Sweden's Karolinska Institutet has published a research review stating that nicotine pouches contain high levels of nicotine and their long-term health effects remain largely unknown — a significant statement from one of Europe's top medical universities.

The review, published by the institute's news service and updated January 21, 2025, addresses the rapid growth of "white snus" (nicotine pouches) and e-cigarettes among young people in Sweden since pouches launched there in 2016.

What researchers say about nicotine pouches

Karolinska's Public Health Agency sources describe nicotine as "a toxic and highly addictive substance" — the primary active ingredient extracted from tobacco plants for use in pouches.

The review notes that nicotine levels in pouches "can be much higher than in brown snus" (traditional Swedish snus), though specific concentration data was not provided in the published summary.

One detail stands out: Thomas Ericsson, the Swedish pharmacist who co-invented nicotine pouches, told interviewers that calling the products "tobacco-free" is "completely wrong" and "misleading" — despite nicotine being extracted from tobacco plants.

The knowledge gap

In June 2023, Sweden's Public Health Agency (Folkhälsomyndigheten) delivered a report to the government titled "Knowledge about the harmful effects of tobacco and nicotine products." The agency's conclusion: knowledge about new products like e-cigarettes and nicotine pouches is limited.

The agency's approach while research catches up: assess pouches based on what's already known about their harmful ingredients — primarily nicotine.

The Karolinska review notes that the "tobacco-free snus" label has allowed pouches to escape tobacco product legislation in Sweden, despite containing tobacco-derived nicotine.

Youth adoption in Sweden

While daily smoking in Sweden has dropped to 6% overall (4% among 16-29 year-olds), the review highlights that nicotine pouches have gained traction primarily among young users since 2016. The products are flavored and marketed in ways that attract new user demographics.

Sweden's 16-29 age group shows higher rates of occasional smoking (8% "party smoking") compared to older groups — the same demographic now adopting pouches.

The review was originally published in the medical journal Medicinsk Vetenskap in 2024 and updated on the Karolinska website in January 2025, suggesting ongoing institutional attention to the issue.

What's next: As one of the world's leading medical research institutions, Karolinska's framing of pouches as high-nicotine products with unknown long-term effects could influence European regulatory discussions — particularly as Sweden holds significant sway in Nordic tobacco policy.

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SOURCES:

• Karolinska Institutet News: "Nikotin i ny skepnad – forskningen om vejp och vitt snus" (https://nyheter.ki.se/nikotin-i-ny-skepnad-forskningen-om-vejp-och-vitt-snus)
• Swedish Public Health Agency (Folkhälsomyndigheten): "Kunskap om tobaks- och nikotinprodukters skadeverkningar" (June 2023)