It is Not Harm Reduction When Children and Youth are Poisoned

Nicotine is a potent toxic alkaloid, and a banned pesticide that stimulates dopamine release. Many adults turn to nicotine pouches believing they are making a safer choice. However, the term harm reduction was never intended to apply to children and youth. When these products leak into the hands of adolescents, the consequences can be severe.

Nicotine poisoning consists of 2 phases:

• Initial stimulatory phase – appears from 15 to 60 minutes after use and includes hypersalivation, vomiting, hypertension and tachycardia
• Depressant phase – lasts 4 to 6 hours and includes bradycardia, hypotension, neuromuscular blockade which results in weakness, hyperventilation, apnea and cardiovascular collapse

These symptoms are severe. For a child, even a single nicotine pouch can trigger the full cascade of poisoning. This is why harm reduction messaging aimed at adults creates dangerous misconceptions when products reach underage users. A teenager who hears “reduced harm” may assume the product is safe for them. It is not.

Nicotine pouches are now the second most frequent tobacco product used by adolescents and children after e-cigarettes. They contain:

• Nicotine (synthetic or extracted from tobacco)
• Plant fibres (to absorb excess saliva produced by the pouch)
• Water
• pH regulators (to increase the rate of absorption of nicotine)
• Flavourings

Although the absorption of nicotine from pouches is slower than smoking, its absorption through the oral cavity avoids the liver and bypasses first-pass metabolism. This results in nicotine entering the bloodstream more directly and remaining in circulation for a longer period of time. The harm reduction promise of slower absorption does not eliminate toxicity – it merely delays the onset of poisoning. A child who does not feel immediate effects may consume multiple pouches, leading to a dangerous overdose.

A 15-year-old boy and a 13-year-old girl were admitted to hospital in 2023 due to nicotine poisoning from pouch use. Both reported using nicotine pouches. Their initial symptoms were rapid heart rate, high blood pressure, dizziness and vomiting. In addition:

• The boy also suffered from vomiting, diarrhoea and tremor
• The girl also suffered from headache and a brief loss of consciousness

Their serum nicotine concentrations at hospital were 134 ng/mL and 266 ng/mL respectively. These are clinically significant levels requiring medical intervention. Both recovered after several hours of supportive therapy. The concept of harm reduction does not account for paediatric poisoning cases like these.

These real-world cases prove that harm reduction rhetoric does not protect adolescents. Without stronger regulation, more children will end up in emergency rooms.

The authors conclude:

“The widespread availability, appealing flavours, and aggressive marketing of these products contribute to the increasing use among adolescents, despite legal restrictions. Strengthening regulatory framework, enforcing age-related sales bans, and implementing targeted educational campaigns are essential to prevent misinterpretation of ‘reduced harm’ claims as ‘risk-free.”

When children are poisoned, the term harm reduction becomes dangerously misleading. Policymakers must act now to close loopholes that allow flavoured nicotine pouches to reach young people.

References

Gketsi, V., Orfanidis, A., Grepi, A., et al, “Acute Nicotine Poisoning From Nicotine Pouch Use in Adolescents: A Case Report of Two Pediatric Cases”, Cureus, 18(2), 7pp. February 16, 2026