The Use of Smokeless Nicotine Products in Sports: A Narrative Review of the Performance Effects, Health Risks, and Anti-Doping Implications of Snus and Nicotine Pouches Among Athletes

Abstract The growing popularity of smokeless nicotine products—such as snus and nicotine pouches—among youth and elite athletes raises important health and regulatory concerns. Though promoted as reduced-risk alternatives to combustible tobacco, their use in sport prompts questions about effects on performance, safety, and oversight. This narrative review summarizes current evidence on their biochemical composition, physiological impact, and usage trends in athletic populations. Nicotine appears to affect endurance, hormonal balance, and cognitive performance. Zandonai et al. reported prolonged time to exhaustion after snus use [1], while Bartík et al. observed reduced pain perception without performance gains [2]. Other studies point to impaired thermoregulation [18], cardiovascular stress [23], and long-term risks such as dependence, hormonal disruption, and delayed recovery [12,24–26]. A monitoring study found nicotine metabolites in 15.3% of athlete urine samples [3], indicating notable prevalence. Despite being under World Anti-Doping Agency surveillance since 2012, nicotine is not included on the Prohibited List [4]. Regulations vary: France has banned nicotine pouches, while Sweden permits them [16,17]. Coordinated efforts from sports medicine professionals and anti-doping authorities are needed to develop clearer policies, enhance education, and safeguard athlete health.