Assessment of biomarkers of exposure and potential harm, and physiological and subjective health measures in exclusive users of nicotine pouches and current, former and never smokers

Introduction:
This article reports the results of a cross-sectional study that aimed to assess and compare biomarkers of exposure and potential harm, as well as physiological and subjective health measures, in exclusive users of nicotine pouches (NPs) and current, former, and never smokers. The study is designed to provide information on the potential health risks associated with using NPs compared to smoking.

Key Points:

* The study included 97 exclusive users of Velo NPs, 30 current smokers, 29 former smokers, and 39 never smokers.
* The primary endpoints included biomarkers of potential harm (BoPHs) linked to smoking-related diseases or their initiating biological processes, and biomarkers of exposure (BoEs) to tobacco/tobacco smoke toxicants.
* The study found that total NNAL, white blood cell count, and COHb were significantly lower in Velo users compared to smokers (91%, 19%, and 46%, respectively).
* Fractional exhaled NO, which has been shown to be lower in smokers, was significantly higher in Velo users (107% higher).
* Several secondary endpoints, including six BoEs, were significantly lower in Velo users (78.8% to 97.2% lower).
* Total nicotine equivalents were significantly higher in Velo users (22.6 ± 12.69 vs 12.1 ± 7.92 mg/24 h, P < 0.0001), but Velo user levels are comparable to those previously reported among oral tobacco users.
* The study provides evidence that exclusive users of Velo NPs have significantly less exposure to tobacco toxicants and more favorable BoPHs associated with initiating biological processes of smoking-related diseases compared to smokers.

Main Message:
The study suggests that exclusive use of Velo NPs may be a less harmful alternative to smoking, as it is associated with significantly less exposure to tobacco toxicants and more favorable BoPHs. However, further research is needed to fully understand the long-term health effects of using NPs. The results of this study can inform regulatory decisions regarding NPs and their role in tobacco harm reduction strategies.

Azzopardi, D., Haswell, L. E., Frosina, J., McEwan, M., Gale, N., Thissen, J., Meichanetzidis, F., & Hardie, G. (2023). Assessment of biomarkers of exposure and potential harm, and physiological and subjective health measures in exclusive users of nicotine pouches and current, former and never smokers. Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals, 28(1), 118–129. https://doi.org/10.1080/1354750X.2022.2148747