18C.6 Public health and regulatory considerations

Last updated: February 2024 

Suggested citation: Greenhalgh, EM, & Scollo MM. 18C.6 Public health and regulatory considerations. In Greenhalgh, EM, Scollo, MM and Winstanley, MH.  Tobacco in Australia: Facts & issues. Melbourne: Cancer Council Victoria; 2024. Available from: https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/InDepth-18C/18c-6-public-health-and-regulatory-considerations


There is concern among public health experts that the marketing of non-therapeutic oral nicotine products – including their similarity to lollies, colourful packaging, sweet flavours, use of social media influencers, and discreet use – could particularly attract young people and non-nicotine users.1 They may also appeal to people who smoke who are looking to quit, despite being largely untested and unregulated as a cessation aid, potentially diverting people who smoke from using evidence-based products and support.2, 3 Due to their recency on the market, the health risks of non-therapeutic oral nicotine products are largely unknown (see Section 18C.5). However, nicotine use is known to be harmful for some population groups such as adolescents and pregnant women,4 and oral nicotine products can contain very high levels of nicotine.5, 6 Descriptors such as ‘tobacco-leaf free’ and ‘pharmaceutical grade nicotine’ used to market the products may alleviate health concerns among users.7

Research regarding the health effects of non-therapeutic oral nicotine products, use among non-tobacco/nicotine users (especially young people), and effects on smoking are needed to guide consumers and policy makers. The World Health Organization (WHO) has called for studies independent of the tobacco industry that examine:3

  • prevalence of use and user profiles, including among never users and users of other tobacco/nicotine products
  • the effects of use on tobacco product uptake and cessation
  • short- and long-term health effects, including addiction
  • the effects of product features and marketing on perceptions and use
  • chemical constituents of products

In the meantime, researchers have suggested that Governments take further steps to regulate or ban non-therapeutic oral nicotine products and ensure adequate enforcement, with studies in the US already highlighting ways that the industry has attempted to undermine regulations.2, 8 Such regulations could explore use of existing tobacco control or other relevant laws to regulate nicotine pouches, and  should aim to minimise product appeal and uptake by young people, increase product safety, and minimise false health beliefs.3 The WHO also recommends that policy makers:3

  • Monitor the brands and types of products and demographics of users
  • Prevent all forms of marketing and promotion to minimise access and use by young people
  • Educate the public regarding the risks of nicotine
  • Require health warnings on packages and set upper nicotine limits
  • Prohibit health-related and cessation claims, unless approved by the appropriate regulatory bodies.
  • Fully implement Article 5.3 of the WHO FCTC to protect policies against undue influence by the tobacco and related industries.
  • Relevant news and research

    For recent news items and research on this topic, click here. ( Last updated May 2024)


1. Unger JB, Barker J, Cruz TB, Leventhal AM, and Pentz MA. Lucy-Novel Flavored Nicotine Gum, Lozenges, and Pouches: Are They Misleading Consumers? Substance Use and Misuse, 2022; 57(8):1328-31. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35586938

2. Borowiecki M, Emery SL, and Kostygina G. New recreational nicotine lozenges, tablets, gummies and gum proliferate on the US market. Tobacco Control, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36319083

3. WHO study group on tobacco product regulation. Report on the scientific basis of tobacco product regulation: ninth report of a WHO study group. WHO Technical Report Series, No. 1047., Licence: CC BY-NC-SA 3.0 IGO.Geneva: World Health Organization, 2023. Available from: https://www.who.int/publications/i/item/9789240079410

4. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf

5. Stanfill S, Tran H, Tyx R, Fernandez C, Zhu W, et al. Characterization of Total and Unprotonated (Free) Nicotine Content of Nicotine Pouch Products. Nicotine & Tobacco Research, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34233354

6. Mallock N, Schulz T, Malke S, Dreiack N, Laux P, et al. Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches. Tobacco Control, 2022:tobaccocontrol-2022-057280. Available from: https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2022/08/05/tc-2022-057280.full.pdf

7. Ling PM, Hrywna M, Talbot EM, and Lewis MJ. Tobacco-Derived Nicotine Pouch Brands and Marketing Messages on Internet and Traditional Media: Content Analysis. JMIR Form Res, 2023; 7:e39146. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36790840

8. Jabba SV, Erythropel HC, Woodrow JG, Anastas PT, O'Malley S, et al. Synthetic cooling agent in oral nicotine pouch products marketed as 'Flavour-Ban Approved'. Tobacco Control, 2023. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37380351