Janet Hoek, Professor in Public Health, University of Otago, Andrew Waa, Associate Professor in Public Health, University of Otago, Jude Ball, Senior Research Fellow in Public Health, University of Otago
It is now clear the government has failed to meet New Zealand’s smokefree goal of fewer than 5% of people from all population groups smoking by the end of this year.
According to the latest New Zealand Health survey, 6.8% of adults smoked daily this year, which is similar to the previous year (6.9%) and 2022-23 (6.8%).
Tobacco remains widely available and large inequities in smoking prevalence continue, with smoking among Maori at 15%.
Meanwhile, vaping is widespread among young people, with the latest New Zealand Health Survey estimating that 13.6% of young people aged 15 to 17 now vape daily.
This estimate increased from 10.3% in 2024 and represents around 27,000 people who are below the legal age for vape sales but now addicted to vaping.
Yet tobacco and nicotine companies want to introduce oral nicotine pouches, claiming these are a “cleaner way to enjoy nicotine”.
But their flavours, packaging and marketing appeal to young people and such a move risks exposing more youth to nicotine addiction and compounding the problems caused by vaping.
How pouches work
Oral nicotine pouches are small sachets containing nicotine extracted from tobacco or synthetic nicotine. People place a pouch under their upper lip and receive a potent dose of nicotine through their gums, without inhaling either smoke from burned tobacco or aerosol from vaping products.
In 2024, Associate Health Minister Casey Costello acted on the National-NZ First coalition agreement and obtained approval in principle from Cabinet to introduce these products.
We have several concerns.
First, Ministry of Health officials advised there was no evidence to support oral nicotine pouches as smoking cessation aids. An expert group convened by the ministry reinforced this view and recommended a moratorium on introducing new nicotine products “until there is clear, independent evidence that [these] are safer than smoking and effective in helping people who smoke to stop smoking”.
A recent systematic review aligned with this conclusion, noting there is no evidence oral nicotine pouches help people stop using tobacco or vaping products, or that they reduce smoking or vaping prevalence.
Even tobacco companies state their products do not aim to help people stop smoking. The Philip Morris website says:
Our smoke-free products […] are not designed as cessation aids.
Second, the risks of oral nicotine pouches are not yet known. While they are not inhaled, pouches may affect oral, cardiovascular and mental health. A recent study noted tissue changes that may indicate increased risk of mouth cancers.
Third, oral nicotine pouches are highly addictive. Nicotine affects brain development, particularly in adolescents and young adults, altering neural pathways associated with learning, attention and impulse control.
Although marketed as the next reduced-harm alternative, experts warn that oral nicotine products may embed nicotine dependence among a large proportion of young people.
Fourth, nicotine addiction is not benign; it imposes lifelong financial, physical, social and emotional costs. Introducing a new consumer product whose primary function is maintaining addiction is not public health progress.
Fifth, international evidence shows oral nicotine pouches are designed to appeal to young people. They use sweet, fruity and alcoholic flavours; their packaging is eye-catching and uses colours likely to appeal to young people.
Pouches look more like chewing gum or mints than a product that could lead to life-long addiction. Influencers promote pouches as lifestyle enhancers that boost energy, help concentration and ease social encounters. In our view, this is not cessation messaging but addiction marketing.
We already face major challenges helping young people to stop vaping. Approving another youth-friendly, easily concealed addicting product would, in our view, be reckless.
New nicotine products won’t solve the problem
Sixth, oral nicotine pouches are virtually invisible when used. They have no smoke, no aerosol clouds, no tell-tale smell. Because they are extremely difficult to monitor, they will be easy to use in schools.
Seventh, the logic of introducing pouches is flawed. Many will know the story of the old lady who swallowed a fly, followed in quick succession by a spider, bird, cat, dog, cow and horse; the story did not end well.
The government introduced vaping products to help people stop smoking. They are now proposing to introduce nicotine pouches to help people stop smoking and vaping.
Legalising more nicotine products is not a targeted solution to solving the problem of smoking, particularly given evidence shows uptake of novel products is greatest in young adults, most of whom do not smoke.
However, the most compelling argument is the risk these products pose to the Tupeka Kore (tobacco free) vision outlined by Maori leaders. This goal doesn’t just aim to reduce smoking, it wants to eliminate addictive nicotine products and the disproportionate burden nicotine addiction imposes on Maori communities.
The tobacco and nicotine industry present pouches as safer and empowering. In fact, these products risk entrenching dependence and inequity. Governments have a responsibility to protect people, particularly young people, from being commercially targeted by manufacturers of highly addictive products.
Before allowing any new nicotine product, robust evidence must show it will improve population health and reduce rather than expand nicotine addiction. That standard has not yet been met for oral nicotine products.
Janet Hoek receives funding from the Health Research Council of New Zealand, the Marsden Fund, NZ Cancer Society and NZ Heart Foundation. She is a member of the Health Coalition Aotearoa's smokefree expert advisory group and was a member of the Ministry of Health's smokefree advisory group. She is a member of the HRC's Public Health Research Committee and a Senior Editor at Tobacco Control (honorarium paid). She serves on several other government, NGO and community advisory groups. She has received travel and accommodation support to present at conferences.
Andrew Waa receives funding from the University of Otago and Health Research Council NZ. He is a co-director of ASPIRE Aotearoa and a member of Te Ropu Tupeka Kore.
Jude Ball receives funding from the Health Research Council of New Zealand and NZ Cancer Society. She is a co-director of ASPIRE Aotearoa and is affiliated with the Public Health Association of New Zealand; she also serves on other NGO and community advisory groups.
