TAccording to a study, tobacco-free nicotine pouches can release high doses of nicotine. Although these are banned in Germany, they are still popular among young people due to advertising on social media, explained experts from the tobacco clinic at Ludwig Maximilian University in Munich. Together with the Federal Institute for Risk Assessment (BfR), they investigated the amount of nicotine these products release and the effects this has on the human body.

According to the BfR, tobacco-free nicotine pouches contain a powder consisting of nicotine salts and carrier substances. These are clamped under the upper lip – according to the researchers, they are therefore inconspicuous and can be used anywhere.

In the study, which was published in the journal “Frontiers in Pharmacology,” the researchers tested pouches from various brands with declared nicotine contents of 6, 20 and 30 milligrams on 15 people who regularly smoke cigarettes. According to the research team, it was found that the products can release high amounts of nicotine – in some cases even higher than cigarettes. The nicotine pouches examined must therefore be assumed to have a high addictive potential, said the head of the LMU tobacco clinic, Tobias Rüther. As with cigarette consumption, the pouches with 20 and 30 milligrams of nicotine had effects on the heart and circulation, including an increased heart rate. In addition, all pouches caused mouth irritation.

The addictive potential could become a serious problem, added co-author Andrea Rabenstein. From neighboring countries such as Austria, we hear that the nicotine pouches, which are legally available there, have already been used in schools on a massive scale, stresses Rabenstein: “In addition to developing a dependency on nicotine, there is of course a strong risk that this will lead to people consuming other nicotine products or tobacco cigarettes.”

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But are nicotine patches or chewing gum and mouth sprays with nicotine better?

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The substance causes certain neurotransmitters to be released in the brain. This is why smokers then feel better, more relaxed and more focused. “Nicotine is an addictive substance that can quickly lead to physical dependence,” says Michaela Goecke from the Federal Center for Health Education (BZgA). Smokers experience this when they give up cigarettes. Nervousness, tiredness, increased irritability, increased appetite: Withdrawal symptoms like these make it difficult to stick with the habit.

Nicotine replacement products promise that this won’t happen. The classic is the patch, but there are also chewing gum, lozenges, inhalers, nasal or mouth sprays. What they do and which product is suitable for whom – an overview.

This is how nicotine patches and the like work.

The products are intended to replace the nicotine in cigarettes that are not smoked and thus cushion physical withdrawal symptoms. This means that smokers still get their dose of nicotine, but do without the other harmful substances in the cigarette – there are said to be almost 4,000 per cigarette.

The nicotine enters the body through the skin or mucous membranes. Over time, the dosage of the products can be gradually reduced. Nicotine replacement products should only be used for a maximum of three to six months, explains Goecke, who heads the department of topic-specific health education at the BZgA. “After that, the nicotine should be phased out of the body, so to speak, and you should no longer have to worry about withdrawal symptoms.” That’s the theory.

Studies show that nicotine replacement products can effectively help some smokers to quit smoking – namely those who have a strong physical dependence. Anyone can find out whether they have this in themselves by taking the Fagerström test, which asks a handful of questions about smoking habits. “It asks, among other things, when you smoke your first cigarette in the morning, how much you smoke, and whether you do it when you’re sick in bed,” says Goecke.

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However, nicotine replacement products are not a miracle cure. “Heavy smokers will not be able to stop smoking with nicotine replacement products alone,” says the BZgA expert. After all, many of them have developed a psychological dependence as well as a physical one. So it is not just the body that craves nicotine. It is also the psyche that demands certain rituals – the cigarette early in the morning, smoking while sitting with friends, the stress cigarette when everything at work becomes too much.

“However, nicotine replacement products only work in the direction of physical dependence,” Goecke explains. “But that does not release you from the need to change your behavior. And that is very, very difficult.”

Goecke advises against trying out non-prescription products such as chewing gum or lozenges on your own. You should get individual advice from your doctor or pharmacy. Which product and which dosage is suitable depends on factors such as how much you have smoked and what pre-existing conditions you have. Another factor that plays a role in the selection is whether you are prone to allergic skin rashes – in this case a plaster is not the best choice. And if you wear dentures, that speaks against chewing gum. If non-prescription remedies do not work, you can ask your doctor to prescribe you a prescription.

Nicotine patches are designed to replace 10, 20 or 30 cigarettes smoked daily, depending on their strength. They are stuck on the skin and remain on for up to 24 hours. However, anyone who uses nicotine patches must be prepared for the nicotine to enter the body more slowly than when smoking a cigarette. The kick that shoots into the brain within seconds – that doesn’t exist.

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BZgA expert Goecke sees an advantage in patches over chewing gum. You stick them on once and then you can forget about giving your body nicotine. “It’s different with chewing gum. You have to keep taking it – similar to how you would keep reaching for a cigarette. This can actually encourage smoking behavior and perhaps even addiction symptoms.”

However, side effects can also occur, such as dizziness, headaches or nausea. Patches can also cause skin irritation: The magazine “Öko-Test” advises always placing the patches on different parts of the body on the torso, hips or upper arms. After all, the concern that harmful substances can enter the body in addition to nicotine is unfounded. At the end of 2022, “Öko-Test” examined ten nicotine replacement products. According to this, all products came out of the test very well and well.

“We only found titanium dioxide in three products – chewing gum and lozenges – which is now banned in food but still allowed in medicines,” reports the magazine’s editor Christine Throl. The antioxidant BHT, which is suspected of acting like an environmental hormone, was also found in three cases.

“Unlearning” smoking

Unlearning smoking as a habit – to do this, you have to observe yourself carefully. A helpful question to ask is: In what situations do I smoke? “In preparation for quitting smoking, you have to think of a strategy: How do I get through the day without a cigarette?” says Goecke. Experts recommend stopping smoking completely from one day to the next, in other words, drawing a clear line under it.

A plan for a possible relapse should be developed beforehand. Because: “Many smokers don’t succeed on the first attempt,” says Goecke. “You have to know that and say to yourself: OK, I’m not giving up. I’m going to keep going. I’ll get more advice.” There are many advice and support services for quitting smoking. The BZgA, for example, offers telephone advice on smoking cessation and also an online cessation program.