{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T02:11:35Z","timestamp":1788487895884,"version":"build-2803163510"},"reference-count":38,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008751","name":"Bundesinstitut f\u00fcr Risikobewertung","doi-asserted-by":"publisher","award":["1322-772"],"award-info":[{"award-number":["1322-772"]}],"id":[{"id":"10.13039\/501100008751","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2022,7,15]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Nicotine pouches without tobacco are new products that deliver nicotine into the body via the oral mucosa. There is a lack of independent research on the chemical composition and product characteristics of these products, contributing to uncertainties regarding product regulation. This study sought to address knowledge gaps by assessing levels of nicotine and screening for tobacco-specific nitrosamines (TSNAs) in a sample of these products.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nicotine pouches (n=44) and nicotine-free pouches (n=2) from 20 different manufacturers were analysed regarding their contents of nicotine and TSNAs by gas chromatography with flame ionisation and liquid chromatography\u2013tandem mass spectrometry, respectively. Product labelling and pH values of aqueous extracts were determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nicotine contents of products ranged from 1.79 to 47.5 mg\/pouch; median product weight, pH, and proportion of free-base nicotine were 0.643 g, 8.8, and 86%, respectively. A clear labelling of the nicotine content was missing on 29 products and nicotine strength descriptions were ambiguous. TSNAs were detected in 26 products, with a maximum of 13 ng N-nitrosonornicotine\/pouch.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although nicotine pouches may potentially be a reduced risk alternative for cigarette smokers or users of some other oral tobacco products, nicotine contents of some pouches were alarmingly high. Presence of carcinogenic TSNAs in the nicotine pouches is of serious concern. Better manufacturing processes and quality control standards should be implemented. Labels of nicotine strength on most products are misleading. A strict regulation regarding nicotine contents and its labelling would be advisable.<\/jats:p><\/jats:sec>","DOI":"10.1136\/tc-2022-057280","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T15:31:27Z","timestamp":1661441487000},"page":"193-199","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":106,"title":["Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches"],"prefix":"10.1136","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-0766","authenticated-orcid":false,"given":"Nadja","family":"Mallock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schulz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Malke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Dreiack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Laux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Luch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"2024051310555514000_33.2.193.1","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntaa239"},{"key":"2024051310555514000_33.2.193.2","unstructured":"European Commission . Meeting of the group of experts on tobacco policy; 2019. https:\/\/ec.europa.eu\/transparency\/expert-groups-register\/screen\/meetings\/consult?do=groupDetail.groupMeeting&meetingId=16984 [Accessed 07 Jul 2022]."},{"key":"2024051310555514000_33.2.193.3","unstructured":"Tactics T . Nicotine pouches. University of Bath, 2021. Available: https:\/\/tobaccotactics.org\/wiki\/nicotine-pouches\/ [Accessed 07 Jul 2022]."},{"key":"2024051310555514000_33.2.193.4","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2019-055321"},{"key":"2024051310555514000_33.2.193.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2021.109136","article-title":"Awareness, use and perceptions of cigarillos, heated tobacco products and nicotine pouches: a survey among Dutch adolescents and adults","volume":"229","author":"Havermans","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2024051310555514000_33.2.193.6","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18168852","article-title":"Heated tobacco products and nicotine pouches: a survey of people with experience of smoking and\/or Vaping in the UK","volume":"18","author":"Brose","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2024051310555514000_33.2.193.7","unstructured":"European Parliament . Directive 2014\/40\/EU of the European Parliament and of the Council of 3 April 2014 on the approximation of the laws, regulations and administrative provisions of the member states concerning the manufacture, presentation and sale of tobacco and related products and repealing directive 2001\/37\/EC; 2014."},{"key":"2024051310555514000_33.2.193.8","unstructured":"Fjellner C . Innovation and less harmful alternatives to tobacco: the case of nicotine pouches regulation. Brussels: ECIPE Policy Brief, 2020."},{"key":"2024051310555514000_33.2.193.9","unstructured":"European Parliament . Regulation (EC) NO 1272\/2008 on the classification, labelling and packaging of substances and mixtures (CLP regulation); 2008."},{"key":"2024051310555514000_33.2.193.10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3390\/separations8060077","article-title":"Determination of Nicotine-Related impurities in nicotine pouches and Tobacco-Containing products by liquid Chromatography\u2013Tandem mass spectrometry","volume":"8","author":"Avagyan","year":"2021","journal-title":"Separations"},{"key":"2024051310555514000_33.2.193.11","first-page":"1","article-title":"Chemical characterization of tobacco-free \"modern\" oral nicotine pouches and their position on the toxicant and risk continuums","author":"Azzopardi","year":"2021","journal-title":"Drug Chem Toxicol"},{"key":"2024051310555514000_33.2.193.12","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1093\/ntr\/ntab030","article-title":"Characterization of total and unprotonated (free) nicotine content of nicotine pouch products","volume":"23","author":"Stanfill","year":"2021","journal-title":"Nicotine Tob Res"},{"key":"2024051310555514000_33.2.193.13","unstructured":"WHO TobLabNet SOP 4 . Standard operating procedure for determination of nicotine in cigarette tobacco filler. Geneva World Health Organization; 2014."},{"key":"2024051310555514000_33.2.193.14","unstructured":"DIN 32645 . Chemische Analytik - Nachweis-, Erfassungs- und Bestimmungsgrenze unter Wiederholbedingungen - Begriffe, Verfahren, Auswertung Berlin: Deutsches Institut f\u00fcr Normung; 2008."},{"key":"2024051310555514000_33.2.193.15","doi-asserted-by":"crossref","unstructured":"Stepanov I , Hatsukami DK , Pickworth WB . Chemical characterization of smokeless tobacco products and relevant exposures in users. In: Smokeless tobacco products: characteristics, usage, health effects, and regulatory implications. Elsevier, 2020: 121\u201350.","DOI":"10.1016\/B978-0-12-818158-4.00006-6"},{"key":"2024051310555514000_33.2.193.16","doi-asserted-by":"crossref","DOI":"10.1186\/s13065-015-0132-1","article-title":"The acrylamide content of smokeless tobacco products","volume":"9","author":"McAdam","year":"2015","journal-title":"Chem Cent J"},{"key":"2024051310555514000_33.2.193.17","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1111\/j.1476-5381.1962.tb01173.x","article-title":"Effects of pH on the activity of nicotine and nicotine monomethiodide on the rat diaphragm preparation","volume":"18","author":"Barlow","year":"1962","journal-title":"Br J Pharmacol Chemother"},{"key":"2024051310555514000_33.2.193.18","unstructured":"ISO 21766 . Tobacco and tobacco products - Determination of tobacco-specific nitrosamines in tobacco products - Method using LC-MS\/MS. Geneva: International Organisation for Standardisation, 2021."},{"key":"2024051310555514000_33.2.193.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2016.03.001"},{"key":"2024051310555514000_33.2.193.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2009.02.003"},{"key":"2024051310555514000_33.2.193.21","doi-asserted-by":"publisher","DOI":"10.1136\/tc.6.3.219"},{"key":"2024051310555514000_33.2.193.22","doi-asserted-by":"crossref","first-page":"1000184","DOI":"10.4172\/2155-6105.1000184","article-title":"Nicotine absorption from smokeless tobacco modified to adjust pH","volume":"05","author":"B Pickworth","year":"2014","journal-title":"J Addict Res Ther"},{"key":"2024051310555514000_33.2.193.23","unstructured":"IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 89. Smokeless tobacco and some tobacco-specific N-nitrosamines; 2007."},{"key":"2024051310555514000_33.2.193.24","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2021-056626"},{"key":"2024051310555514000_33.2.193.25","doi-asserted-by":"publisher","DOI":"10.1080\/14622200802443544"},{"key":"2024051310555514000_33.2.193.26","doi-asserted-by":"publisher","DOI":"10.1080\/14622200500490151"},{"key":"2024051310555514000_33.2.193.27","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1021\/acs.chemrestox.6b00268","article-title":"Tobacco-Specific nitrosamines in the tobacco and mainstream smoke of U.S. commercial cigarettes","volume":"30","author":"Edwards","year":"2017","journal-title":"Chem Res Toxicol"},{"key":"2024051310555514000_33.2.193.28","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-09-1084"},{"key":"2024051310555514000_33.2.193.29","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1021\/acs.chemrestox.8b00089","article-title":"Presence of the carcinogen N'-nitrosonornicotine in saliva of e-cigarette users","volume":"31","author":"Bustamante","year":"2018","journal-title":"Chem Res Toxicol"},{"key":"2024051310555514000_33.2.193.30","unstructured":"VG Augsburg . Beschluss v. 19.06.2020 - Au 9 S 20.847; 2020."},{"key":"2024051310555514000_33.2.193.31","unstructured":"VG M\u00fcnchen . Beschluss v. 20.05.2021 - M 26b S 20.6309; 2021."},{"key":"2024051310555514000_33.2.193.32","doi-asserted-by":"crossref","unstructured":"EFSA STATEMENT . Potential risks for public health due to the presence of nicotine in wild mushrooms, 2009.doi:10.2903\/j.efsa.2009.286r","DOI":"10.2903\/j.efsa.2009.286r"},{"key":"2024051310555514000_33.2.193.33","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1093\/ntr\/ntaa068","article-title":"Pharmacokinetic comparison of a novel non-tobacco-based nicotine pouch (ZYN) with conventional, tobacco-based Swedish Snus and American moist snuff","volume":"22","author":"Lunell","year":"2020","journal-title":"Nicotine Tob Res"},{"key":"2024051310555514000_33.2.193.34","doi-asserted-by":"crossref","DOI":"10.1016\/j.ypmed.2020.106099","article-title":"Tobacco harm reduction: past history, current controversies and a proposed approach for the future","volume":"140","author":"Hatsukami","year":"2020","journal-title":"Prev Med"},{"key":"2024051310555514000_33.2.193.35","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: a systematic analysis from the global burden of disease study 2019","volume":"397","author":"Reitsma","year":"2021","journal-title":"The Lancet"},{"key":"2024051310555514000_33.2.193.36","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2020-056446"},{"key":"2024051310555514000_33.2.193.37","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/nts093"},{"key":"2024051310555514000_33.2.193.38","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2016-053212"}],"container-title":["Tobacco Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/tobaccocontrol.bmj.com\/syndication\/doi\/10.1136\/tc-2022-057280","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tc-2022-057280","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T17:56:41Z","timestamp":1715623001000},"score":1,"resource":{"primary":{"URL":"https:\/\/tobaccocontrol.bmj.com\/lookup\/doi\/10.1136\/tc-2022-057280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,5]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,20]]},"published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1136\/tc-2022-057280"],"URL":"https:\/\/doi.org\/10.1136\/tc-2022-057280","relation":{},"ISSN":["0964-4563","1468-3318"],"issn-type":[{"value":"0964-4563","type":"print"},{"value":"1468-3318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,5]]}}}