A new study led by ICMR-–National Institute of Cancer Prevention and Research has found that nicotine pouches are reaching Indian cities through online platforms, hookah shops and gig delivery services — available in 445 flavours, at strengths up to 120 mg.

Under Section 18 of the Drugs and Cosmetics Act, 1940, oral nicotine pouches (excluding approved nicotine replacement therapies such as gums, patches, and lozenges) constitute unapproved drugs, with violations under Section 27(b)(ii) of the same Act. The Drug Controller General of India (DCGI) is the designated authority empowered to direct all State Drug Controllers to initiate enforcement action accordingly.

The study `Unmasking nicotine pouches in India;product availability and industry tactics’ surveyed point-of-sale (POS) outlets, online/internet electronic vendors (IEVs) and social media platforms across ten cities including New Delhi, Chandigarh, Ahmedabad, Mumbai, Hyderabad, Bengaluru, Kolkata, Chennai, Guwahati, and the North Goa Beach Belt to map the market presence, consumer demographics, and promotional strategies of nicotine pouches in India. The data factsheet was presented at a recent `National consultation on Countering Nicotine and Tobacco Addiction in India: From Evidence to Action”.

Dr Prashant Singh, senior scientist at ICMR-NICPR and lead author told The Indian Express that nicotine pouches were available in 7 out of 10 cities, with 9% of all point-of-sale outlets found to be selling these products. Sixty eight unique brands were available through online platforms and third-party e-commerce, with 63.2% from international manufacturers — indicating significant cross-border penetration.

“We identified 445 unique flavours, spanning eight categories including mint/menthol, fruit, desserts, and alcohol-themed variants — all designed to attract young consumers. Nicotine content as displayed on product packages ranged from as low as 2 mg to an alarming 120 mg per pouch. Priced between Rs 200 and Rs 1,500 (containing 15–20 pouches each), the hookah/modern retail tobacco shops were the most common offline sales points, while online platforms dominated with 68 unique brands available through direct web sales,” Dr Singh said.

Point of Sale (POS) vendors (46 outlets across 10 cities identified) indicated the consumer profile as being working men aged 18–40 years, and were drawn to these products as a perceived alternative to smoking, citing reasons such as no smoke, no smell, trendiness and peer influence.

Health harms

Prof. (Dr.) Shalini Singh, Director, ICMR-NICPR, also pointed out that tobacco or nicotine, whether in traditional or novel forms, threatens the health and potential of our youth. According to experts, nicotine pouches deliver addictive nicotine directly through the oral mucosa, stimulating dopamine pathways in the brain. “Their documented health harms include cardiovascular risks (increased heart rate and blood pressure, risk of stroke and heart disease, irregular heart rhythm), oral health effects (gum recession, tooth decay, oral potentially malignant disorders), and mental health impacts (depression, anxiety, insomnia),” Dr Singh said adding that the study demands an immediate policy response and enforcement roadmap to curb nicotine pouches.

Children being exposed to nicotine

Tshering D Bhutia, Chief Innovation Officer and Senior VP – Preventive Health at Salaam Bombay Foundation admitted that over the years they have observed many children were routinely exposed to tobacco use not only in public spaces, but also within homes and neighbourhoods.

“Our recent adolescent-led observation study involving 1,632 adolescents was conducted to better understand the extent to which tobacco is visible in children’s everyday environments. Traditional tobacco products such as gutka, masheri, raw tobacco continue to pose a significant challenge as they continue to remain visible in many communities and household settings. Within the schools, we are seeing a significant rise in availability and access to e-cigarettes and vapes among adolescents. These newer nicotine products are often perceived by young people as harmless, fashionable, or less addictive, which is far from the reality. At the same time, the tobacco industry constantly finds newer ways to appeal to young people through surrogate advertising, attractive packaging, flavoured products, digital visibility, and the glamorisation of tobacco and nicotine use. Even where direct advertising is restricted, indirect promotions continue to influence perceptions among adolescents,” Bhutia pointed out.