This scoping review examines the potential public health impact of oral nicotine pouches (ONPs), a new class of nicotine products. Sixty-two studies were included, with 17 funded by industry. Most studies were from the United States, where current ONP use among youth is estimated at 1.5% and lifetime use below 2.5% through 2023. Between 35% and 42% of U.S. adolescents and young adults have heard of ONPs, with 9-21% of tobacco-naïve youth susceptible to trying them. Adult use estimates varied widely, with current use ranging from 0.8% to 3% and lifetime use from 3% to 16%. ONPs contain fewer harmful compounds than cigarettes and smokeless tobacco (SLT), except formaldehyde. Industry-funded studies suggest ONPs may deliver nicotine at levels comparable to or higher than SLT or cigarettes, though with slower nicotine release. Evidence on ONP toxicity relative to SLT is mixed. ONPs are marketed as "tobacco-free" and may encourage youth initiation and dual use in adults. The review highlights the need for independent research, as industry-funded studies may bias findings. ONPs could serve as a less harmful alternative to combustible products, but their public health impact depends on their role in replacing or supplementing more harmful tobacco products. The review also notes that ONPs may attract youth with characteristics similar to those who use SLT. While ONPs show potential for harm reduction, independent studies are needed to confirm their safety and efficacy. The review underscores the importance of regulating ONPs to prevent their misuse and ensure public health. The FDA has not authorized ONPs as a modified-risk or cessation product, and global regulatory frameworks need to be updated to include ONPs, particularly those containing synthetic nicotine. The review concludes that ONPs may have a complex public health impact, requiring careful regulation and further research.This scoping review examines the potential public health impact of oral nicotine pouches (ONPs), a new class of nicotine products. Sixty-two studies were included, with 17 funded by industry. Most studies were from the United States, where current ONP use among youth is estimated at 1.5% and lifetime use below 2.5% through 2023. Between 35% and 42% of U.S. adolescents and young adults have heard of ONPs, with 9-21% of tobacco-naïve youth susceptible to trying them. Adult use estimates varied widely, with current use ranging from 0.8% to 3% and lifetime use from 3% to 16%. ONPs contain fewer harmful compounds than cigarettes and smokeless tobacco (SLT), except formaldehyde. Industry-funded studies suggest ONPs may deliver nicotine at levels comparable to or higher than SLT or cigarettes, though with slower nicotine release. Evidence on ONP toxicity relative to SLT is mixed. ONPs are marketed as "tobacco-free" and may encourage youth initiation and dual use in adults. The review highlights the need for independent research, as industry-funded studies may bias findings. ONPs could serve as a less harmful alternative to combustible products, but their public health impact depends on their role in replacing or supplementing more harmful tobacco products. The review also notes that ONPs may attract youth with characteristics similar to those who use SLT. While ONPs show potential for harm reduction, independent studies are needed to confirm their safety and efficacy. The review underscores the importance of regulating ONPs to prevent their misuse and ensure public health. The FDA has not authorized ONPs as a modified-risk or cessation product, and global regulatory frameworks need to be updated to include ONPs, particularly those containing synthetic nicotine. The review concludes that ONPs may have a complex public health impact, requiring careful regulation and further research.