NNN is produced by the nitrosation of nornicotine during the curing, aging, processing, and smoking of tobacco.

[citation needed] NNN is metabolized by cytochrome P450, which adds a hydroxy group to either the 2' or 5' carbon on the 5-membered ring.

[7] From there, Nornicotine undergoes nitrosation (the conversion of organic compounds into nitroso derivatives by gaining a nitrosonium (N=O) group) on that same nitrogen, converting it to NNN.

[10] Symptoms of NNN are similar to those of nicotine poisoning and include irritation at the point of absorption (for example, the gums when dipping tobacco is used), nausea and vomiting, sleep disturbances, headache, and chest pain.

The FDA has put limits of nitrosamines in other consumable products (such as cured meats) at levels below 10 parts per billion (ppb).