Cigarettes are by far the most harmful way to consume nicotine, according to Dr Rayyan Zafar, a neuropsychopharmacologist at Imperial College and senior researcher at Drug Science. He told Metro that 'cigarettes, by a very large margin' cause the most damage, primarily because of combustion.
Why cigarettes are the most harmful
When tobacco burns, it produces carbon monoxide, fine particles and thousands of chemicals, including numerous carcinogens. Smoking is linked to lung cancer and cancers of the mouth, throat, larynx, oesophagus, pancreas, bladder and kidney. It also dramatically increases the risk of coronary heart disease, heart attack, stroke and peripheral vascular disease, and is a major cause of chronic obstructive pulmonary disease (COPD), chronic bronchitis and emphysema.
Dr Zafar says the majority of these issues 'are caused by inhaling the toxic chemicals produced when tobacco burns, rather than by nicotine itself.' He adds: 'There is no safe level of cigarette smoking. Even smoking relatively few cigarettes can cause disproportionate cardiovascular harm.'
Vaping and nicotine pouches
Vaping is not harmless, but because vapes don't burn tobacco, users are exposed to 'substantially lower concentrations' of many harmful chemicals. However, vapour may contain fine particles, metals, aldehydes and flavouring-related chemicals that irritate airways, causing coughing, dry mouth, sore throat, headaches and nausea. Nicotine can temporarily raise heart rate and blood pressure, and high-strength vapes can create significant dependence.
Tobacco-free nicotine pouches 'may be the least harmful' of the three, says Dr Zafar, as there's no carbon monoxide or combustion. But research on long-term use is limited. Side effects include gum irritation, dry mouth, ulcers, white lesions, nausea, hiccups, headaches and increased heart rate or blood pressure. There's also a risk of nicotine poisoning if swallowed, and dependence potential similar to cigarettes.
Dr Zafar warns: 'Nicotine pouches should not be used by children, pregnant people or adults who do not already use nicotine. I am particularly concerned about marketing which encourages users to start low… this needs to be urgently looked at.'
The ranking and verdict
From least to most harmful, Dr Zafar's broad ranking is: no nicotine use or licensed nicotine-replacement therapy, tobacco-free nicotine pouches or regulated vapes, snus (tobacco-containing pouches), and cigarettes. The precise order in the middle is uncertain and depends on the product, dose and pattern of use.
'For a smoker who switches completely to a regulated vape or tobacco-free pouch, this is likely to represent a substantial reduction in harm. For a child or an adult who has never smoked, starting to vape or use pouches provides no health benefit and introduces a risk of dependence,' he says. 'Dual use is another important issue. Somebody who vapes or uses pouches but continues to smoke may retain much more smoking-related risk than they realise. The greatest health benefit comes from switching completely.'
Essentially, 'being free from both tobacco and nicotine carries the lowest risk.' If you already smoke cigarettes, moving entirely to either non-combustible product is vastly better for you.
