Nicotine Is in Unchartered Territory

The Atlantic

5 days ago

For the better part of the past century, the case against nicotine was simple: Smoking a cigarette might feel nice, but it will eventually kill you. Nearly one in five deaths in the United States is caused by complications from cigarette smoke. Chewing tobacco is less dangerous, but still deadly: It has long been associated with head and neck cancers.
But in 2025, nicotine isn't so straightforward. Smoking is so deadly not because of nicotine, per se, but because of tobacco: Lighting a cigarette burns tobacco, releasing nicotine into the body. Chewing tobacco entails gnawing on actual tobacco leaves. Nowadays, it's easier than ever to get a nicotine buzz without any tobacco at all: Just puff on a vape or pop a tiny nicotine pouch between your teeth and upper lip. These cigarette alternatives have been around for a while, but only recently have they gone fully mainstream. In January, the FDA officially sanctioned the sale of Zyn, among the most recognizable nicotine-pouch brands. In the past three months alone, Philip Morris International, which makes Zyn, shipped 190 million cans of the stuff to stores. And last month, the agency reversed a prior ruling and authorized Juul e-cigarettes. These products, the FDA has concluded, 'generally have lower health risks than cigarettes.'
In this nicotine boom, it's easy to see the drug as harmless, even good for you. Ads that tout the benefits of nicotine are everywhere: Zyn, for example, has been marketed as an 'office essential' that also offers 'relaxation on-the-go.' Nicotine somehow feels both energizing and relaxing at the same time, kind of like the buzz of a vodka Red Bull. The drug has been linked to statistically significant improvements in a number of cognitive exercises. The marketing goes further: Joe Rogan has hawked Athletic Nicotine, a nicotine-pouch brand that claims the drug can serve as an 'exercise performance-enhancing tool.' Tucker Carlson—who has his own brand of nicotine pouches—recently claimed that because of nicotine, he is 'never sick.'
But nicotine is not a wonder drug. The cognitive improvements found in studies were modest. Bethea AnnaLouise Kleykamp, an assistant professor of psychiatry at the University of Maryland who has studied nicotine, summed it up this way: The drug 'might be, if you were to subtract it from the smoke, something that could help some people,' such as those who are sleep-deprived or have a cognitive disorder like ADHD. Not exactly a ringing endorsement. Moreover, there's still a lot we don't know about what nicotine alone does to the body.
All of this has nicotine in a strange place. Before the advent of newer products, the field of public health was united in its stance that no one should be using cigarettes, and thus nicotine. Now the message is more muddled than ever.
Some public-health experts still suggest staying away from nicotine in and of itself. After the decades-long war against smoking, they see new products as Big Tobacco's latest gambit to hook the public. Others make a different calculation: If the health effects of nicotine alone are less concerning than those of cigarettes, what's so bad about an adult sucking on a Zyn? Presuming people recognize that these products 'may have some health risks,' Neal Benowitz, an emeritus professor of medicine at UC San Francisco, told me, 'I have no problem with that.'
Such differing views stem from the unclear health effects of cigarette alternatives. Consuming nicotine via vape or pouch is surely safer than smoking a cigarette, but that isn't saying much. No researchers I spoke with gave nicotine an unequivocal endorsement. 'I would never go so far as to say that any drug is completely safe,' Jed Rose, an emeritus professor of psychiatry at Duke University who runs a research firm that has done paid research for nicotine companies, told me. 'Whether nicotine contributes in any way to other diseases associated with smoking is not as firmly resolved as people like to think.'
Rose cited a study that showed nicotine accelerated tumor growth in mice. Other experts I spoke with cited data from Sweden demonstrating that smokeless products carry some cardiovascular risks. And emerging research indicates that the components inside of vapes can leach heavy metals into the mist that users inhale, potentially exposing them to increased cancer risk. For the most part, science simply hasn't answered the question of how bad nicotine alone is for you. Most of the studies on the bodily effects of nicotine have been completed using subjects who smoke.
For now, the clearest problem with puffing on a Juul is that nicotine remains extremely addictive, whatever form it comes in. Addiction researchers have said that nicotine is just as difficult to quit as heroin. Smokeless products might be a little easier to quit than cigarettes, based on how they deliver nicotine. But it's reasonable to assume that these new products will also worsen the problem of nicotine addiction by making the drug easier to consume. Desk workers can pop nicotine pouches without having to step away for a smoke break. Vape clouds are more readily concealed than the stench of cigarette smoke. This is part of the appeal: Rogue, a Zyn competitor, advertises its product as a way to 'enjoy the nicotine you love without getting noticed, whether you're in a marathon of meetings, perfecting your meal-prep, or just can't step away for a smoke break.' (Rogue, like other nicotine brands, has to legally include warnings in its ads that its products are addictive.)
The effects of an addiction alone are not typically a first-order concern in the world of public health. Addictions typically come with other, more pressing consequences: For cigarettes, it's heart attacks and cancer; for heroin, it's overdoses. Anyone who has seen photos of smokers hooked to oxygen or revealing their lung-cancer scars can attest that public health has become expert in warning potential victims of these types of health problems. The risks of a nicotine addiction without the smoke are murkier. 'There are interpersonal, intrapersonal, and economic consequences to being addicted,' Eric Donny, a neuroscience professor at Wake Forest University who studies nicotine, told me. 'It's really hard to quantify this in a way that we are used to.'
Nicotine boosters have compared the drug to caffeine—which is also addictive, but generally not a problem. (Hence the Death Before Decaf shirts, tote bags, and even tattoos.) But research suggests that nicotine addiction is more intense than a caffeine dependency, potentially taking a bigger toll on people's lives. The financial costs alone can be onerous: Nicotine prices vary a lot from state to state, but in Washington, D.C., where I live, someone with an extreme Zyn habit may be shelling out upwards of $10 a day to feed their addiction. A Juul isn't much cheaper. With either product, a heavy user is likely to spend several thousands of dollars a year.
Addiction can also take a psychological toll. Being hooked on nicotine means your brain is always screaming for another hit of the drug. At times, the longing can feel insatiable, and can force people to act in ways that are entirely against their own self-interest. A teen addicted to vaping might take a few puffs in the school bathroom, even if getting caught might mean a suspension. Or a longtime user may continue to pop nicotine pouches after a heart attack, despite research showing that quitting nicotine significantly reduces someone's risk of death.
These downsides might seem minuscule compared with those of cigarettes. A rotting lung is considerably worse than a $10-a-day nicotine habit. But they shouldn't be ignored. If cigarette-smoking rates continue their decades-long drop, it's reasonable to assume that vaping and pouches will become the dominant ways people consume nicotine. New nicotine products might have solved the biggest problem with smoking. Many other, more subtle problems still remain.