicotine can calm the user—especially if the anxiety is due to nicotine withdrawal. However, nicotine is classified as a stimulant. It increases heart rate and raises blood pressure. In some situations, snus may also improve concentration, although this effect is usually tied to the relief of withdrawal symptoms. [6] [9]

Key risks

Acute risks: For individuals unaccustomed to nicotine, snus and nicotine pouches may cause dizziness, headache, and nausea—signs of nicotine poisoning. Nicotine poisoning can occur anytime the amount of nicotine exceeds what the body is used to. [7] Due to its stimulating effects, nicotine can also interfere with falling asleep.

Risks of heavy use: Heavy use of snus and nicotine pouches is particularly concerning for oral health. Snus can cause localized thickening and damage of the mucosa, known as “elephant skin” or snus lesions. Gums may also begin to recede, making tooth roots more vulnerable to decay. [1] [10] Oral mucosal changes are common among nicotine pouch users as well. [11]

Regarding cancer risk, heavy use of tobacco snus has been linked especially to an increased risk of oral and throat cancer. There is also an elevated risk of esophageal and stomach cancer. The independent link between nicotine and various cancers has been studied, but research findings are conflicting. [1]

The use of snus and other smokeless tobacco products has been suggested to increase the risk of type 2 diabetes and cardiovascular diseases. [12] [13] However, researchers are not in full agreement on this. Overall, snus is considered less harmful to health than cigarette smoking when it comes to cancer and cardiovascular disease. [14] [15]

Addiction: Nicotine is highly addictive. [6] Although nicotine’s effects vary between individuals, regular use is likely to lead to dependence. Heavy use is associated with oral health damage and other long-term risks. [1] [10] With repeated use, the body attempts to reduce the effects of nicotine by developing tolerance. [16] A survey among nicotine product users suggests that the addiction potential of snus and cigarettes is roughly equal. [17]

Use during pregnancy: Snus and nicotine pouches are not recommended during pregnancy. Smoking is especially harmful to the fetus, but nicotine alone also carries risks. [18] Nicotine narrows blood vessels, reducing oxygen supply to the fetus. [19] If nicotine use is necessary during pregnancy, short-acting nicotine products such as gum or tablets are recommended. [18]

How can risks be reduced?

As with all substances, the best way to reduce harm from snus and nicotine pouches is to use them less frequently and in lower quantities. Choosing products with lower nicotine content can also make it easier to quit later.

Oral damage may be reduced by changing the placement of the pouch or snus in the mouth, which decreases localized gum stress. Regular dental checkups are also recommended.

People with sleep difficulties should avoid nicotine products before bedtime.