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Natural American Spirit has a 2.4 star rating from 72 reviews, 40% would recommend, and consumers are mostly dissatisfied with many unfavorable reviews

The FDA stated: Following a rigorous science-based review through the premarket tobacco product application (PMTA) pathway, the agency determined that authorizing these products for the US market is appropriate for the protection of the public health because, among several key considerations, the products produce fewer or lower levels of some toxins than combustible cigarettes. However, the agency added: While todays action permits the tobacco products to be sold in the US, it does not mean these products are safe or FDA approved. It falls on harm reductionists to hammer home that HNB products are much safer than cigarettesas the FDA grudgingly acknowledged with its appropriate for the protection of the public health comment

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This usually involves providing a valid government-issued ID at the time of delivery