In continuation to our concern about the harms of nicotine and smokeless tobacco products,through this letter we want to draw attention toward the new Tobacco Harm Reduction (THR) strategy which is designed to reduce the health risks associated with tobacco use. Modern Oral Products (MOPs), also referred to as tobacco-free nicotine pouches, have emerged as a popular alternative to tobacco-based portion-size smokeless products. Novel MOPs made from permeable viscose fibers, are similar in appearance and use to Swedish-style snus, but do not contain tobacco. Major tobacco manufacturers are currently selling them and according to the latest MarketWatch press release in December 2020, the global Nicotine Pouches market size is projected to reach USD 32 770 million by 2026, from USD 2376.6 million in 2021, at a CAGR of 54.9% during 2021–2026. British American Tobacco sells Lyft in the United Kingdom and Sweden, and Velo in the United States, Swedish Match sells Zyn in Europe and the United States, Kretek International sells Dryft in the United States, and Japan Tobacco International sells Nordic Spirit in Sweden. These MOPs are not combusted and contain synthetic pharmaceutical grade nicotine instead of nicotine from tobacco leaves. MOP pouches, containing nicotine in dry powder form sold across the United States and United Kingdom, vary greatly in the nicotine content per pouch. These smokeless, tobacco-free products, currently used discreetly, are seen as the least harmful of all currently available nicotine products and constitute a regulatory gap because they fall outside the Federal Food, Drug, and Cosmetic Act’s (FDCA) definition of a tobacco product. Most of the companies, manufacturing nicotine, have pending patents and the Food and Drug Administration (FDA) currently has no regulatory authority over synthetic nicotine.

The use of Synthetic Nicotine is also becoming increasingly popular among the vaping communities. Tobacco-free nicotine has no odor and is tasteless, not having the foul smell and flavor of tobacco, thus has the potential for rapid uptake by youth and young adults. Different types of nicotine-flavored desserts, e-liquids, juices, or candy in vaping forms are present in the market today. Similar to e-cigarettes and heated tobacco products, MOPs are augmented with a variety of additives like sweeteners, salts, humectants, gum Arabi, artificial flavorings like fruit, peppermint, etc.3

Though Synthetic Nicotine is devoid of carcinogenic tobacco-specific nitrosamines and other harmful substances that enter during tobacco processing, the chemical and biological properties of nicotine are the same, irrespective of its source. The human body absorbs only about one-tenth of the nicotine from a cigarette, around 1 mg, during smoking. While MOPs when placed under the lips against the gums for 30–60 minutes, quickly release nicotine which is efficiently absorbed into the bloodstream through the oral mucosa.6 Nicotine is known to cross the blood–brain barrier within 8 seconds and has a half-life of around 2 hours. As per the CDC, 50–60 mg of nicotine can be a lethal dose for an adult who weighs about 70 kg.

A recent study published in this journal, Nicotine and Tobacco Research, showed that despite a lower nicotine content, the non-tobacco-based MOP namely Zyn 6 mg gave rise to a significantly larger uptake of nicotine to the systemic blood circulation than conventional, tobacco-based 8 mg general snus. While Zyn 8 mg delivered similar amounts of nicotine as the Longhorn Natural moist snuff (18 mg).6 Nicotine exposure at an early age interferes with neurological development in adolescents, leading to long-term cognitive and mental health consequences, deeper levels of addiction and difficulty in quitting later.8 Nicotine poisoning symptoms include abdominal pain, nausea, vomiting, diarrhea, headaches, a decrease in blood pressure and even, death from suppression of breathing. Animal studies suggest that nicotine alone may be a key chemical responsible for many of the long-term effects on the offspring, such as impaired fertility during adulthood, type 2 diabetes, obesity, hypertension, neurobehavioral defects, and respiratory dysfunction, etc.9 Long-term nicotine exposure has been linked with heart disease and an increased risk of stroke and can promote tumor.10

It is recommended that regulatory bodies like the FDA should regulate the use of Synthetic Nicotine by categorizing Synthetic Nicotine products as drugs, as its use could act as a gateway to smoking tobacco, establishing a dependence on nicotine in nonsmokers. Since the commercialization of Synthetic Nicotine has begun, users must be warned about the health effects of Synthetic Nicotine.

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Synthetic NicotineSynthetic Nicotine is used for E-Cigarettes
In continuation to our concern about the harms of nicotine and smokeless tobacco products,through this letter we want to draw attention toward the new Tobacco Harm Reduction (THR) strategy which is designed to reduce the health risks associated with tobacco use. Modern Oral Products (MOPs), also referred to as...