New nicotine products:
What insurers need to know
Nicotine replacement therapies (NRTs) are evolving rapidly, with new products entering the market and changing patterns of use among both smokers and non-smokers. In this article, Kate Baldry, Underwriting Research & Systems Developer at the Hannover Re UK Life Branch, explores the UK-specific implications for risk assessment, customer disclosures and testing, and how insurers may need to adapt underwriting practices as nicotine consumption continues to diversify.
Nicotine – what's new?
We’ve noticed 2 new products enter the nicotine replacement therapy (NRT) arena recently. These include:
Nicotine pearls
Nicotine pearls are small tablets which are placed under the tongue.
They dissolve and release nicotine quickly.
Nicotine strips
Nicotine strips, also known as nicotine films, are about the size of a postage stamp.
They dissolve on the tongue or against the cheek.
Both products are available in a range of strengths, as well as different flavours, including mint and tropical fruit. As these products are so new, there’s little detail available on how many people in the UK are using them.
They join the variety of existing nicotine replacement options, including gum, lozenges, pens, patches and pouches. Even nicotine pouches – or snus – are a relative newcomer, but are gaining in popularity, with a UK survey noting that current use among adults is 1.1% and ever use is 6%.
The increase is highest among men aged 18-39, 13.4% of whom have tried, and 3.5% currently use nicotine pouches.[1]
Regulation & market trends
Nicotine pearls, pouches and strips are largely unregulated across many territories. This means that they are not subject to the same advertising rules, retail display restrictions, or age-of-sale regulations that apply to tobacco products and nicotine-containing e-cigarettes. The UK Government’s Tobacco and Vapes Bill, introduced in November 2024, includes proposals to bring nicotine pouches under regulatory control.
In the UK, nicotine gum and lozenges are regulated under the Tobacco and Related Products Regulations 2016, which means they are licensed for quality and safety. They are designed for smoking cessation and tend to release 2-4mg of nicotine.
Nicotine pouches:
A typical pouch product contains between 5 mg - 20 mg of nicotine.
The upper limit of nicotine absorption for pouches in a 2024 study.[2]
Cigarettes:
An average cigarette contains about 12 mg of nicotine.
The upper limit of nicotine absorption for cigarettes (roughly 1-2 mg) in a 2024 study.[2]
Notably, products containing more than 100mg of nicotine per pouch have been found to be on sale.
Some people who smoke tobacco also use e-cigarettes as a quitting aid and may view them as a form of nicotine replacement.
However, an increasing number of individuals who have never smoked are now using e‑cigarettes, vapes, or nicotine pouches recreationally.
Implications for Underwriting
“When new products like this enter the market, it’s an ideal moment to review customer‑facing application forms to ensure they remain comprehensive. We suggest explicitly referencing e‑cigarettes, as their use in the UK is now as widespread as traditional smoking. Including these options helps customers provide accurate information more easily.
It is also best practice to ask about the use of any nicotine‑containing products. Finally, given the rising number of younger people who vape or use nicotine pouches, it may be worth considering additional cotinine testing. Since cotinine is a metabolite of nicotine, these tests should detect use of such products.”
Kate Baldry, Underwriting Research & Systems Developer, Hannover Re UK Life Branch
Are nicotine replacement therapies risky?
Current evidence suggests that nicotine replacement products do not increase cancer or cardiovascular disease risk and are far safer than continued smoking. However, these studies are likely to focus on more established products, such as gum and patches, so very long-term effects remain less certain. It’s possible that these dissolvable oral nicotine products are more potent than chewing nicotine gum, but because these products are so new, the research is not available to draw any conclusions for years. There is growing concern over the damage nicotine pouches do to gums, with some dentists seeing patients with deep gum lesions caused by these products.[3]
Nicotine is an addictive product, and the long-term effects of pearls, films and pouches remain unknown. It’s therefore appropriate that nicotine replacement remains in the all-encompassing “smoking” section, until we have better evidence to broaden the spectrum of categories currently available to tobacco and nicotine users.
Conclusion
As nicotine products continue to evolve, insurers should continue to review question wordings, testing approaches and regulatory developments to ensure underwriting remains aligned with emerging risk patterns, while monitoring new evidence as it becomes available.
Author
Kate Baldry Underwriting Research & Systems Developer
kate.baldry@hannover-re.com
Hannover Re UK Life Branch
References
Header image: Justlight.stock.adobe.com
- Leonie Brose, Laura Bunce, Hazel Cheeseman, Prevalence of Nicotine Pouch Use Among Youth and Adults in Great Britain—Analysis of Cross-Sectional, Nationally Representative Surveys, Nicotine & Tobacco Research, Volume 28, Issue 2, February 2026, Pages 213–222, https://doi.org/10.1093/ntr/ntae295
- Mallock-Ohnesorg, Nadja, Anja Rabenstein, Yannik Stoll, Matthias Gertzen, Björn Rieder, Sebastian Malke, Nadine Burgmann, et al. “Small Pouches, but High Nicotine Doses—Nicotine Delivery and Acute Effects After Use of Tobacco-Free Nicotine Pouches.” Frontiers in Pharmacology 15 (2024): 1392027. https://doi.org/10.3389/fphar.2024.1392027.
Video visual: logoboom.stock.adobe.com
3. M. Jackson, J., Weke, A. & Holliday, R. Nicotine pouches: a review for the dental team. Br Dent J 235, 643–646 (2023). https://doi.org/10.1038/s41415-023-6383-7
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