The highly respected Cochrane Library has published a review looking at nicotine pouches as a smoking cessation aid. Despite current limitations, the study marks an important step toward giving pouches serious scientific scrutiny and seeing them as a potential tool to help smokers quit. 

Published in October 2025, the review, Oral nicotine pouches for cessation or reduction of use of other tobacco or nicotine products, assesses the effectiveness and safety of pouches in helping users stop or reduce smoking and other tobacco use.  

And while the authors call for more studies, the mere fact that Cochrane — considered a gold standard for health reviews — has taken on the subject represents a sea change in how alternative nicotine products are being evaluated. 

Small steps, big implications 

The review included four randomised controlled trials covering 1,766 participants, mainly from the US and New Zealand.  

Researchers found that oral nicotine pouches (ONP) may help some users quit smoking and reduce tobacco use, although the overall certainty of the evidence was judged to be low due to the small number of studies and participants. 

“Limited, short-term data did not identify any serious health harms from ONP when used to help people transition away from tobacco smoking,” the report reads. 

“More research on the effects of ONP for cessation or reduction of use of other tobacco or non-pharmaceutical nicotine products is urgently needed.” 

Nonetheless, the findings are a milestone for those advocating harm reduction. This is one of the first instances in which pouches – which are an increasingly popular way to consume nicotine – have been evaluated in a rigorous, systematic way alongside traditional cessation tools such as nicotine gum or patches. 

“We welcome that Cochrane is taking nicotine pouches seriously as a possible solution for smokers who want to quit,” says Patrik Strömer, Secretary General of the Association of Swedish Snus Manufacturers.  

“Too often, these products are dismissed outright or lumped in with cigarettes — despite their radically different risk profiles.” 

Lack of Swedish data ‘regrettable’  

Interestingly, Sweden – the European leader in low smoking rates and high use of snus and nicotine pouches – was not represented in any of the studies. Considering Sweden’s success in using alternative nicotine products to drive smoking rates to record lows, the absence of Swedish data is regrettable, says Strömer. 

“It’s harder to measure how nicotine pouches have contributed to reducing smoking in Sweden, as opposed to traditional snus, which already has a strong evidence base,” he explains. 

“Hopefully, more researchers will focus on the impact of pouches in the future. I would expect the results of the next Cochrane review will look different.” 

Industry-funded data and Swedish public health statistics suggest that pouches are more effective than nicotine replacement therapies (NRTs) such as gums and patches — especially when it comes to long-term success. 

“We know from industry research that NRT performs worse than snus,” says Strömer.  

“Many who use NRT eventually relapse into smoking. That’s why it’s encouraging to see more robust knowledge-building around nicotine pouches, especially given how much junk science and outright denial have dominated the discussion until now.” 

A gateway out, not in 

Another Cochrane review looking specifically at e-cigarettes – another less-harmful alternative to cigarettes – concludes that they can serve as a viable smoking cessation aid. 

“Nicotine e-cigarettes can help people to stop smoking for at least six months,” the report reads.  

“Evidence shows they work better than nicotine replacement therapy, and probably better than e-cigarettes without nicotine.” 

The timing of the Cochrane reviews examining alternative nicotine products is also significant. Critics often claim that these less-harmful products act as a gateway to smoking. 

But these latest reviews find no such evidence. In fact, it hints that pouches and vapes may do just the opposite: help smokers transition away from more harmful forms of tobacco. 

Sweden’s experience backs this up. With the lowest smoking prevalence in the EU and a growing number of users of nicotine pouches, the country shows that these products can be a tool for good, not a threat to public health. 

The road ahead 

While Cochrane’s conclusions are cautious — rightly so, given the limited data — the review opens the door for further investigation. And for a public health community often slow to acknowledge harm reduction strategies, this marks important progress. 

“We need more studies, especially from countries like Sweden where pouches are widely used,” Strömer concludes.  

“But what’s clear is that serious research is finally catching up to what consumers already know: that pouches can be part of the solution.”