This Cochrane review outlines the primary and secondary objectives for assessing whether oral nicotine pouches (ONPs) support smokers in transitioning away from combustible tobacco and how they influence population-level smoking prevalence. As ONPs have rapidly expanded since 2016, claims of harm reduction have intensified, but robust evidence remains limited. The review also aims to determine how ONPs affect individuals using other non-combustible nicotine products and whether their availability changes patterns of alternative nicotine use.
A comprehensive search across CENTRAL, MEDLINE, Embase, PsycINFO, ClinicalTrials.gov, and WHO ICTRP included studies published from 2000 to January 2025. The methods reflect a structured approach to identifying both benefits and harms, ensuring coverage of clinical outcomes and behavioral shifts associated with ONP use. This framework sets the foundation for evaluating ONPs within tobacco harm reduction strategies and their broader public health implications.
Keywords: oral nicotine pouches, harm reduction, combustible tobacco, nicotine products