“Quite a few of my friends have stopped vaping and are now using pouches. One of them is now importing extra-strength ones that he says contain 50mg of nicotine. That sounds like a lot to me when others only contain between 2-20mg. I remember when vaping first started to become popular, some people got quite sick – I think it was called ‘nic-sick’. Can you overdose on pouches? “
Although it’s highly unlikely to be fatal, you can indeed overdose on pouches. As with any drug, using too much nicotine can result in an overdose. If it happens, you’re going to feel quite unwell and will likely vomit and, in extreme cases, it could result in poisoning and a trip to hospital. Babies and small children, as well as pets, are far more susceptible to nicotine poisoning, which is why it’s so important to keep any nicotine products well out of their reach.
Oral nicotine pouches are placed between a person’s lip and gum allowing nicotine to be absorbed through the mucous membranes inside the mouth. The drug then enters the bloodstream, providing a ‘nicotine hit’. Unlike ‘snus’ – a product that’s been around for hundreds of years – instead of supplying nicotine via shredded tobacco leaf, these products use synthetic ‘tobacco-free’ nicotine. There are many brands of pouches available and in addition to the synthetic nicotine, most also contain flavourings, e.g., cool mint, apple, coffee.
The nicotine concentrations of the different brands can vary greatly, with some containing much higher levels than cigarettes. The lowest strength pouches typically have a similar effect to smoking one cigarette, with the strongest (9-11mg of nicotine) being the equivalent of around 10 cigarettes. As you say, however, there are other brands that can contain far more nicotine, some up to 50mg. Although not all the nicotine contained in the pouch is absorbed when they’re used, this is still an extreme amount and these products need to be used very carefully.
Pouches are marketed as a less harmful alternative to smoking and vaping but recent studies suggest they may have the potential for toxic exposure for those who use them. Apart from the addictive nature of nicotine, there are other potential health-related effects, including poisoning or overdose. Although other research suggests a lethal dose of nicotine may actually be much higher, the Centre for Disease Control in the US has stated that 50-60mg of the drug could prove deadly for inexperienced, healthy males weighing around 70kg.
A recently published paper discusses the first reported case of acute nicotine toxicity through nicotine pouches. A 21-year-old male presented to an emergency department with “depressed mental status after … acting bizarrely”. To help him study, he’d used 15 11mg pouches (≈165mg of nicotine) over a 12-hour period. His brother had found him and said “he was confused and responded nonsensically to questions. He was unable to sit in his chair and later slumped over the table, eventually sliding onto the floor.” Typical features of an early stage of nicotine overdose also include headaches, nausea, dizziness and excessive sweating. If untreated, the later stage could potentially include coma, convulsions and even respiratory failure.
The risk of nicotine overdose from the use of pouches is low but it can happen, particularly if you haven’t smoked or vaped and you’re not used to the effects of the drug. It’s important to note that this is far more likely to occur if higher strength products are used and if they’re taken in multiple doses over a short period of time.
First published: March 2025
