A rise in oral nicotine pouch use raises health concerns for high schoolers | Hacker News Reader

A rise in oral nicotine pouch use raises health concerns for high schoolers

smeharbinger.net

25 pointsmooreds61 comments

This sounds like moral panic (not saying that it is).

They say things like, “Smith wasn’t aware that using Zyn delivered more nicotine per use than his vape did. In fact, his 6-milligram Zyn has 100 times more nicotine than the 0.06-milligram puff of a vape.” which is a false equivalence, since pouches will stay in your mouth for up to an hour gradually leeching out the nicotine.

Then they say things like “it’s just as dangerous as tobacco products”, and then characterise it as a gateway drug.

If these pouches are just as bad as tobacco, it needs a much better argument than this article presents. The tone, absurd claims, and lack of information certainly don’t convince me.

[Anecdotally I did use Snus (Jacobssons Wintergreen) to quite smoking, and then ultimately quit the Snus. Snus was much easier to quit than cigarettes. The Pavlovian conditioning is so much stronger in cigarettes, as they deliver the nicotine so rapidly that your brain knows that it needs a cigarette.]

yeah, but these aren't people who are tying to quit smoking are they?

Yeah. The anecdote was partially a response to the point in the article about it not being marketed as a quitting aid; and partially just a tangential anecdote about my experience of addiction and conditioning.

I think a lot of society has decided that most teenagers under 18 don’t have the capacity to decide whether or not to use addictive substances, and are sometimes in environments that encourage bad decision making.

This is a new delivery mechanism for an addictive substance that may be catching on among teens. I don’t think it’s a moral judgement so much as a practical concern - a new thing for younger teens to potentially get addicted to.

I am using nicotine gum to quit smoking, using about 5 4mg gums/day. I have substituted one addiction for another. I am also worried that these gums are not benign and whether there is a higher risk of cancer from using them. Someone told me to instead use Zyn - thankfully I stayed away from that.

I know a guy who works for a gun manufacturer and he says the synthetic gum base is made on the same line that car tire rubber is made on (they clean it between runs of course).

Zyns are pretty clean as far as ingredients go but it is a plastic pouch, and they do contain artificial sweeteners.

I found NicNac Naturals (nicnac.com) which is sold out of the UK and it’s a fully dissolving mint, no plastic or non-natural ingredients involved

Nicotine is vastly safer than tobacco. You've substituted an addiction that unambiguously kills millions of people to one that, if it is harmful, is sufficiently less so that we haven't managed to measure the effect clearly.

By all means, if you dislike being addicted to something because it interferes with life, because it's expensive, or because you're worried it will eventually be found to have modest health harms, then quit. But moving from smoking to gum gets you 90% of the benefits.

The cancer risk from chewing tobacco is mostly caused by the abrasive damage it does to the oral mucosal soft-tissue¹. If someone chewed maples leaf with the same vigor as someone who chewed tobacco it would probably cause oral cancer to.

The nicotine itself doesn't appear to be a carcinogen² so unless your chewing gum is abrasive, I would be surprised if it caused cancer, but the scientific literature on oral cancer and nicotine chewing gum is almost inexistent so my opinion is mostly based on a feeling.

1- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172921/ 2- https://cancer-code-europe.iarc.fr/index.php/en/ecac-12-ways...

Zyn is probably safer than nicotine gum. Gum often contains heavy metals like cadmium and lead.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985244/

Is nicotine itself dangerous? what about caffeine? I find this 2015 deep dive intriguing: https://gwern.net/nicotine

> Is nicotine itself dangerous?

Yes: https://en.wikipedia.org/wiki/Nicotine_poisoning https://en.wikipedia.org/wiki/Green_Tobacco_Sickness

That is if you consume too much. Anything is poisonous in great enough quantities, including water. I'm assuming OP is asking about whether it's dangerous in normal dosages.

Yes. Multiple studies have found nicotine promotes and accelerates tumor growth -- basically helping carcinogens develop into cancers faster.

Nicotine itself likely causes a whole slew of negative health impacts on your cardiovascular, respiratory, renal and reproductive symptoms. Not to mention it's highly addictive.

Worth a read: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/

There is also pretty decent evidence that it's not that dangerous:

https://gwern.net/nicotine

-edit- that write up is almost exclusively for adults. The affects on teens and children, with developing brains etc., is much less clear and if nothing else the precautionary principle would probably say that it's a bad idea.

But for adults, I'm personally convinced that the balance of evidence is that nicotine itself is not particularly harmful when consumed in reasonable amounts.

-edit- also realized that I linked to the same article that the top level comment linked. Considering that that post includes dozens of journal articles, linking one single research article without addressing any of the contrary ones isn't particularly useful. Beware the man of one study:

https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-...

Interestingly, I totally missed it in the parent but not yours. The first sentence makes a big difference!

That source is excellent. Very fascinating indeed

If you read the article carefully it accelerate tumor growth but it's doesn't cause cancer it act synergistically with other carcinogenic:

  Through its tumor promoter effects, it acts synergistically with other carcinogens from automobile exhausts or wood burning and potentially shorten the induction period of cancers.

That difference is subtle and past a certain age that difference is meaningless.

This seems like a fairly weak review, it just presents links to other papers with a lot of “might”s. I don’t see any meta-analysis computing actual harm.

Eg “nicotine and cancer”:

> In addition, nicotine is a precursor of tobacco specific nitrosamines (TSNAs), through nitrosation in the oral cavity.[32,33] It is shown that nitrosation of nicotine could lead to formation of NNN and NNK. This effect of nicotine may be important…

As Gwern noted, the cardiovascular risks are nonzero, but it doesn’t seem like there is evidence of a strong effect for increasing cancer. (Still room for a weak effect I suppose.)

Thanks for linking this. I wish though that there were a more useful standard of summary: a list of a lot of "nicotine has a negative effect on X" and "associated with a negative on Y" that only tells you a sign, which some publication found statistically "significant". What matters for decisions is effect size and the probable range thereof. (Either sign has a prior probability of 50%, and you can expect publication bias.)

Since I'm only curious I'm not doing all the work to try to figure that out; hope someone else has that kind of review.

The evidence is fairly weak.

> Although nicotine itself does not cause cancer in humans,[40] it is unclear whether it functions as a tumor promoter as of 2012.[104] A 2018 report by the US National Academies of Sciences, Engineering, and Medicine concludes, "[w]hile it is biologically plausible that nicotine can act as a tumor promoter, the existing body of evidence indicates this is unlikely to translate into increased risk of human cancer."[105]

https://en.wikipedia.org/wiki/Nicotine#Cancer

In any case, it's crucial to distinguish between a weak tumor promoter which may have statistically minor impact on cancer rates (nicotine), and an unambiguous carcinogen that kills people by the bucketload (tobacco).

It’s addictive, it costs money, and it makes you feel worse when you are not using it. I think that’s enough to say it’s harmful, although it’s every adult’s right to choose whether they want to use it or not.

The same could be said of coffee

As someone who's been addicted to tobacco, there is no way I'm putting coffee in the same league

This thread is talking about nicotine, not tobacco. Very different.

True, but from observing a dear one who is addicted to these pouches, they only drink coffee in the morning but pouches is an all day adventure and they buy one that is the strongest

nicotine is much more addictive and much more expensive.

Although I do agree that society definitely seems to turn a blind eye to caffeine addiction

From personal experience from vaping: it used to elevate my resting heart rate about 8 to 12bpm throughout the day.

That can't be good.

That's likely the vape smoke rather than the nicotine.

A studied on vapes showed that any smoke/irritant (including vapes) going through the air passageways stimulates the vagus nerve and cause a inflammation in arteries/increased heart rate/increased cardiac risks.

Nicotine delivered without smoke didnt have the same effect

Interesting. I have a high resting heart rate and I vape, maybe it’s time to switch to lozenges and patches. Thanks for the info!

Few substances are as addictive as Nicotine. At the same time it is a potent substance with such a high impact on the human system that it is used as stressor for medical tests where the step response is measured. Overdosing is feasible with retail size quantities. Not safe and definitely not safe for teenagers.

When I was growing up, it was cigarettes. I got hooked when I was 12 but fortunately I was able to switch to vapes in the past few years. Kids are gonna do it, you can't put that genie back in the bottle. I'm just glad it's a habit that won't kill them.

What are the available solutions? Throw the kids in jail? Shame them? Kick them out of school? All solutions way worse than nicotine patches.

I don't think I'm comfortable with the idea that kids will just get addicted to things and that's that.

You don't have to be comfortable with it, but you do have to accept reality at some point. If you can come up with a solution that isn't worse than the problem, I'm all ears.

Then stop letting them run wild. Society can't be organized around what unsupervised children might do.

Eh... No let kids more freedom but equip them with the skills and knowledge to choose. Kids are not property.

No need for a false dichotomy with complete apathy.

I would apply moderate shame/disapproval on my kids for smoking cigarettes, but I struggle to get upset at hazard ratios as low as pure nicotine.

Ultimately kids have to make some decisions, including some bad ones, in order to become adults.

We are not talking about shooting heroin here.

I found this article insightful: https://www.nytimes.com/2024/01/12/opinion/children-nicotine...

tl;dr: marketing via social media influencers bypasses advertising regulation allowing these to be advertised to children.

> So how are kids learning about these little pouches? Greyson Imm, an 18-year-old high school student in Prairie Village, Kan., said he was 17 when Zyn videos started appearing on his TikTok feed. The videos multiplied through the spring, when they were appearing almost daily. “Nobody had heard about Zyn until very early 2023,” he said. Now, a “lot of high schoolers have been using Zyn. It’s really taken off, at least in our community.”

> It’s a world that’s invisible to us, because when we log on to our social media, we don’t see what they see. Thanks to algorithms and ad targeting, I see videos about the best lawn fertilizer and wrinkle laser masks, while Ian is being fed reviews of flavored vape pens and beautiful women livestreaming themselves gambling crypto and urging him to gamble, too.

What evidence do you/NY Times have that Zyn was paying 17 year olds to market on social media? Call me skeptical

There doesn’t need to be any link between Zyn and the viral social marketing for it to be a serious problem in need of fixing

It’s actually harder to solve the more decentralized it is: if any creator can make money off of a viral video and nicotine vapes go viral, that’s just tough

At the end of the day, teenagers shouldn’t see videos promoting Zyn every day, but there is money to be made in doing it, even from the engagement alone.

That’s an interesting argument. Took me two reads to get it but you might have won me over

I’m happy to hear it! I only reframed the problem, though, and didn’t really propose a solution, which is often the part that people disagree with

The centralized player with the most control over this is the viral platforms themselves. If they’re smart, they’re working on a self-regulating solution to this problem before lawmakers get around to it.

Things like tagging videos about nicotine and demonetizing them or tweaking the algorithm to make sure only those of legal age can see them.

Alcohol and nicotine advertising is already heavily regulated on TV, where targeting is impossible and minors watch it

Juul was found do be doing exactly this, so your priors should now be that a spike in child usage of nicotine products is plausibly due to targeted advertising.

My next door neighbor murdered his wife and went to jail. Should my wife be worried about me?

More worried than the counterfactual world where there is no evidence of husbands murdering wives at elevated rates vs. the base population risk? Of course.

But the differences in base rates make this a spurious analogy. A substantial portion of vape companies (by market cap) engaged in direct marketing to minors, we are not talking about unlikely scenarios such as murder.

As a user myself every now and then who quits on and off, these are fairly innocent at the weak strengths but raise blood pressure and when I used the strongest ones I bled from my nose fairly often, doctor said high blood pressure when checking something else and I'm fairly young, also poorer sleep, and somewhat expensive in the long run. And to be honest a few extra toilet visits not the best for your stomach. Cultural difference: bottom lip? Never seen anyone do that.

Anyway, maybe the kids wouldn't resort to addictive short term tricks if the school system wasn't filled with so much bullshit.

40 years ago we had Skoal Bandits, pretty much the same thing unless the Zyn pouches don't make you spit constantly. Sooooo much spitting. Ugh.

No spitting with Zyn.

Also known as 'snus':

https://www.youtube.com/watch?v=lyFk-Z80P6k

No, snus has tabacco. Nicotine pouches have no tobacco.

From my son I know that they call them snus, even the ones without tobacco in them.

Fair enough, that might be recent usage among teenager. But if we're discussing how nicotine pouches (and lozenges, etc.) are replacing smoking/dip/snus, it seems super important to distinguish between the ones with tobacco and the ones that aren't.

No problem, go ahead. I just wanted to let you guys know how actual users are referring to those things.

Snus, colloquially, have tobacco in them.

Zyns are amazing because they do not. It’s just pharmaceutical nicotine and some harmless food grade fillers (this has been independently verified many times).

Not a doctor, but many have said the health risk of zyns is very low. Addictive risk, worth pondering.

The moral panic around snus is ridiculous and causes great harm. The EU has a snus ban that has little scientific basis while Sweden with an exception has the lowest lung cancer rate of Europe.

What does snus have to do with lung cancer?

Wouldn’t you want to look at rates of oral and throat cancers among oral tobacco users?

TL;DR: Talking head claims, without evidence, that non-carcinogenic nicotine fix is as dangerous as smoking. Won't someone think of the children?

Who else thinks nicotine is the planets revenge on mankind?

considering it's a poison to other insects, producing nicotine is probably more of a survival instinct w.r.t. people:

if humans are clearly going to be around, might as well make yourself indispensable to them

Why? There are literally no downsides to using nicotine itself besides the addiction. If anything it’s the perfect drug. A great stimulant that helps with alertness and helps maintain mental acuity in old age.

> There are literally no downsides to using nicotine itself besides the addiction.

Other than that, Mrs Lincoln, how did you like the play?

Addiction of the kind that nicotine causes, doesn’t lead to things like domestic violence, home burglaries or any short or long term health effects. It’s a mild stimulant that doesn’t lead to drastic changes in behavior.

Probably a lot cheaper than wegovy too.

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