Tobacco use remains the single greatest cause of preventable death in the world. Whilst much has been achieved in tobacco control policy, this has been predominantly to tackle the use of cigarettes by adult males whilst tobacco use has changed direction away from cigarettes towards the new forms of tobacco and in women and children. The Gulf Region has witnessed a rapid rise in the use of powdered tobacco, dokha, smoked in small pipes called midwakh. This article discusses the emerging literature to date which warrants concern for the widespread use, health effects and difficulty in regulation of midwakh. The few studies on usage suggest that over a quarter of students in the United Arab Emirates smoke midwakh regularly. There are initial reports of higher nicotine levels and deleterious health effects compared with cigarette use. Most of the regulatory mechanisms in place, such as bans on smoking in public places and the regulation of sales, are not applicable to the sale of dokha. Whilst the WHO Global Monitoring Framework target of a 30% relative reduction in tobacco use by 2025 includes all forms of smoking, the vast majority of the current tools at our disposal, from the scant evidence available, are not fit-for-purpose in tackling non-cigarette tobacco use. Further research and shift in tobacco control policy is needed in the Gulf Region and beyond to tackle the burgeoning use of new forms of tobacco such as midwakh.