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"Do you smoke cigarettes?" I asked my patient during a recent clinic appointment.

As with any patient, I gauged his readiness—or reluctance, in some instances—to change his nicotine use.

I asked about his interest in trying nicotine replacement therapy, a medical treatment that provides low, controlled amounts of nicotine. Initially, his response caught me by surprise.

I gathered my thoughts and explained that while nicotine pouches are indeed a form of nicotine replacement, there are important caveats. Actual nicotine replacement therapy products are regulated by the Food and Drug Administration to help people quit smoking. In contrast, I explained that Zyn and other nicotine pouches are commercial tobacco products that are regulated by the FDA but are not FDA-approved smoking cessation medications.

My patient was surprised because he had not realized there was a difference, which is a common misunderstanding. This encounter proved pivotal in the direction I would take in my subsequent clinical encounters.

As an addiction medicine physician, I often talk with patients who use nicotine in various forms.

Understanding how these products differ and what we know about their relative risks can help people make more informed choices.

One of the most important distinctions I make when I talk to patients is between the harms caused by nicotine itself and the harms caused by the way it is delivered.

Combustible tobacco products such as cigarettes expose users to thousands of chemicals produced by burning tobacco, while newer products such as vapes deliver nicotine without combustion.

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