By Brady Ziegler, Student Pharmacist and Karen Kier, Pharmacist
ONU Healthwise Pharmacy 

Shock rock artist Alice Cooper released a song titled Poison on July 17, 1989. The song hit #7 on the Billboard Hot 100 in the United States and #2 in the United Kingdom. Cooper was fascinated with horror movies and remembers watching them around Halloween. The horror genre influenced much of his work. 

Are nicotine pouches creating a horror picture for poisonings in the United States?

There is a rising popularity of nicotine products in the United States, including e-cigarettes and nicotine pouches. This trend has led to a concerning increase in nicotine consumption among children. These products feature attractive packaging and sweet flavors, which makes them appealing to children. 

The October 16, 2025 edition of the Truth Initiative reported an increase use of the nicotine oral pouches among both adults and teenagers. One oral pouch can contain between 1 milligram to 50 milligrams of nicotine. The average cigarette contains 10-12 milligrams of nicotine, but only 1-2 milligrams are absorbed by the body. A full package of cigarettes (20) would provide 20-40 milligrams of nicotine.  

The most popular strength of the oral nicotine pouches is 6 milligrams with about 2 milligrams being absorbed after the pouch is placed between the lip and gum. The 6-milligram oral pouch would have a similar absorption to 1 cigarette.  

The best-selling brands in the United States include ZYN, Velo, FRE, On!, and zone. Sales of the pouches increased by 207% between January 2023 to April 2025.  Sales in January 2023 totaled $145.5 million and $446.8 million in sales was recorded in April 2025. The most recent data shows an increase in sales of high-strength products with the 8-milligram pouch becoming more popular.

With growing sales, nicotine products present a serious public health concern due to their ability to cause poisonings in children.

A recent study, “Nicotine Ingestions Among Young Children: 2010-2023,” published in the journal Pediatrics, evaluated the unintentional, single-substance nicotine ingestions among children under the age of six. The study included 134,663 reported incidences of accidental ingestion, most in boys younger than two years of age. 

Reported poisoning outcomes varied from 36.8% having no effect, 19.6% having minor effects, 1.2% having moderate effects, and 39 cases having major effects. The National Poison Data System (NPDS) classifies the severity of cases as follows: minor effects go away on their own without lasting problems, moderate effects cause more noticeable symptoms but are not life-threatening, and major effects result in serious or life-threatening conditions and/or long-term disability. 

Two deaths occurred, both from liquid nicotine (e-cigarette) ingestions in infants under the age of one. While cigarettes were the most common product involved, liquid nicotine stood out for its role in severe outcomes and deaths. To note, 42% of cases were “not followed,” meaning the true impact may be underestimated. 

Ingestions of such products rose 59% from 2010-2015, then fell 34% from 2015-2023. Although ingestions have been on a downward trend, the study highlights a 763% increase in nicotine pouch ingestions from 2020-2023, with higher odds of serious medical outcomes. These findings emphasize the growing need for public awareness and prevention efforts as new nicotine products such as pouches become more widely used.

Individuals can proactively decrease the risk of nicotine ingestion among children in various ways. Education is important at a young age regarding these products. Nicotine products should be disposed of immediately after use in a concealed and supervised area. 

Parents should encourage open communication with children about the dangers of nicotine products and the harm they can cause. Parents who consume these products should be aware of the signs and symptoms of nicotine poisoning, such as nausea/vomiting and pale skin color.

Besides poisonings in children, adults, teens, and pets can also have toxic reactions or poisonings. Remove the horror of poisonings and keep all products stored properly and away from children and pets. 

If you are interested in more information on this topic, please contact ONU HealthWise Pharmacy at 419-722-3784.

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