Can the extensive body of epidemiological evidence on Swedish snus help us better understand the public health potential of nicotine pouches?
In this presentation, the speaker explores how decades of research on snus can inform the scientific assessment of nicotine pouches. The session examines similarities and differences between the two products, discusses the strengths and limitations of existing epidemiological evidence, and considers what current data can tell us about health risks, harm reduction, and population-level impacts.
This presentation is part of the Global Forum on Nicotine 2026 (GFN26), where international experts discuss the latest science, policy, and innovation in tobacco harm reduction.
Transcription:
00:11 - 03:41
[Gizelle Baker]
Hello, everybody. Today we're going to have the first science lab. And as you can see, I'm sitting here with three Annas and one Lindsey, which, as you can imagine, and maybe from a visual perspective that doesn't make sense yet, but it will. When we started thinking about this session, we thought we could name it Science Lab Number One, Nicotine Pouches. That would be great. But then in the end, we ended up having a little bit of a debate on whether it should be called Lindsay and the Annas or Giselle and the Annas. And in the end, we thought with a small scientific intervention, if Lindsay could get her name changed quickly enough, it could be Giselle and the Annas. But in the end, Anna Franzen got ill and was unable to join us today. So we have Thomas here to represent her film. and have the discussion on that. And with that, our small little intervention became unneeded, and we're going to have to just call it the science on nicotine pouches. So we have four videos for you today, and we're going to look at nicotine pouches from a few different angles. We get to look at how they are designed, kind of what is the materials in them and how does that influence delivery. We get to look at what do they contain and what is the variability between these different types of products that are out there on the market. Are they all one category or are they different? And then we get to look at how we interpret the evidence around these. How far can the evidence that we have in the epidemiological data on snus be carried forward to understand what nicotine pouches do? And then lastly, we get to understand whether they perform consistently and whether that consistency is consistent over time. What is the stability of these products and how do they change? So the goal today is to keep this rather informative. We got lots of different angles to look at. And I think the idea here is to see if we can find a common thread through the different videos to really understand the so what about these products, and what are the differences in the products, and how we should look at these products. So without going much further, I think we get to introduce the first video. And the good news is I think we get Anna number one for this one. Bridging the epidemiological evidence from snus to nicotine pouches. We get to hear from Anna about what we know about nicotine pouches because we know that these products are relatively new and there's a lot of questions we don't have science on today. But is there a way we can look at what we know about snus and how do we carry that forward? So with that in mind, let's really drive forward and see that first video and then open the floor to Anna. Hello, I'm Giselle Baker and I'm the head of scientific affairs here at Philip Morris. And I'm joined today by Trigve Young, our brand new chief medical officer. So I think today we're gonna address Bridging. The concept of scientific bridging between a snus and a nicotine pouch. And we're going to ask two really important questions. Can you bridge between snus and nicotine pouches? And then what are the limits when you do something like that? What can you do and what can't you do in bridging?
03:42 - 07:29
[Tryggve Ljung]
Right, so the short answer is yes, you can. But you also need to take into consideration how to do that, what questions you need to ask yourself and be able to answer to make that bridge. So as an example, we have two products which are quite similar, but not the same. So we have the snus product and the nicotine pouches. They are both pouch products put on the lip by the consumer, used in a similar way, and the nicotine is absorbed through the oral mucosa. But one is tobacco based, the other is not. So there are differences. that the bridge can be made. So if you start to look at it, both deliver nicotine and flavors. That's the kind of consumer experience you have from it. At the same time, If you want to make that pitch, you have to compare the content between the products. So you are looking at harmful or potentially harmful constituents you find in tobacco and you see, okay, do I find them in the nicotine pouch? And we have done that exercise. And to the large extent, Most of the toxicants or chemicals of concern in the tobacco-based product is not found in the nicotine pouches. And among those who are found in both products, the levels are generally much lower in the nicotine pouches. So you have a very good start to build that bridge. Second part is, of course, if you use them, what are you as a consumer exposed to? And we can measure that. We use biomarkers to measure the exposure of identified chemicals that you are exposed to. And we've done that exercise, and we can demonstrate that the chemicals of concerns the exposure to those are much lower in the nicotine pouch. So we have at least two steps of that bridge, right? Of course, there are more to it because it's science. So we also want to be able to demonstrate that the nicotine exposure is not higher for those who are using the nicotine pouches compared to snooze users because that would raise a new set of questions. So we did that exercise and we have measured the nicotine exposure among users in their daily life who are using snooze and the other group who were using nicotine pouches. as the normally gypsy products. And we could clearly demonstrate that the nicotine exposure did not differ And I have to bring back also when you actually develop the product, getting rid of toxicants is not enough. You also have to be aware of not adding new ones, right? So what you find in nicotine pouches, all constituents meet the pharma grade or food grade levels and constituents. So what you find in these products are either found in pharma products or in food and are generally accepted at the levels we put into the product. And finally, it's about how you use the product. And we have data demonstrating that the usage of the products is very similar. So yes, I think we are in a place where we have built that scientific bridge.
07:30 - 07:49
[Gizelle Baker]
But is this something that's accepted? Is this something that is a normal process that you just create a new product and then reference it to some other product that you just happen to like? Is there a real scientific approach to this? Is it acceptable or is it just kind of Trigvay's gut feeling? They seem similar enough.
07:49 - 08:41
[Tryggve Ljung]
Let's go for it. I wish, I wish. But you know, this is according to robust science thinking and procedures. And it's not specific for me or our industry. It's used across different industries. It's used in pharma. You can take insulin as an example. Insulin in the beginning was injected and now you have seen the development over time with insulin pens and pumps That doesn't mean that each generation of insulin products needed to start from scratch. So you had to understand, okay, what can you take with you? What is still scientifically valid? And what new questions arise from the new format? And then you have to fill the gap.
08:42 - 08:52
[Gizelle Baker]
I guess seems like a very reasonable approach. But if you do that, in the end, what is it that you can really say about nicotine pouches if that's the only data you have?
08:53 - 09:37
[Tryggve Ljung]
I think we could say that these products like the snus products, are a magnitude less harmful than the market leading tobacco products, cigarettes. So I think we have enough data to say that these products have far less risk associated compared to cigarette smoking. If you did a prediction, I would say, and FDA I suppose agree with us according to their briefing documents, is that the snus epidemiology is the upper limit of the foreseeable risk for nicotine pouches.
09:39 - 10:04
[Gizelle Baker]
Well, thank you, Trigme. Thanks for joining us today. I think this was an interesting conversation and a great way to get through such a complex topic. And thank you, everybody, for joining us. And maybe we'll see you next year at GFN. Thank you, Yacel. But now I'm going to hand it over to Anna to talk about the video and the science behind it.
10:06 - 12:24
[Anna Masser]
Yeah. If I just recap on the data parts that was in between this great conversation. So first, it showed the content of the products and how when we remove the tobacco, so going from snus to nicotine pouches, we get a lot less of harmful and potentially harmful constituents in there. And you saw that they were not down to 100%, but most of them were below what we call limit of quantification. So we cannot say that it's a 100% reduction. We can only go as low as our quantification level allows. But for one of the worst constituents, the tobacco-specific nitrosamines, we were pretty close to 99.5, I think. And then we went into people, so we looked at biomarkers of exposure. And there we could confirm that we could not quantify any tobacco-specific nitrosamines in the nicotine pouches, and we did not find them in the people using nicotine pouches either. And then there was the nicotine exposure. And I think when you often in studies who look at nicotine exposure, they do pharmacokinetics and they look at pharmacokinetic curves and they compare one unit to one unit in a standardized setup. But here we had people using the products as they wished. So they were not in the clinic. They were just out living their ordinary, normal life. And then they came back and we drew plasma from them to look at nicotine and the metabolites. And based on this, the group of exclusive snooze users and the group of exclusive nicotine pouch users they had the same levels of nicotine and the main metabolite, cotinine.
12:29 - 12:51
[Gizelle Baker]
All right. So I think we can open it for questions. And I'm going to say I actually have one to start it off, which is, what is the strongest part of the bridge between this? And then we'll open it to the floor. If you have this bridge with all these different levels of evidence, which one is the strongest to say you can use SNUS evidence for understanding pouches?
12:58 - 12:59
[Tomas Hammargren]
It's for you. I would like to add another thing.
13:00 - 13:14
[Anna Masser]
Yeah, I would go with the FDA there to say that just that we start off by having lower levels of toxicants in the product. I would think that's a very good start. It's a great start.
13:14 - 13:15
[Gizelle Baker]
Now we have from the floor.
13:17 - 13:41
[Attendee]
Hi. Yeah, I wanted to ask about the nicotine comparison. Have you done nicotine comparison across categories? compared oral products to inhaled products to cigarettes. And do they equate or are there significant differences if you have done such a study?
13:41 - 14:53
[Anna Masser]
So in the study where we here only showed the pouch users and the snooze users, it was also a group of cigarette users. And what we saw there was that when they came into the clinic, the plasma nicotine levels across groups were the same. But when you look at the metabolites, the cigarette group had lower levels of cotinine. But when it came to the toxicants, like the tobacco-specific nitrosamines, Cigarette users had higher levels of those. Some were similar to the snus group. And of course, we also found the biomarker of exposure to benzoylpyrine were very high in the smokers. So overall, the smokers, we found more toxicants, slightly less nicotine metabolites. We did not include any vapors.
14:55 - 15:06
[Attendee]
And do you have a hypothesis as to why the metabolites are lower? Cotinine is lower in some users of nicotine and not others?
15:11 - 15:28
[Anna Masser]
Well, it could be how the nicotine is delivered, that with smoking, you get these really rapid peaks of delivery, whereas with oral products, it's more slow, more gradual.
15:31 - 15:33
[Gizelle Baker]
You had a question, Thomas?
15:33 - 16:25
[Tomas Hammargren]
Maybe a suggestion, Anna, too. That's my new nickname. In Sweden, we do have NRT pouch. It actually came to the market two years before consumer pouches were available, approved in several countries, three, four, I think, proven then safe and effective. So maybe that's a good comparator. Maybe. I'm thinking out loud. I'm being semi-scientific. But in addition to bridging, you actually approved NRT as comparison. What does it contain? being Swedish. Yes.
16:25 - 16:27
[Anna Masser]
I think Lindsay actually has this.
16:30 - 16:46
[Lindsay Reese]
So not to give you a little preview, among the 447 products that we tested last year, we also added one from this year, which was 4 milligram Zonic. So we'll talk about what's in that in my video.
16:48 - 16:55
[Gizelle Baker]
I think we have time for one more question, and then we'll try and see if we have time at the end for additional questions.
16:58 - 17:24
[Attendee]
So, Anna, the risk, you know, this risk continuum where you see cigarettes and it's normalized to 100, and you see it going down to nicotine pouches being the lowest. Your study really confirmed that risk continuum when you look at biomarkers, or did you see anything new under the sun. You know which one I'm referring to is... Yes, I know.
17:25 - 17:29
[Anna Masser]
Yeah, no, I think this confirmed what we will be expected.
17:30 - 17:39
[Attendee]
Yeah. Okay. So it's confirming that thing that we all present in PowerPoint presentations, that that is valid.