PT - JOURNAL ARTICLE AU - Nadja Mallock AU - Thomas Schulz AU - Sebastian Malke AU - Nadine Dreiack AU - Peter Laux AU - Andreas Luch TI - Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches AID - 10.1136/tc-2022-057280 DP - 2022 Aug 05 TA - Tobacco Control PG - tobaccocontrol-2022-057280 4099 - http://tobaccocontrol.bmj.com/content/early/2022/08/05/tc-2022-057280.short 4100 - http://tobaccocontrol.bmj.com/content/early/2022/08/05/tc-2022-057280.full AB - Background Nicotine pouches without tobacco are new products that deliver nicotine into the body via the oral mucosa. There is a lack of independent research on the chemical composition and product characteristics of these products, contributing to uncertainties regarding product regulation. This study sought to address knowledge gaps by assessing levels of nicotine and screening for tobacco-specific nitrosamines (TSNAs) in a sample of these products.Methods Nicotine pouches (n=44) and nicotine-free pouches (n=2) from 20 different manufacturers were analysed regarding their contents of nicotine and TSNAs by gas chromatography with flame ionisation and liquid chromatography–tandem mass spectrometry, respectively. Product labelling and pH values of aqueous extracts were determined.Results Nicotine contents of products ranged from 1.79 to 47.5 mg/pouch; median product weight, pH, and proportion of free-base nicotine were 0.643 g, 8.8, and 86%, respectively. A clear labelling of the nicotine content was missing on 29 products and nicotine strength descriptions were ambiguous. TSNAs were detected in 26 products, with a maximum of 13 ng N-nitrosonornicotine/pouch.Conclusion Although nicotine pouches may potentially be a reduced risk alternative for cigarette smokers or users of some other oral tobacco products, nicotine contents of some pouches were alarmingly high. Presence of carcinogenic TSNAs in the nicotine pouches is of serious concern. Better manufacturing processes and quality control standards should be implemented. Labels of nicotine strength on most products are misleading. A strict regulation regarding nicotine contents and its labelling would be advisable.All data relevant to the study are included in the article or uploaded as supplemental information.