Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches

Mallock, Nadja; Schulz, Thomas F.; Malke, Sebastian; Dreiack, Nadine; Laux, Peter; Luch, Andreas

doi:10.1136/tc-2022-057280

Cited by 39 publications

(39 citation statements)

References 27 publications

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“…Here we expand the existing ONP flavor wheel of snus (natural) and non-tobacco (synthetic) flavor wheel dividing them among the availability of their flavors and discrete brands marketing ONP in the US and Europe. ONPs has been marketed in U.S. and Europe as a substitute for tobacco smoking [1][2][3]. We could review that the European region demonstrates a large share of about 88% of Snus ONPs distributors whereas USA depicts about 12% of Snus distributors.…”

Section: Discussionmentioning

confidence: 99%

“…Oral Nicotine Pouches (ONPs) are a type of emerging smokeless tobacco product sold by some large tobacco companies [1]. Starting from Scandinavia, the selling of ONPs quickly spread to many other countries including the European Union, the UK, the US, and Japan [1][2][3]. The US Food and Drug Administration (FDA) closely describes these oral pouches as "ground, cut, leaf or powdered tobacco regularly available in moist or chew gum snuff often packed in a pre-portioned pouch [1,4].…”

Section: Introductionmentioning

confidence: 99%

“…[5,6]. The appearance of these tobacco-free pouches is similar to that of snus and similarly, the ONPs are placed in a user's anterior maxillary vestibule (between the gum and the lip) for chemicals to be released and absorbed [2,3]. Since 2016 the US [2,7] market consists of nicotine pouches that do not contain tobacco leaves in the final product, and since 2018 in Europe [2,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Classification, Perception, Sociological Aspects, and Toxicity of Emerging Flavored Oral Nicotine Pouches

Shaikh¹,

Newton²,

Tung³

et al. 2023

Preprint

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Introduction: Oral Nicotine Pouches (ONPs) are the new form of nicotine pouches that have become a type of emerging smokeless tobacco product sold by various tobacco companies. These smokeless tobacco products are being marketed for usage all over as Snus containing tobacco-derived nicotine (Natural) or as tobacco-free nicotine (Synthetic) as substitutes for other tobacco products that are limited in public places. ONPs have become popular tobacco products among adolescents/young adults and over 50% of young adult users of ONP use flavored ONP, such as menthol/mint, tobacco, dessert/candy, and fruity, being the most popular flavors. Various new ONP flavors are currently popular locally as well in the online market. Tobacco, Menthol, and fruit-flavored ONPs could motivate cigarette smokers to alteration to ONPs. Methods: We expanded our knowledge on natural/synthetic ONP flavors wheels to available data on ONPs, describing in detail their flavors and brands (US and Europe) in both natural/Synthetic ONP categories. We classified over 152 snus and 228 synthetic ONPs into the following flavor categories: “Tobacco”, “Menthol/Mint”, “Fruity”, “Candy/Deserts”, “Drink”, “Aroma”, “Spices” and “Mixed Flavors”. Results: Based on total numbers, wefound that the most popular ONPs flavor sold as tobacco and menthol to be among natural ONPs, among synthetic ONPs fruity and menthol as the most prominent flavors with varying concentrations of nicotine and other flavoring chemicals including coolant WS-23. We also illustrated possible molecular targets and toxicities due to exposure to ONPs activating several signaling cascades like AKT and NF-B might possibly lead to apoptosis and epithelial mesenchymal transition (EMT). Conclusions: Considering the marketing of ONP products with various flavor profiles and most of these products containing tobacco/menthol/fruit flavor, it is likely to have regulation and marketing disclaimer on some of these products. Further, it would be logical to determine how the market reacts in terms of compliance and non-compliance with flavor restrictions by the regulatory agencies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Classification, Perception, Sociological Aspects, and Toxicity of Emerging Flavored Oral Nicotine Pouches

Shaikh¹,

Newton²,

Tung³

et al. 2023

Preprint

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“…Most ONPs are labeled with varying nicotine content levels, in either milligram nicotine per pouch or gram. It ranges from 0 (free) to 50 mg total nicotine/pouch [8,17,19]. Mallock et al analyzed 44 nicotine pouches and two nicotine-free pouches products from 20 manufacturers.…”

Section: Major Constituents and Categories Of Onpsmentioning

confidence: 99%

Emerging Oral Nicotine Products and Periodontal Diseases

Rahman

2023

International Journal of Dentistry

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Oral nicotine pouches are emerging as a new “modern oral” nicotine product. These prefilled pouches contain nicotine, flavorings, and filling agents that dissolve in the mouth. Nicotine can be derived from tobacco leaf or chemical synthesis. Traces of TSNAs and toxic chromium were detected in the pouch products. This raises the concern about general and periodontal health. This review aims to update the current oral nicotine products research relating to periodontal disease and its relevance in periodontal inflammation. Nicotine interacts with host cells and affects inflammatory responses to microbial challenges. It may directly or indirectly deteriorate periodontal tissues by activating nicotinic acetylcholine receptors, repressing PDL fibroblasts cells, increasing cellular ROS and cytokines/chemokines, growth factors, breaking microbiota balance, and dysregulating miRNAs expression. Studies show that appealing flavorings contained in nicotine pouches pose harm to periodontal innate immune responses and increase penetration of nitrosamines. In addition, flavored ONPs increase the risk of dual or poly-tobacco products among young adults, stacking up detrimental effects on the periodontium. Given the recent growth of users, further studies are needed to elucidate the impact of ONPs, even poly-tobacco use, on systemic and periodontal health. Moreover, policymakers should ensure to avoid generating a new wave of nicotine addiction among youths in the U.S.

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“…Most notably, they deliver nicotine to the oral mucosa resulting in systemic nicotine exposure. As these products contain no polycyclic hydrocarbons and can be produced so that no TSNAs are present [9][10][11] the health effects are predicted to be substantially smaller for NP users compared to cigarette smokers.…”

Section: Introductionmentioning

confidence: 99%

Randomized trials assessing the impact of flavors on pharmacokinetic, pharmacodynamic, and subjective parameters in dry and moist nicotine pouch products

Staaf¹,

Masser²,

Pramfalk³

et al. 2022

Preprint

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The nicotine delivery profile of oral nicotine pouches (NPs) affects their abuse liability and ability to function as alternatives for users of riskier combustible products. However, it is unclear if flavors exert any effect on nicotine pharmacology. Here, data from two open-label, randomized, nine-way cross-over, single dose administration pharmacokinetic (PK) and pharmacodynamic (PD) studies of unflavored and flavored varieties of a dry 6 mg nicotine and a moist 9 mg nicotine NP product was analyzed. Maximum plasma concentrations of nicotine (Cmax) were observed ~ 1 h after NP administration, with overlapping mean values for the two products (13.02–15.95 ng/mL). The total nicotine exposure (AUCinf) was 44.65–54.53 h*ng/mL. Equivalence testing for AUCinf and Cmax between unflavored and flavored NP varieties showed equivalence for all varieties except NP moist D minty and NP moist H minty compared to NP moist A unflavored. Neither AUCinf, Cmax, or time to maximum nicotine concentration were affected by flavor. The effect of flavor was more pronounced for the moist product, where subjects rated the flavored varieties higher for satisfaction, product-liking, and intent to use again. Overall, large variations were seen between subjects in terms of flavor preferences, highlighting the requirement for multiple varieties and products.

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Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches

Cited by 39 publications

References 27 publications

Classification, Perception, Sociological Aspects, and Toxicity of Emerging Flavored Oral Nicotine Pouches

Classification, Perception, Sociological Aspects, and Toxicity of Emerging Flavored Oral Nicotine Pouches

Emerging Oral Nicotine Products and Periodontal Diseases

Randomized trials assessing the impact of flavors on pharmacokinetic, pharmacodynamic, and subjective parameters in dry and moist nicotine pouch products

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