Swedish Snus and Tobacco Harm Reduction. 27 July 2014.

I recently returned to college, and one of my first classes was a Composition class. If you've been reading this blog long, you know how much I love to write about snus. After 5 years of writing, it surprises me that I've never actually written a full Tobacco Harm Reduction article for this website. In my class, I was assigned a research paper, which I wrote on Swedish Snus and Tobacco Harm Reduction.  After class was over, I felt like it was something I wanted to share here.  Swedish Snus isn't something I'm passionate about because I enjoy it, rather it is something I enjoy writing about because I know it's ability to help people quit smoking first hand.  I was a smoker who was able to put down the cigarettes after an almost 10 year addiction - all thanks to Swedish Snus.

Tobacco harm reduction is a relatively new ideology in America which should be embraced to help those addicted to cigarettes quit smoking by switching to less harmful tobacco based products. One of the products that has caught on in the tobacco harm reduction community is Swedish snus. Snus is a relatively new product in America, but according to Swedish Match is one that has existed in Europe for over 200 years. Swedish snus is a form of smokeless tobacco sold primarily in Sweden. According to a 2003 study from Tobacco Control, snus is “…a moist, ground oral tobacco product that is typically placed behind the upper lip, either as loose ground tobacco or contained in sachets appearing like small teabags.” Being placed in the upper lip prevents the snus from coming into contact with the lower lip salivary glands which makes snus spit-free. This also makes Swedish snus more discrete for the user. Since snus began growing in popularity in America in 2007, awareness of harm reduction has grown significantly, but is still not fully embraced as an adequate method of helping people quit smoking. If Americans can look at Swedish snus as a safer form of tobacco use, it can help those addicted to smoking quit by moving to a less harmful product.

In the United States, there is an alarming number of people addicted to smoking and the results of that addiction are catastrophic. It was said in a 2009 article in HR Focus that an estimated 443,000 people die yearly due to smoking related causes. The New York Times recently published that there are 44 million people addicted to smoking and of those addicted 70% expressed interest in quitting. An article in Drug Topics expressed that only 15% of smokers are actually able to wean themselves off nicotine when attempting to quit. When pharmaceutical aids and professional help are factored in that number can increase to a 44% success rate. In a study published in 2003, it was discovered that 71% of daily smokers with a history of snus use were able to completely quit smoking by switching to snus, whereas 54% of those with no history of using snus were able to quit by switching from cigarettes to Swedish snus. The goal of the United States a whole should be to lower the number of addicted Americans to 2%, the percentage of doctors that smoke, or lower.

“Look to Sweden” is an often used phrase in the tobacco harm reduction movement that references the Swedish Experience. The Swedish Experience is something that is looked at when discussing Swedish snus as a practical aid in tobacco harm reduction and smoking cessation. In 1997, Sweden became the first country in the world to reach the World Health Organization’s goal of having a less than 20% population of adult smokers. The European Smokeless Tobacco Council recently published an article referencing the Swedish Experience, stating, “The risk of dying from a tobacco-related illness is lower in Sweden than in any other European country despite tobacco consumption being on a comparable level with other European countries.” The Swedish Experience is often looked at as a tool by tobacco harm reduction strategists to help raise awareness that Swedish snus can be a useful aid in helping people quit smoking.

Availability of products that aid in smoking cessation is a factor in tobacco harm reduction. Other than Swedish snus, there are other nicotine based pharmaceutical products, referred to as Nicotine Replacement Therapy, available for those who wish to quit smoking. Pre-2007, these products were the most widely available form of aids in smoking cessation. According to TobaccoHarmReduction.org, research has shown these products yield a 90% failure rate. These NRT’s are designed to help the smoker quit by gradually tapering down their nicotine consumption. Many smokers find the amount of nicotine delivered to be unsatisfactory, which is a reason for the high rate of failure. These products are generally more expensive than smokeless tobacco products, which make them much less appealing to the smoker. Swedish snus distribution has grown substantially in the US over the past several years, making this form of smokeless tobacco much more easily available to the American population, and to those looking for a different form of nicotine replacement. In an interview with CNBC, Emmett Harrison, senior vice-president of investor relations at Swedish Match, remarked that, “…total U.S. sales of snus is around 47-50 million cans per year and has grown from virtually nothing in 2007.” Whereas before, the most widely available form of nicotine replacement was these pharmaceutical aids, Swedish snus is becoming equally available to those looking for a product to aid in smoking cessation.

Tobacco Harm Reduction has many obstacles, however, that hinder it from being an acceptable practice of smoking cessation. Articles published frequently suggest that there is a link between snus and oral cancer. An article recently published in USA Today stated, “Although some say smokeless tobacco poses fewer health risks than cigarettes, they note that it has been linked to various types of cancer and warn against using any tobacco product.” Snus products sold in the US still carry the same cancer warnings as other forms of smokeless tobacco, such as moist snuff, that carry a higher risk of oral cancer. However in a study released in 2003 from Tobacco Control it was noted that their “…results do not support any association between use of oral snuff and oral cancer.’’ In a report recently submitted to the American FDA, Dr. Lars Erik Rutqvist noted that snus sold in Sweden is treated as a food product by the Swedish FDA and does not carry the cancer warning labels that snus sold in America carries. According to an article on CSPnet.com in regards to Swedish Match’s attempts at this modified risk label, it would “…certify its General-branded pouches of tobacco as less harmful than cigarettes” and present them as an acceptable aid in smoking cessation and remove the oral cancer warnings that have been placed on Swedish snus products sold in the US.

Another issue the harm reduction movement faces is also cancer related. Opponents to tobacco harm reduction continue to assert that there is an increased risk of pancreatic cancer associated with use of Swedish snus. An article in USA Today referenced a study funded by the Swedish Cancer Society which said that although there wasn’t a risk of oral cancer, snus users were twice as likely to get pancreatic cancer. In an article in the McClatchy – Tribune Business News, Theresa Knox, tobacco prevention coordinator for Grand Forks Public Health, suggests there is a 60% or higher chance of pancreatic cancer. However, it was discovered in a 2011 study released in the Oxford Journals that while there is, “…evidence that cigar smoking is associated with an excess risk of pancreatic cancer, while no significant association emerged for pipe smoking and smokeless tobacco use.”

There is one issue that both opponents of, and those in favor for, Tobacco Harm Reduction can agree on, however – that nicotine is highly addictive. In a study released in the British Medical Journal, it was said that, “Nicotine is as addictive as "hard" drugs such as heroin.” However, in an article in The Los Angeles Times, Brad Rodu from the University of Alabama suggests, “…nicotine should be treated more like caffeine: as an addictive drug that can be used safely. We would have smokers understand the nicotine addiction can be separated from the smoking.” It is important to separate the dangerous health risks from the addictive ones to be able to approach tobacco harm reduction as a practical aid in smoking cessation. A key principal to recognize is that harm reduction is not harm elimination. In 2010, Dr. Karl Fagerström spoke to this in an interview with 60 Minutes for their televised broadcast of “Going Smokeless” stating, “It’s true. It’s true. And that’s why I say this not to harm elimination. They are still dependent. And addiction is seen as an unnatural state. Thus, addiction is a problem. But this is less of a problem than lung cancer.” While it is recognized that Swedish snus contains nicotine and is addictive, the addiction to nicotine can be handled safely and responsibly and present Swedish snus as an alternative to the smoker who wishes to quit.

In conclusion, it is clear that Swedish snus is an appropriate alternative to aid in smoking cessation. It is in the best interest of the public health to embrace the Swedish Experience and accept tobacco harm reduction as a way to help the millions of Americans addicted to nicotine that simply cannot quit with pharmaceutical products. Many Americans want to quit, but simply cannot achieve their goal with pharmaceutical products, and snus is an alternative that has been proven to enable people to finally put down the cigarettes and move forward with their lives. Moving from a harmful form of tobacco to a vastly less harmful one can save lives. As Swedish snus awareness and availability continues to grow in America, the main obstacle is overcoming the myths that snus causes oral or pancreatic cancer, and helping people view it from the same perspective as it is viewed in Sweden, a product that can lower the smoking percentage to the goal of the World Health Organization, or lower. Though both sides agree that nicotine is addictive, when viewed from the perspective of tobacco harm reduction it is clear that nicotine can be used safely as a practical aid in smoking cessation. In time, the United States can have the same low smoking rates that Sweden has by simply embracing the Swedish Experience, tobacco harm reduction and Swedish snus.