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Nicotine pouches entered the US market in 2014 and estimated global sales have increased from 292 million units in 2018 to 6.8 billion units in 20211 and 20.2 billion units in 2023.2 Most sales (85%) are within the USA,3 and one brand (Zyn) has over 70% of the global nicotine pouch market4; however, multiple brands are increasingly available in other countries. Several market developments have been identified including the use of different market channels, such as direct mail and Tik Tok,5 6 and variations in nicotine strength, including products with very high levels of nicotine (up to 97.5 mg per pouch).7