A recent Cochrane review evaluated the safety and effectiveness of oral nicotine pouches (ONP) as a potential tool for helping people transition away from combustible tobacco use. Across four small randomized controlled trials involving 284 participants, the evidence showed high uncertainty, with quit rates varying widely and confidence intervals often including the possibility of no benefit. While ONP may slightly increase smoking abstinence compared with no intervention, the certainty of evidence was very low, and comparisons with e-cigarettes suggested ONP may be less effective for quitting smoking.
Safety findings showed no serious adverse events across studies, and limited biomarker data suggested reductions in tobacco-specific nitrosamines and carboxyhemoglobin when switching from smoking to ONP, although these results were highly imprecise. The review concluded that current evidence is insufficient to determine whether ONP meaningfully support smoking cessation and emphasized the need for larger, well-designed trials comparing ONP with established cessation tools such as nicotine replacement therapy and e-cigarettes.
Keywords: oral nicotine pouches, smoking cessation, tobacco harm reduction, nicotine products