Is nicotine classified as a pesticide, and what are the long‑term health risks associated with chronic use of nicotine pouches?

Is Nicotine a Pesticide?

Yes, nicotine is classified as a pesticide—it is a naturally occurring insecticide derived from tobacco plants that has been used extensively as a commercial insecticide, acting as a potent agonist on nicotinic acetylcholine receptors in insects. 1

Nicotine evolved in tobacco plants as a natural defense mechanism against insects and other herbivores, demonstrating potent insecticidal activity by targeting the nervous systems of invertebrates. 1 This same compound, when consumed by humans through tobacco products or nicotine pouches, acts on similar receptor systems in the human nervous system, leading to addiction and multiple organ system effects. 2

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Long-Term Health Risks of Nicotine Pouches

Cardiovascular Damage

Nicotine pouches cause direct and progressive cardiovascular harm regardless of the absence of tobacco combustion, with effects that accumulate over years of use and approximately double the 10-year fatal cardiovascular risk with no safe lower threshold identified. 3, 4

• Nicotine directly increases blood pressure, heart rate, and myocardial oxygen demand while simultaneously causing arterial narrowing, creating a dangerous supply-demand mismatch. 5, 3, 6
• Nicotine contributes to arterial wall hardening (atherosclerosis) that accumulates over time and can lead to myocardial infarction. 5, 3, 4
• Even a single nicotine pouch exceeds the acute reference dose for cardiovascular effects by at least 20-fold, making clinically relevant heart rate elevation very likely after consumption. 7
• The cardiovascular risk persists across all levels of nicotine consumption, with no evidence of a safe lower limit. 4

Addiction and Neurological Harm

Nicotine is highly addictive and causes permanent harm to the developing brain, particularly in adolescents whose brains are uniquely vulnerable to nicotine's neurotoxic effects. 5, 3, 4

• Nicotine is the primary psychoactive component causing addiction in all tobacco products, maintaining lifelong use and continued exposure to harmful substances. 5, 4
• Adolescent nicotine exposure causes irreversible brain developmental damage, as executive function and neurocognitive processes have not fully matured during this critical period. 5, 4
• Nicotine acts as a "gateway" drug for cocaine and other illicit substances, particularly when exposure occurs during adolescence. 5
• Nicotine pouches deliver nicotine at levels sufficient to cause dependence, perpetuating addiction across the lifespan. 8

Mortality and Life Expectancy

Lifelong nicotine use reduces life expectancy by approximately 10 years compared to non-smokers, representing one of the most significant preventable causes of premature death globally. 4

• Lifetime nicotine users face a 50% probability of dying directly from nicotine-related causes. 4
• Even after 25+ years of complete cessation, former users maintain more than 2-fold elevated risk of lung cancer death compared to never-users, demonstrating permanent residual harm. 4
• Nicotine and tobacco exposure account for roughly 21% of all deaths attributed to coronary heart disease worldwide. 4

Pregnancy and Fetal Consequences

Nicotine crosses the placenta during pregnancy and causes multiple adverse consequences, including sudden infant death syndrome, representing permanent harm to the next generation. 4

• Fetal nicotine exposure creates lifelong health vulnerabilities in offspring that extend beyond the immediate pregnancy period. 4
• In utero nicotine exposure causes long-lasting neurocognitive, behavioral, and respiratory harms. 5

Youth Uptake and Population Health Concerns

Nicotine pouches are one of the fastest-growing segments of the retail tobacco market, with sweet, minty, and other youth-appealing flavors that pose significant risks to global health, particularly among young people. 5, 3

• The candy-like appearance, discreet form, and added flavorings make nicotine pouches attractive to youth and young adults. 5, 3
• Widespread adoption among otherwise nicotine-naive individuals may reduce the net public health benefit of these products. 8
• Nicotine pouches threaten to renormalize and glamorize nicotine use, potentially reversing more than 50 years of progress in tobacco control. 5

Acute Toxicity Risk

The concentrated nicotine in pouches poses a poisoning risk, with reports of acute nicotine toxicity increasing and at least one child death reported from unintentional exposure. 5

• Nicotine is well absorbed from mucosal surfaces, skin, and intestines, allowing exposure through multiple routes. 5
• While symptoms of acute toxicity are generally mild and resolve within 12 hours, large exposures can be fatal. 5

Evidence Gaps and Regulatory Concerns

There is currently limited evidence regarding long-term individual health risks or potential public health impact of nicotine pouches, with significant variation in how countries regulate these products. 3, 9

• Many countries' current regulatory approaches fail to regulate nicotine pouches that use synthetic nicotine. 9
• The American Heart Association, World Heart Federation, American College of Cardiology, and European Society of Cardiology state that governments should prevent industry from making health claims about products not substantiated by rigorous research. 3
• Most nicotine pouch studies to date are tobacco industry-funded, highlighting the need for more independent academic research. 8

Critical Clinical Caveat

Using nicotine pouches while continuing to smoke (dual use) does not reduce harm and maintains nicotine addiction. 3

Healthcare providers should unequivocally recommend that individuals avoid all forms of nicotine exposure through tobacco or nicotine products for optimal health outcomes, as there is no safe level of nicotine exposure. 4, 6