Last summer, health agencies in the United States issued similar pleas on social media. The health department of Multnomah County, Oregon, warned parents to “keep nicotine pouches away from young children.” A network of poison control centers in Florida urged them to “stay informed and vigilant.” 

The North Texas Poison Center posted on Facebook, “We’re seeing a sharp rise in young children accidentally swallowing nicotine pouches — and even a small amount can cause serious harm.” 

Nicotine pouches — which are small packets of nicotine powder and flavorings that users tuck between the gum and lip — have exploded in popularity in recent years. In August, monthly sales of nicotine pouches in the U.S. reached $510 million, according to the CDC Foundation. Two years earlier, it was about $146 million.

As sales have risen, so too have reports of nicotine poisoning. 

Poison control centers across the country reported 4,254 cases in 2025, nearly double than the year before, according to America’s Poison Centers, a nonprofit that represents 53 centers. In 2020, there were only 200 cases. 

Nearly three-quarters of cases last year involved children under the age of 6, according to America’s Poison Centers. Typical symptoms include nausea, vomiting, headaches and dizziness. While most calls to poison centers don’t lead to medical intervention, large doses of nicotine can cause seizures, paralysis and even death. 

“It’s important to remember that nicotine can be very dangerous,” said Dr. Hannah Hays, medical director of the Central Ohio Poison Center. “And small amounts are enough to cause serious poisoning in a young child.”

The U.S. is not the only country facing this problem. Though poison control centers are less widely utilized outside the U.S., health workers, researchers and school officials in Sweden, Denmark, Ireland and South Africa shared stories with The Examination about teenagers being poisoned. 

Doctors said they aren’t surprised that kids are getting sick from nicotine pouches, given that they are small, fruit-flavored and often packaged in ways that resemble food or candy. Black-market pouches with extremely high concentrations of nicotine (up to 50 mg) are becoming more popular, alarming health experts. (Pouches legally sold in the U.S., by comparison, range from 3 to 9 mg each.)

“Why would a young child not drink what looks and smells like juice — or eat what looks like a chewing gum smelling like mango?” Dr. Richard van Zyl-Smit, a professor and consultant pulmonologist at the University of Cape Town and Groote Schuur Hospital, told The Examination by email. “One cannot package a poison like a sweet and not expect people to be poisoned by it.”

Unauthorized products, little enforcement

Requiring childproof packages or banning flavors that appeal to kids would reduce poisonings and youth use, experts said, but the U.S. Food and Drug Administration has not done either. In response to rising poisoning cases, the FDA has asked — but not required — manufacturers to use child-resistant packaging.

“The fruity flavors and bright, colorful designs of nicotine pouch products could resemble candy and seem attractive to children,” FDA Commissioner Dr. Marty Makary said in a September news release. “Manufacturers should consider what steps they can take to prevent accidental exposures and ingestion.” 

There is little sign the agency plans to take a stronger stance. 

Part of the problem, researchers said, is that the FDA lacks the staff to keep tabs on a booming market.  

Under U.S. law, companies must seek the FDA’s authorization to market any new nicotine product. ZYN and on! PLUS — both of which have childproof packaging — are the only two brands that have obtained this authorization and can be sold legally. A British American Tobacco subsidiary has applied for authorization for VELO. It is at the FDA’s discretion whether companies can continue to sell their products while applying for authorization.

If you walk into a smoke shop, you’ll see many more brands for sale. Even more are offered online, often promoted by young social media influencers. 

Those products “should not be technically on the market,” said Sairam V. Jabba, a senior research scientist at Duke University. “But you will see [those products] everywhere because there is nobody really regulating.”

The FDA has a backlog of millions of applications to sell new nicotine products, many of which are pouches. While the FDA has its own special agents, and it sometimes works with state and federal law enforcement to crack down on shops selling unauthorized products, its main tactic is to send warning letters to these shops. 

“They’re functionally like cease and desist orders,” said Meghan Morean, a researcher at Yale School of Medicine. But those letters are not effective, she said. 

For Big Tobacco, a smoke-free gold mine 

The tobacco industry has turned to nicotine pouches, along with vapes and heated tobacco products, to counter declining cigarette sales. 

In 2019, two years after purchasing a Swedish snus company, British American Tobacco launched its VELO line of nicotine pouches. (Snus is also a smoke-free tobacco product, but unlike a nicotine pouch, it contains ground-up tobacco leaves.) 

Also in 2019, U.S.-based Altria Group Inc. began its acquisition of the Swiss nicotine pouch on!. In 2022, Philip Morris International purchased Swedish Match, which owned ZYN, the No.1 nicotine pouch brand. At a cost of about $16 billion, it was the biggest deal in Philip Morris International’s history. 

Today, ZYN, VELO and on! are the three most popular nicotine pouch products, owned by the three biggest tobacco companies. Philip Morris International, British American Tobacco and Altria Group didn’t respond to requests for comment.

ZYN, for example, is sold in at least 37 markets. From 2021 to 2024, the number of cans of ZYN manufactured annually soared from 1.1 million to 644 million, according to Philip Morris International’s annual reports. 

By September, annual U.S. sales of all brands of spitless tobacco (a category mostly made up of nicotine pouches) totaled $5.85 billion, according to an industry report.

Sales in Europe also increased significantly. In its 2024 annual report, Philip Morris International reported that the number of nicotine pouches shipped there had risen 40% since 2023. Pouches have become the company’s fastest growing product. 

While nicotine pouches are subject to the same age restrictions as cigarettes, it’s easier to grab shoppers’ attention with pouches. Anti-tobacco laws often require cigarettes to be packaged discreetly and placed behind a counter or out of sight. Colorfully packaged nicotine pouch products are often displayed alongside snacks and candies on the counter.

“The challenge is the marketing wants to make it attractive to their ‘adult’ clients — but attractive, bright colors make it attractive to young people, too,” van Zyl-Smit said.

And then there’s the advertising. In some European countries, including Austria, France, Italy and Ireland, tobacco advertising has been banned or restricted for decades. Ads for nicotine pouches, however, are common in those countries, said Charlotta Pisinger, a professor of tobacco and nicotine prevention at Frederiksberg Hospital in Denmark.

TikTok, Instagram and other social media is teeming with young, glamorous influencers who extol the virtues of nicotine pouches as less harmful products with attractive flavors. Many videos use the hashtag #Zyn. While it’s hard to know whether those users have been paid to promote the product or are simply fans, the content tends toward the laudatory.

“They are marketing these products with first, the concept that it’s pretty healthy, and then … that they taste very good and they're cool,” said Dr. Magnus Lundbäck, associate professor of cardiology at Sweden’s Karolinska Institute and a physician at  Danderyd Hospital in Stockholm. 

In-person marketing campaigns include sponsorships of music festivals, sporting events and parties with open bars. While these look different across the globe, what they have in common is that they’re aimed at young people. 

In Denmark, when big tobacco companies host marketing events, “it's typically really close to schools,” said Sofie Bergman Rasmussen, a Ph.D. candidate who works at the Center for Clinical Research and Prevention at Frederiksberg Hospital and has studied nicotine use among high school students. 

“And when they rent clubs and invite people to come for a free bar,” she said, “it's typically clubs where people around 18 are going and partying.”

Tobacco companies say their products are suitable only for adults; the age limit is 21 in the U.S. and 18 in most European countries. Despite age restrictions, researchers say tobacco company marketing appeals to minors.

Teens are getting sick, too

Studies show the popularity of nicotine pouches over other tobacco products.

In October, health officials in New York said that tobacco use among high school students had fallen to a record low, with just 17% using cigarettes, vapes, smokeless tobacco or heated tobacco. 

The sole exception was nicotine pouches, whose use had doubled to 3% over three years. Researchers at the University of Southern California found a similar trend nationally. 

A study published in March 2025 by the Nordic Welfare Centre showed that in nearly all Nordic and Baltic countries where data is available, youth usage of nicotine pouches has increased significantly. 

One factor behind the increase: It’s a lot easier to use nicotine pouches at home or school, researchers say. Unlike cigarettes or vapes, nicotine pouches can’t be seen when in use and leave no odor. 

“It's so easy to hide,” Rasmussen said. “I had one kid say to me, ‘They can't just go and touch my lip. They're not allowed to do that.’” 

The proliferation of nicotine pouches may be fueling another poisoning trend, this one among teens, researchers said. But it is harder to measure.

The symptoms, including nausea, headaches and trouble sleeping, are often mild and short-lived, making them easy to hide. Cases may be reported only if a teacher notices. 

Teens “are not in the picture because they don’t call the poison control or tell their parents,” Rasmussen said. “They know exactly what made them sick: They took too many nicotine pouches.” 

The CDC Foundation has received funding from Bloomberg Philanthropies, which also provides financial support to The Examination. The Examination operates independently and is solely responsible for its content.