Chock-full of nicotine, APH says pouches a danger to local kids

Algoma Public Health officials are concerned about nicotine pouches getting into the hands — and mouths — of children and teens.

The APH board of health will be penning letters of concern to the federal and provincial Ministries of Health about the sale of nicotine pouches to individuals younger than 18 years of age.

“We’ve tried to clamp down on vaping and this is the next level in terms of nicotine delivery. It really poses a risk in terms of nicotine addiction at a young age so whatever we can do to advocate for better control of this would be prudent,” said Dr. John Harding, APH acting medical officer of health at Wednesday’s APH board meeting.

“Tobacco companies are looking to deliver nicotine in any way they can. It’s very strategic and tactical to market a product like this with different flavours to children. These are quite high doses of nicotine and quite easily used in a clandestine manner,” Harding said.

Health Canada authorized the use of one nicotine pouch brand — Imperial Tobacco Canada’s Zonnic — in July 2023. Nicotine pouches are sold in pocket-sized packs similar to mints that contain 10 or 24 pouches and come in a variety of flavours like Berry Frost, Chill Mint and Tropic Breeze.

They are smokeless and tobacco-free but each pouch — placed in the mouth between the gum and cheek — contains 4 mg of nicotine. That’s the same amount that is absorbed when smoking three to four cigarettes. 

That amount is usually recommended for adults who smoke 25 or more cigarettes a day who want to quit smoking.

Because the nicotine pouches fall under Natural Health Products Regulations (NHPR) they are available for purchase with no minimum age requirements or regulations on packaging, flavouring or advertising.

APH says that is a regulatory gap that needs to be closed.

Health agencies want the pouches to be regulated under the federal Tobacco and Vaping Products Act and the provincial Smoke Free Ontario Act to restrict the advertising and display of the pouches in stores and enforce a minimum age for purchase. 

Health agencies have been receiving reports of unauthorized nicotine products being sold at convenience stores, gas stations and other retail locations across Canada and over the Internet. These may contain ingredients that can lead to serious reactions. Zonnic is the only nicotine pouch approved in Canada but other brands with higher levels of nicotine have made their way to Ontario.

They are promoted in stores and on popular social media platforms like Tik Tok.

“Nicotine pouches are packaged, flavoured, displayed, and marketed in ways that appeal to youth. They are easy to conceal and can be consumed anywhere, including in areas where smoking and vaping are prohibited. Nicotine is highly addictive and harmful to the developing adolescent brain. These pouches can create a new generation of non-smokers who are dependent on nicotine,” wrote Kristy Harper, APH director of health promotion and chief nursing officer in a report to the APH board.

“Nicotine is a highly addictive substance and can have permanent adverse effects on the developing brain. Too much nicotine can lead to acute poisoning. Youth under the age of 25 can become nicotine dependent faster than adults because the part of the brain that is responsible for decision making and impulse control is not fully developed. Exposure to nicotine during adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control and can affect memory and concentration, as well as increase risk of cognitive and behavioural problems. Nicotine use can also intensify symptoms of depression and anxiety. Youth who use nicotine-containing products may have a difficult time quitting and are at risk of developing lifetime nicotine dependence,” Harper wrote.

In March 2024, federal Minister of Health Mark Holland acknowledged the government’s concern over the popularity and recreational use of nicotine pouches by youth and marketing of the pouches toward youth and non-smokers. Miller acknowledged that Health Canada wants to put laws and regulations in place to protect youth from pouch use.

The Canadian Lung Association, Heart and Stroke, Physicians for a Smoke-Free Canada, Canadian Cancer Society, Action on Smoking & Health and other organizations want action to either require prescriptions for the pouches or suspend sales until tougher regulations are in place.

The full text of Algoma Public Health’s resolution regarding nicotine pouches, passed at Wednesday’s APH board of health meeting follows:

Whereas, nicotine pouches have been approved for sale by Health Canada under the Natural Health Products Regulations, currently being sold by Imperial Tobacco Canada since October 2023; 

and Whereas, nicotine pouches do not fall under the federal Tobacco and Vaping Products Act (TVPA) or provincial Smoke Free Ontario Act (SFOA) 2017, and therefore are not regulated under provincial or federal tobacco laws; 

and Whereas, the ways in which nicotine pouches are packaged, flavoured, displayed, and promoted make them appealing to youth; 

and Whereas, nicotine use poses risks to youth, it is highly addictive and harmful to the developing brain; 

and Whereas, Health Canada has identified a regulatory gap and provided a notice of intent to address this gap over concerns of the risks to youth and young adults; 

and Whereas, local Boards of Health and other health agencies have called on the provincial and federal government to act now to protect youth;

Therefore be it resolved that the Board of Health of Algoma Public Health send a letter to Minister of Health of Canada, calling on Health Canada to close the regulatory gaps that allow the sale of nicotine pouches and other nicotine-containing products that have not yet been proven effective as cessation aids to individuals under 18 years of age; 

and Be it further resolved that the Board of Health of Algoma Public Health send a letter to the Minister of Health of Ontario, calling on the provincial government to consider taking action to embed restrictions on the flavouring, sale, display, and promotion of nicotine pouches and other nicotine-containing products under the Smoke-free Ontario Act, 2017. Be it further resolved that these letters be shared with other Ontario Public Health units.

A public advisory regarding nicotine pouches can be found on the federal government’s website.