Snus

:Not to be confused with the dry (inhaled through the nose) form of tobacco, snuff.

label General.]] Snus () is a moist powder tobacco product originated from a variant of dry snuff in the early 19th century in Sweden, consumed by placing it under the lip for extended periods of time. The precursor of snus, the dry form of snuff inhaled through the nose, was introduced in Europe much earlier. Snus is a form of snuff that is used in a manner similar to American dipping tobacco, but typically does not result in the need for spitting. Snus is also unique in that it is steam-pasteurized rather than fire-cured, is not fermented and contains no added sugar. The sale of snus is illegal in the European Union, but due to exemptions, it is still manufactured and consumed primarily in Sweden and Norway. Its popularity is growing in the United States as an alternative to smoking and traditional "chewing" tobacco.

Previously, Swedish snus was available by mail order within the United States, however an increasing number of tobacco retailers have begun to stock popular Swedish snus products. Both R. J. Reynolds Tobacco Company and Philip Morris USA now produce similar products called Camel Snus and Marlboro Snus, respectively. While it's packaged in much the same way (moist tobacco in a small pouch), production methods vary considerably from traditional Scandinavian methods. Snus is sometimes used in Sweden to quit smoking, but it is arguable if this leads to any personal health benefits all in all. Differences in the way the American versions are formulated may also diminish some of the possible benefits.

History

In the 16th century snuff (pulverized tobacco), the precursor of snus (moist snuff), was introduced to France by Jean Nicot, who worked at the court of King Henry II of France. He recommended snuff to Catherine de' Medici as a migraine remedy. As she became a regular user of snuff it became a fashion amongst the court and upper class citizens of France.

This trend of inhaling snuff through the nose also spread to Sweden at the beginning of the 17th century. Later in the 19th century Swedish producers began to manufacture local brands of moist snuff placed under the upper lip which did not require spitting, and became known as snus. As of today, Ettan, registered since 1822, remains the oldest snus still sold.

A wide-spread urban legend holds that snus contains fragments or particles of glass as an aid to absorbing nicotine into the user's blood. However, mucous membranes in the lips obtain the nicotine much like nicotine plasters. The prick or burning sensation in the palate is a result of salt and not glass fragments.

Confusion of snus and snuff

Confusingly, the English word snuff is translated to snus in Swedish and the word snuff is, often incorrectly and outside Sweden, used to refer to both the inhaled form and the placed under the lip form of snus/snuff.

However, snuff intended to be inhaled through the nose is referred to as torrsnus (dry snus) or more correctly as luktsnus (smelling-snus) in Swedish. The moist form of snuff placed under the upper lip is just called snus in Swedish, and the correct word for referring to this form would be snus in English as well.

Moreover, what may add to the confusion is that the word snuff may also refer to dipping tobacco (also known as moist snuff which may confuse even more), which is applied to the lower lip and the gums rather than inhaled or placed under the upper lip. Thus all three forms are different products.

Difference between dip, chew, snuff and snus

Some forms of tobacco consumed in the mouth may be categorized as:

Snus (Scandinavian), a moist Scandinavian form of snuff which is placed under the upper lip which does not result in the need for spitting.

Snus (American), similar to Scandinavian form of snus, but altered by American tobacco companies to satisfy consumer preferences, increase satisfaction (and thus sales) or serve other less clear purposes. The products are marketed as cigarette replacements in scenarios when smoking is prohibited. It produces a very low blood concentration of nicotine, due to smaller portion size, low moisture content, and low pH, which hinders the absorption of nicotine into the bloodstream. The American versions of this product may not eliminate the urge to smoke, and it has been speculated that they are intended to sustain a cigarette smoking habit, while fostering a second tobacco habit simultaneously. The World Health Organization (WHO) acknowledges that Swedish men have the lowest rate of lung cancer in Europe, partly due to the low tobacco smoking rate, but does not argue for substituting snus for smoking, citing that the effects of snus still remain unclear. Around 2005 several reports, partially funded by the snus industry, pointed to the fact that no carcinogenic effects could be attributed to Nordic snus and this resulted in the removal of the warning label that claimed snus could cause cancer. It was replaced with the more neutral label "Can affect your health negatively". Research is still going on but at the moment no conclusive reports have been made regarding the health effects of snus.

Many cardiologists believe that nicotine products ( oral) contribute to the potentiation of sympathetic nerve tone , and aggravate hypertension due to nicotine's adverse effects on cholinergic and dopaminergic neuro-transmission , tachycardia and reflex bradycardia can also occur , trigerring serious arrythmias or even cardiac arrest in sensitive individuals . Further studies are needed in this regard.

The European Union banned the sale of snus in 1992, after a 1985 WHO study concluded that "oral use of snuffs of the types used in North America and western Europe is carcinogenic to humans", but a WHO committee on tobacco has also acknowledged that evidence is inconclusive regarding health consequences for snus consumers.. Only Sweden and EFTA-member Norway are exempt from this ban. A popular movement during the run-up to the 1994 referendum for Sweden's EU membership made exemption from the EU sale ban of snus a condition of the membership treaty.

Recent actions by many European governments to limit the use of cigarettes has led to calls to lift the ban on snus, as it is generally considered to be less harmful than cigarette smoke, both to the user and to others.

Debate among public health researchers

There is some debate among public health researchers over the use of "safer" tobacco or nicotine delivery systems, generally dividing along two lines of thought. Most researchers are currently of the belief that no form of tobacco or nicotine use is safe, and should be minimized among the population. A minority (primarily in the European Union and Canada) believes in "harm reduction," where the belief is generally that, while it should remain a goal to reduce addiction to nicotine in the population as a whole, the reduction of harm to the health of those who choose to use nicotine should override the need to reduce overall nicotine addiction. For example, some research available today shows that snus use reduces or eliminates the risk of cancers that afflict other users of tobacco products such as "chewing tobacco" (the type primarily used in the United States and Canada, created in a process similar to cigarette tobacco) and cigarettes. It is hypothesized that the widespread use of snus by Swedish men (estimated at 30% of Swedish male ex-smokers), displacing tobacco smoking and other varieties of snuff, is responsible for the incidence of tobacco-related mortality in men being significantly lower in Sweden than any other European country; in contrast, since women traditionally are less likely to use snus, their rate of tobacco-related deaths in Sweden can be compared to that of other European countries.

Snus may be less harmful than other tobacco products; according to Kenneth Warner, director of the University of Michigan Tobacco Research Network, :"The Swedish government has studied this stuff to death, and to date, there is no compelling evidence that it has any adverse health consequences. ... Whatever they eventually find out, it is dramatically less dangerous than smoking."

Ongoing discussion and debates among primary scientific researchers of the effects of snus use on life expectancy appears to indicate that there is a significant increase in life expectancy among persons who previously smoked tobacco and switch to snus, depending on the age of the persons who switch, even when it is assumed that 100% of the risk of cardiovascular diseases among smokers transfers to snus users. It is also noted, in the correspondence seen in the previous citation that concerns about the effect of marketing by the tobacco industry, as influenced by the results of these scientific studies, is of primary concern to many researchers in the field, including the risk of emboldening the industry to attempt to increase snus sales among young people and promote dual-use of snus and smoked tobacco, and that the use of medical nicotine, rather than snus, can better target at-risk populations, given better access and pricing.

Opponents of snus sales maintain that, nevertheless, even the low nitrosamine levels in snus cannot be completely risk free, but snus proponents point out that inasmuch as snus is used as a substitute for smoking or a means to quit smoking, the net overall effect is positive, similar to the effect of nicotine patches, for instance.

In addition, this eliminates any exposure to second-hand smoke, further reducing possible harm to other non-tobacco users. This is seen by public health advocates who believe in "harm reduction" as a reason for recommending snus as well as other nicotine replacement therapies rather than continued use of cancer-causing nicotine delivery systems. It still contains arsenic, cadmium and lead though.

This does not, however, eliminate any harm to health caused by the nicotine itself. Current research focuses on possible long-term side effects on blood pressure, hypertension and possible risk of pancreatic cancer due to tobacco-specific nitrosamines (TSNAs). TSNAs are the only component of tobacco shown to induce pancreatic cancer in laboratory animals. Nicotine may also exacerbate pancreatic illness, because nicotine stimulates the gastrointestinal tract's production of cholecystokinin, which stimulates pancreatic growth and may be implicated in pancreatic cancer. Thus far the evidence specifically implicating snus in pancreatic cancer is only suggestive. It should also be noted that the probability of developing pancreatic cancer from cigarettes is higher than the suggested chance of developing pancreatic cancer from snus.

The effects of Swedish snus on blood pressure has been studied at Umeå University in a randomly selected population sample of 4,305 Swedish men between 25 and 74 years of age. In the study, published in November 2008, the researchers found no elevation of blood pressure in snus users who had never been smokers compared to non tobacco users. In fact, snus users had lower systolic blood pressure than non tobacco users in the unadjusted data.

Published peer-reviewed studies

Effect of smokeless tobacco (snus) on smoking and public health in Sweden, October, 2003 (full text)

Broadstock M. Systematic review of the health effects of modified smokeless tobacco products, N Zealand Health Technol Assessment Rep, February 2007 (full text)

Cardiovascular diseases

Broadstock M. Systematic review of the health effects of modified smokeless tobacco products, N Zealand Health Technol Assessment Rep, February 2007, p37-56 (full text)

Diabetes

Cancer

Juhua Luo MSc, Weimin Ye MD, Kazem Zendehdel MD, Johanna Adami MD, Prof Hans-Olov Adami MD, Prof Paolo Boffetta MD and Prof Olof Nyrén MD Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study The Lancet, Volume 369, Issue 9578, Pages 2015-2020 (abstract - full text by subscription only)

Smoking cessation

Medical community discussions and reports

Kjell Asplund. Snuffing, Smoking and the risk for heart disease and other vascular diseases. 3rd revised version. ASH Britain; 2002 (full text)

The 3rd (2002) International Conference on Smokeless Tobacco - Daily Media Summaries from the U.S. National Cancer Institute

Discussion of Declining smoking in Sweden: is Swedish Match getting the credit for Swedish tobacco control’s efforts?; Tobacco control (BMJ). 2003.

Some practical points on harm reduction: what to tell your lawmaker and what to tell your brother about Swedish snus, Tobacco Control Online, December, 2003

General media articles

A Smokeless Alternative To Quitting (Unabridged Version), The New York Times, April 6, 2004

Should Snuff Be Used as a Tool To Quit Smoking?, The Wall Street Journal, September 16, 2006; Page A1.

Doctors: Swedish snus cut risk of cancer, Associated Press via USA Today, May 10, 2007

Swedish Smokeless Tobacco Aims at U.S. Market New York Times, October 3, 2007

Doctors call for new nicotine products Reuters (UK) Oct 5, 2007 12:48pm BST

Going Smokeless, 60 Minutes, April 4, 2010 5:00 PM

References

External links

Articles

"Use Of Swedish 'Snus' Is Linked To A Doubled Risk Of Pancreatic Cancer", Science Daily, May 11, 2007

Snus - a safer option for smokers Slate, July 10, 2007

Dr. Gunilla Bolinder talked about snus (video, in Swedish)

The Snus Experience - Lessons from Norway Sweden and Canada on the public health consequences of widespread oral tobacco use (PDF) Physicians for a Smoke-Free Canada, October, 2007 - PSC's response to claims made by Imperial Tobacco Canada that snus is linked to reduction of smoking rates and tobacco-related deaths using statistics from snus and non-snus countries

Non-medical blogs and commentary

Tobacco Truth blog - science and policy information about tobacco harm reduction, by university-based expert

Snubie.com -A complete snus news, reviews, and information site with a compilation of snus related health articles.

SnusAuthority.com -A blog with information and reviews on snus and snuff. Also has articles about health effects, getting started guides, deals, and more.

Snus forum & discussion database, more than 7000 snus related topics

Category:Tobacco