Nicotine and Tobacco Research Journal Case Study

The Nicotine and Tobacco Research Journal recently published a case study about a 21-year-old male who was brought to hospital by his brother. The paper says that his symptoms upon arrival included being “nauseated, somnolent, and diaphoretic”. In layperson’s terms, he was sickly, sleepy, and sweaty. But that wasted shot at alliteration is not the worst of it.

The man’s brother had found him in a state of distress. According to the report, “he was confused and responded nonsensically to questions. He was unable to sit in his chair and later slumped over the table, eventually sliding onto the floor.”

As it turns out, the man had taken “15 extra-strength NPs (10.9 mg per pouch) over the preceding 12-hour period as a study aid, having read these pouches could promote alertness.”

Interestingly, the paper also states that “he had run out of his amphetamine/dextroamphetamine”, which he’d last used the night before. After 24 hours of care in the hospital, he returned to normal and was allowed to go home.

In summary, a man cramming for his exams ran out of Adderall. He’d heard that nicotine pouches can help with focus and alertness, so he took 15 strong nicotine pouches over 12 hours and got nicotine poisoning. He became sick and had to go to hospital, but recovered 24 hours later.

What can we learn from this incident?

There are many different things to take from the paper and the incident. First, let’s look at the conclusion of the paper:

Unique pharmacokinetics

The paper states:

Put simply, nicotine pouches take longer to absorb than cigarettes or vapes. As a result, users might not feel the effects of nicotine as quickly, meaning they might use another pouch to get the feeling they’re after.

According to the authors, this means that nicotine pouches present a credible harm risk. However, per this BfR report about pouches, “A few cases of poisoning from nicotine pouch use have been reported but none with a severe course.”

Aggressive Marketing

Unfortunately, the paper veers away from scientific objectivity and makes a few easily undermined claims. For starters, it states that pouches are “marketed as a safe alternative to smoking.” This is simply untrue. Pouches, when they are marketed at all, are advertised as “safer” rather than “safe.” It’s not some minor distinction.

There is a similar looseness of definition in the claim that pouches are aggressively marketed. As shown in the recent Eurobarometer report, 3 in 4 people aged 18-24 years old have never seen an ad or promotion for nicotine pouches. With such low reach, suggesting that pouches are aggressively marketed is pure fantasy.

Lack of warning labels

There isn’t a huge amount of real estate on a tin of nicotine pouches. However, depending on the brand, both front and back have warning labels. However, these labels typically state something like this, courtesy of NBC News:

At the back, you’ll find something along these lines:

The uniformity of these warning labels is no accident. They are a result of compliance with packaging laws for tobacco and nicotine products.

You’ll notice that the VELO pack above directs users to the velo.com website, where common questions and directions for use are easily accessed.

One piece of advice that you can learn there is “Start with a low nicotine strength (like 4mg or 6mg VELO MINI) to get a feel for the product and understand what works best for your needs.”

Of course, it’s not just the tins themselves that offer guidance. The online retailer Haypp provides guides for sensible use, too.

Final thoughts

Nicotine is a mild stimulant. To me, it feels nothing like Adderall. However, I’m aware that students and financial professionals are increasingly using pouches to stay alert and awake for unnatural periods.

The big takeaway here is that if you’ve never used nicotine before, don’t take 15 extra strength pouches over a short space of time, expecting that it will function like Adderall.

Otherwise, I’m glad the guy was okay in the end, and I hope he passed his exams.