Vista Clinic warns council: nicotine pouches rising among youth, not FDA-approved cessation aids

Jennifer Gill, program manager of Vista Community Clinic’s Tobacco Prevention Program, told the San Marcos City Council on Sept. 9 that nicotine pouches are an emerging product with rising use among youth and potential health risks.

"The number one product [youth] are reporting using are e-cigarettes or vape products, primarily flavored," Gill said, then shifted focus to nicotine pouches, which she described as "a little small pouch that looks like this that you put in between your cheek and your gum" and which the industry markets as tobacco-free because they do not contain loose-leaf tobacco.

Gill told the council that nicotine pouches contain nicotine and other substances (cellulose and additives), can contain from "1.5 to 12 milligrams per pouch" in common products and that she had seen some pouch products advertised with nicotine levels as high as 50 milligrams. By contrast, she said a single cigarette contains about 8 to 20 milligrams of nicotine but typically yields only 1 to 2 milligrams absorbed by the smoker. "So these pouches have a very high concentration of nicotine that you're ingesting," she said.

Gill said the pouches can cause short-term effects such as mouth and gum irritation, higher blood pressure and increased heart rate; they contain tobacco-specific nitrosamines that have been linked to cancer; and nicotine itself is not harmless. She emphasized concerns for youth brain development and mental-health effects and described nicotine pouches as potentially following the same social-marketing path as Juul. "We're concerned that the nicotine pouches are the next Juul," Gill said.

Council members asked whether identification is required to purchase the pouches and whether state enforcement is addressing flavored products. Gill replied that retailers should require identification, and she described a state process establishing an "unflavored tobacco product list" for products that can be sold legally in California. She said manufacturers must apply to be listed; products not on the list should not be sold. Gill also said the California attorney general has issued notices of determination to manufacturers for non-characterizing (e.g., "chill" or "ice") flavors intended to evade flavor bans.

She recommended reducing youth exposure to nicotine products through restrictions on where products can be used, limiting retail availability to reduce youth access, community advocacy and cessation referrals. Gill noted the cessation resource "Kika California," a free service for California residents 13 and older.

Council members thanked Gill and said staff will follow up. The council did not take any regulatory action at the meeting; Gill's presentation was an informational item and part of council deliberations about possible local prevention and outreach work.