The FDA Keeps Clearing Nicotine Pouches. The Writer Who Quit One Cold Turkey Saw Searchlights.

The writer Rosecrans Baldwin had been tucking a Zyn pouch under his lip, all day, every day, for more than a year. One 15-pouch can per day. Then he stopped, all at once, and a few hours later, in his own words in GQ, he was haunted by “yellow-tinted hallucinations, sweeping in and out of my mind like searchlights.” He had a panic attack. He said he was “afraid I’d lost my mind.” Dizziness, headaches, soaking sweats, a racing heart, a clenched jaw.

A nicotine pouch is not a safer cigarette for someone who has never smoked. For that person it is a first addiction, with a mint flavor.

That sentence is the argument of this spotlight, and it is a different argument from the one the federal government is currently making. On August 4 the FDA authorized four more “on!” pouches (Rich Berry, Cappuccino and Autumn Spice), bringing the total it has cleared to 30, through a pilot program built to make reviews faster. The agency’s logic is a real one: the pouches carry lower levels of most harmful chemicals than smokeless tobacco, and an adult smoker who switches completely may cut their exposure. The FDA’s own wording also says that “dual use does not provide the same degree of health risk reduction.” Both things can be true. The harm-reduction case is written for a 45-year-old with a pack-a-day habit. The product is being sold, in cappuccino, to everyone else.

What the dependence actually feels like

Strip out the pharmacology and here is what happened to Baldwin. Nicotine hits the brain’s reward system within seconds and trains it to expect a drip, all day long. A pouch is built for that: it sits in the mouth and releases nicotine continuously, so there is no natural end point the way a cigarette ends. Baldwin described the result as a dependence he “fed unwittingly, with a sachet secreting nicotine into every waking moment for more than a year.” The word that matters there is unwittingly. Nobody who is handed a pouch at a party thinks of themselves as someone starting a daily medication they will not be able to skip.

When the drip stops, the brain doesn’t politely adjust. It protests, loudly, in the body and in the mind: sweating, a pounding heart, irritability, a sense of dread that has no object. If you have ever tried to quit a pouch or a vape and felt panic you couldn’t explain, that was not weakness and it was not in your head. It was your nervous system asking for the thing it had been trained to expect every few minutes. Baldwin’s second attempt worked because he tapered gradually over several months instead of stopping overnight.

Baldwin is one writer, and one account. It is a single published case, not a measure of how common hallucinations are. What it gives you is a face for the numbers. About 460,000 middle and high school students used nicotine pouches last year, making them the second most common tobacco product among young people behind e-cigarettes, and monthly sales rose 250% between January 2023 and August 2025, CBS News reported in August. And 85.6% of young people who use pouches choose flavored ones, according to figures the American Lung Association cites.

We have seen this order of operations

An adult harm-reduction story gets a flavored nicotine product onto shelves, and teenagers get the product. That is the pattern the American Lung Association is pointing at when it warns that the FDA’s spring authorization of four flavored e-cigarettes, fruit flavors among them, risks another youth vaping epidemic like the 2017 to 2019 surge when Juul’s mango flavor was everywhere. Remember how that one went. Mango pods circulated in school bathrooms and parking lots long before anyone had counted them. A whole age cohort learned nicotine dependence from a device small enough to hide in a fist. Regulators then spent years pulling flavors back, product by product, from kids who were already dependent. Harold Wimmer, the Lung Association’s CEO, condemned the decision on exactly those grounds. The pattern is the same one we keep running in this field: authorize first, count the teenagers later, and treat the withdrawal as a personal failing.

Regulators then spent years pulling flavors back, product by product, from kids who were already dependent.

Dr. Brian King told CBS that pouches create “a profound risk for a nicotine-naive person to get dependent and addicted.” Dr. Purnima Kumar of the University of Michigan was careful where others are not: “Just because we don’t have evidence at this point doesn’t mean that there’s no harm.” Both sentences are about the same gap, and the gap is time. The long-term data on pouches in people who never smoked do not exist yet, because the people who never smoked are 19.

The part nobody screens for

Here is the part that matters most for the people reading this who are in recovery, or work next to recovery. Nicotine is the one dependence that too often never makes it onto the intake form, and the young people who say they would welcome help are not hard to find. A University of Michigan survey of 622 respondents aged 14 to 24 (average age 20) found that 60% felt negatively about Zyn and similar products, and most thought doctors should ask about use and offer help quitting. The people who use pouches are, in large part, asking to be asked.

There is a medical answer once somebody asks. A CNS Drugs umbrella review published in August, covering 371 trials, found varenicline produced quit rates 2.32 times those on placebo across 41 trials and 17,395 people, against 1.55 times for nicotine replacement across 133 trials and 64,640 people. That is a stronger effect for varenicline, with the usual limits of an umbrella review: different trials measured quitting differently, and most were done in smokers, not pouch users, so how well the numbers carry over to pouches is not yet established.

If you work in a clinic, a recovery program or a school-based service, here is a concrete move for this week: add one line to your intake form that asks about pouches, vapes and any other nicotine alongside alcohol and other drugs, and name the person on your team who can start a conversation about varenicline or nicotine replacement the same day. If a patient wants to stop, tell them what Baldwin learned the hard way: a slow taper is a legitimate plan, and the panic they feel on day two is the product, not their character.

If you are the one holding the can, you are not behind and you are not alone. The first thing to do is not to throw it out in a rage and white-knuckle it. Talk to a doctor or a pharmacist about a taper or a medication, and call 1-800-QUIT-NOW if you want a free coach. That is still yours, tonight.

The FDA is clearing pouches faster than the field is learning how to help people stop them. Until somebody asks the 19-year-old the question at intake, the searchlights are going to keep sweeping through someone’s head at 2 a.m., and they are going to think it is only them.