Snus

From Safer nicotine wiki

Description

‘Siberia’ Snus

Snus is a tobacco product (pouch) which the user places  in the mouth between the gum and cheek. No combustion is involved. Once in place, the saliva and general moistness of the mouth work to release the nicotine into the system. This process does not require any form of combustion. For other smokeless tobacco products try the SLT page.

Properties

  • It's mostly portioned into convenient pouches (like teabags). These are available in differing portions, from mini, slim, and up to ordinary sizes.
  • Whereas "loose snus" tobacco powder has to be squeezed into spherical/cylindrical shape before use.
  • Not chewed, but usually placed behind the upper lip.
  • It is available in a range of flavours and strengths to suit any palate / nicotine requirement.
  • Produced to a high standard, the processing including pasteurization, results in ultra low levels of nitrosamines and other known carcinogens that occur naturally in tobacco.
  • Common ingredients added are 20-60% water, 1.5-3.5% sodium chloride, 1.5- 3.5% humectants, 1.2-3.5% sodium bicarbonate, and less than 1% flavours.
  • Can be used for 20-60 min usually, or as long as it still emits flavours or until it liquifies too much.
  • Often available for around 5 euro for a tin of 20 (sizing varies).
  • Lower nicotine likely implies lower dependency profile than cigarettes, because of slower nicotine absorption (akin to gums).
  • Should be stored in the fridge, if infrequently used.

Potential benefits of Snus

  • Snus is considered by scientists to be 95%, and possibly closer to 99%, less risky than smoking
  • Snus poses no respiratory risk. Respiratory diseases, predominantly lung cancer, chronic obstructive pulmonary disease
  • Low risk oral nicotine product.
  • Highly effective way of quitting cigarettes.
  • Eliminates second-hand smoke.
  • Snus poses no risk to others, such as work colleagues and family members as there is no combustion and consequently no ‘second hand’ smoke and no risk of fire.

Potential risks of Snus

  • Snus may cause irritation of the oral mucosa and a stinging/tingling sensation, however 'Sting free Snus' is one approach to help solve this. The other is to place the pouches in different locations each time. Note there is no link to disease or cancer, merely discomfort at worst.

Is snus an appropriate and acceptable harm reduction product?

Snus fulfils the criteria for a tobacco harm reduction product. It is a low risk nicotine product and delivers acceptable doses to those who use it. In countries in which it is allowed it is popular and has contributed to declines in smoking and smoking related diseases.

The human cost of the ban on snus

Using data on tobacco-related mortality across the EU, and applying the Swedish mortality data to other EU countries, it has been calculated that among men over the age of 30, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate.

Legal Status

Africa

Snus may be banned in some locations, legal in others. It's use is not common, other more harmful oral tobacco is used more often.

Europe

Illegal to sell in the EU (excluding Sweden), but purchase and use is not illegal (unclear if just due to tobacco industry track record, general opposition to proliferation of further tobacco products, preempting regulation for geographically restrained appeal, or even pharma influence).

Sweden

Snus is legally on the market only in Sweden. The minimum age to purchase is 18 years of age.

UK

Illegal in the UK, but calls have been made by Appgvaping to legalise it's sale. Snus is reasonably easy to obtain in the UK, from sources on social media, and can be ordered online. Little to no enforcement appears to be carried out to block it's transit through customs, or to stop it's use.

North America

The US FDA has authorized the marketing of products through the modified risk tobacco product (MRTP) pathway. The authorizations are for eight Swedish Match USA, Inc. snus smokeless tobacco products sold under the “General” brand name.

FDA authorizes the manufacturer to market these specific products with the claim “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.”

The FDA’s review determined that the claim proposed by the company in its application is supported by scientific evidence, that consumers understand the claim and appropriately perceive the relative risk of these products compared to cigarettes, and that the modified risk products, as actually used by consumers, will significantly reduce harm and the risk of tobacco-related disease to individual tobacco users and benefit the health of the population as a whole.

Related Information

Snus and Stopping/Displacing Smoking

The most popular source  of Nicotine consumed globally is still combustion cigarettes. Cigarettes make up 92% of all tobacco and nicotine products sold.

Smoke from combustion cigarettes  up of over thousands of chemicals, including at least 70 known to cause cancer. These cancer-causing chemicals are referred to as carcinogens.

Safer Nicotine  Products  like Snus make tobacco  use safer by eliminating  all these carcinogens and only  delivering  Nicotine  without  necessary  the process  of combustion.

Some of the carcinogens Snus eliminates include Hydrogen cyanide, Formaldehyde, Lead, Arsenic, Ammonia, Radioactive elements,Benzene, Carbon monoxide, Tobacco-specific nitrosamines (TSNAs), Polycyclic aromatic hydrocarbons (PAHs) among  others.

Studies general information

2022: The effect of a non-tobacco-based nicotine pouch on mucosal lesions caused by Swedish smokeless tobacco (snus) (Sara Alizadehgharib, Anna Lehrkinder, Ali Alshabeeb, Anna-Karin Östberg, Peter Lingström)

"Oral mucosal lesions are commonly found in Swedish smokeless tobacco (snus) users where the pouch is placed. These lesions are reversible, that is, clinical and histological tissue changes return to normal following cessation."

"The main aim of this study was to investigate how the oral mucosa was affected if users substituted their regular Swedish snus with non-tobacco-based nicotine products (investigational products)."

"Because of these circumstances, the extent to which the use of the investigational non-tobacco-based nicotine pouch may cause mucosal lesions similar to those produced by regular, tobacco-based snus is unclear. "

2022: Swedish snuff (snus) dipping, cigarette smoking, and risk of peripheral artery disease: a prospective cohort study (Shuai Yuan, Olga E Titova, Scott M Damrauer, Agneta Åkesson, Susanna C Larsson)

"Cigarette smoking but not Swedish snus dipping was associated with an increased risk of PAD (peripheral artery disease)."

2021: No association between moist oral snuff (snus) use and oral cancer: pooled analysis of nine prospective observational studies

  • We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer.
  • Snus use was not associated with oral cancer among never smokers
  • During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer
  • There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (⩽ 4 cans/week) was associated with a reduced risk

2019: Snus: a compelling harm reduction alternative to cigarettes (E Clarke / K Thompson / S Weaver / J Thompson / G O’Connell)

  • "The available scientific data, including long-term population studies conducted by independent bodies, demonstrates that the health risks associated with snus are considerably lower than those associated with cigarette smoking."

2016: Moist smokeless tobacco (Snus) use and risk of Parkinson’s disease (Fei Yang, Nancy L Pedersen, Weimin Ye, Zhiwei Liu, Margareta Norberg, Lars Forsgren, Ylva Trolle Lagerros, Rino Bellocco, Lars Alfredsson, Anders Knutsson)

  • "Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users"

2015: Time to First Use Among Daily Smokers and Smokeless Tobacco Users (B Rodu / N Plurphanswat / K Fagerström)

  • "[…] offering some support for the Fagerström-Eissenberg hypothesis that the dependence level of cigarettes is higher than that of ST." (certainly applies to Snus as well)

2013: Patterns of dual use of snus and cigarettes in a mature snus market (K E Lund / A McNeill), n=3524

  • Dual use is relatively small. Large percentage of users have stopped smoking, or are planning to by using snus. […]

2012: Contrasting snus and NRT as methods to quit smoking. an observational study (J Scheffels / K E Lund / A McNeill)

  • "Norwegian men frequently use snus as a method for quitting smoking whereas women are more likely to use NRT. The findings indicate that switching to snus can be an effective method for quitting smoking

2003: Effect of smokeless tobacco (snus) on smoking and public health in Sweden (J Foulds / L Ramstrom / M Burke / K Fagerström)

  • "Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence."

Studies Norway

* Snus for a long time has been the most preferred method for quitting smoking among successful quitters (see figure 2) in this report:

2022: hadde halvparten av den voksne befolkningen aldri røykt mens den andre halvparten utgjøres av nåværende og tidligere røykere. Litt over halvparten av nåværende og forhenværende røykere har brukt en eller annen form for hjelpemidler ved det siste sluttforsøket.  Google machine translation in english

  • Those who have never smoked make up an equal proportion of the population as those who smoke or have smoked in the past.
  • About half of daily smokers want to quit smoking
  • One in four daily smokers has tried to quit in the past 12 months
  • Snus use is a more common method of quitting smoking than using nicotine replacement products

* Former smokers make up a large segment among snus users

Lund KE, Vedøy TF, Bauld L. Do never smokers make up an increasing share of snus users as cigarette smoking declines? Changes in smoking status among male snus users in Norway 2003-15. Addiction. 2017 Feb;112(2):340-348. doi: 10.1111/add.13638. Epub 2016 Dec 5. PMID: 27741374; PMCID: PMC5248595.

  • Among men who reported life-time experience with both products, a large majority had initiated their tobacco use with cigarettes.
  • The average number of cigarettes smoked weekly was lower among dual users compared with current smokers who were former snus users or had never used snus.
  • During the period 2003–15 in Norway, which has a mature snus market, even though smoking has declined and the relative size of the category of never-smokers among male users of snus has increased, the majority of snus users are still former or current smokers.

Kvaavik E, Lund I, Nygård M, Hansen BT. Lifestyle Correlates of Female Snus Use and Smoking: A Large Population-Based Survey of Women in Norway. Nicotine Tob Res. 2016 Apr;18(4):431-6. doi: 10.1093/ntr/ntv126. Epub 2015 Jun 11. PMID: 26069033.

  • While most snus users among older women were former or current smokers, this was not the case among younger women.
  • The correlates of female snus use and smoking were not identical, and were similar to those previously documented for men.
  • Female snus use was positively associated with intermediate education, alcohol consumption, number of sexual partners, and hard physical activity.
  • Smoking was also positively associated with alcohol consumption and number of sexual partners, but negatively associated with physical activity and education.

Lund KE, McNeill A. Patterns of dual use of snus and cigarettes in a mature snus market. Nicotine Tob Res. 2013 Mar;15(3):678-84. doi: 10.1093/ntr/nts185. Epub 2012 Sep 18. PMID: 22990221; PMCID: PMC3572872.

  • In the mature snus market of Norway, the magnitude of dual use of cigarettes and snus is relatively small.
  • Dual users consume fewer cigarettes, and a higher proportion portray themselves as smoke-free in the future than do exclusive cigarette smokers.

* The quit ratio for cigarette smoking is higher among snus users than non-users

Lund KE, Scheffels J, McNeill A. The association between use of snus and quit rates for smoking: results from seven Norwegian cross-sectional studies. Addiction. 2011 Jan;106(1):162-7. doi: 10.1111/j.1360-0443.2010.03122.x. Epub 2010 Sep 30. PMID: 20883459; PMCID:

Scheffels J, Lund KE, McNeill A. Contrasting snus and NRT as methods to quit smoking. an observational study. Harm Reduct J. 2012 Feb 29;9:10. doi: 10.1186/1477-7517-9-10. PMID: 22376006; PMCID: PMC3311082.

Lund KE, Vedøy TF, Bauld L. Do never smokers make up an increasing share of snus users as cigarette smoking declines? Changes in smoking status among male snus users in Norway 2003-15. Addiction. 2017 Feb;112(2):340-348. doi: 10.1111/add.13638. Epub 2016 Dec 5. PMID: 27741374; PMCID: PMC5248595.

Lund I, Lund KE. How has the availability of snus influenced cigarette smoking in Norway? Int J Environ Res Public Health. 2014 Nov 13;11(11):11705-17. doi: 10.3390/ijerph111111705. PMID: 25402565; PMCID: PMC4245639.

* Dual users of snus and cigarettes consume fewer cigarettes, and a higher proportion portray themselves as smoke-free in the future than do exclusive cigarette smokers.

Lund KE, McNeill A. Patterns of dual use of snus and cigarettes in a mature snus market. Nicotine Tob Res. 2013 Mar;15(3):678-84. doi: 10.1093/ntr/nts185. Epub 2012 Sep 18. PMID: 22990221; PMCID: PMC3572872.

* Snus is associated with higher likelihood in of quitting smoking within the first 5 years after snus initiation

Lund I, Christiansen SG. Association between snus use over time and smoking cessation in Norwegian smokers. Addiction. 2020 Jan;115(1):170-174. doi: 10.1111/add.14809. Epub 2019 Oct 23. PMID: 31502348.

* Snus is used as a quitting method by smokers who do not want to use NRTs

Lund KE, McNeill A, Scheffels J. The use of snus for quitting smoking compared with medicinal products. Nicotine Tob Res. 2010 Aug;12(8):817-22. doi: 10.1093/ntr/ntq105. Epub 2010 Jul 9. PMID: 20622023; PMCID: PMC2910876.

* Among current snus users who had quit smoking, 83% reported that snus was used in their final quit attempt

Lund KE, Vedøy TF, Bauld L. Do never smokers make up an increasing share of snus users as cigarette smoking declines? Changes in smoking status among male snus users in Norway 2003-15. Addiction. 2017 Feb;112(2):340-348. doi: 10.1111/add.13638. Epub 2016 Dec 5. PMID: 27741374; PMCID: PMC5248595.

* Snus use was found to be a “stand-alone” cessation aid, and only weakly associated with the use of other cessation aids.

Lund M, Lund I. Smoking cessation aids and strategies: a population-based survey of former and current smokers in Norway. BMC Public Health. 2022 Mar 31;22(1):631. doi: 10.1186/s12889-022-13032-z. PMID: 35361172; PMCID: PMC8973793.

Other references

Suggestions to Add to This Page

2021: Smoking and snus use among Norwegian students: Demographic, personality and substance use characteristics

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