TCS Daily


To Snus or Not to Snus

By Michael Kunze - June 30, 2003 12:00 AM

The medical community has known for years that tobacco is harmful to humans. And, for just as many years, those of us who work in this field have been seeking ways to cut its usage.

Many tools have been tried, often involving government policies restricting either the usage or distribution of certain tobacco products. Ironically, a new look at the evidence suggests that perhaps one of our best tools to fight the ill effects of tobacco may actually be to relax some of those anti-tobacco rules. In discussing such a prospect at our laboratory, the question we sometimes pose is one of whether to snus or not to snus?

Snus? you ask. Because snus is banned in all EU countries except Sweden, many are not familiar with it. It is a form of moist ground tobacco that users place between their lip and gum. By doing so, they are able to fulfill their nicotine addition because the nicotine is then absorbed into their blood stream. Because snus is legal and widely available in Sweden, it is the tobacco product of choice throughout the country. In fact, about half the males in Sweden are snus users. But because of the ban in other EU countries, use is minimal throughout the rest of the EU.

This marked difference in snus usage is very relevant when coupled with the fact that Sweden has the lowest rate of male smoking in Europe, with about 16 percent of adult males in the country saying that they smoke daily. These figures are significant in our work devoted to the control of lung cancer, which is a man-made epidemic, caused primarily by cigarette smoking in the great majority of cases. This is true for both males and females.

Looking at comparative epidemiology figures, we noted that Swedish males experience much lower lung cancer rates than men in most of the other countries, especially in the European Union. Swedish females show similar lung cancer rates as in any other country of the same region.

Given these figures, we must ask ourselves why? One explanation might be linked to the fact that Swedish males use not only cigarettes and nicotine replacement products for their nicotine intake but also use smokeless tobacco, namely Swedish snus. Interestingly enough, Swedish females do not yet use Swedish snus to a great extent.

By taking a closer look into the tobacco consumption patterns in Sweden, one comes away with a very interesting conclusion: Swedish snus might be useful in helping highly addicted tobacco users rid themselves of cigarettes. Being heavily involved in the diagnosis and treatment of tobacco addicts, we at the Institute for Social Medicine at the University of Vienna as well as the Nicotine Institute, Vienna, are especially interested in new approaches to help those who are heavily addicted to nicotine. Our reasons are straightforward: we do so because they are the ones who not only face the highest risk of contracting lung cancer and other tobacco related diseases, but because they have also traditionally been less receptive to and responsive to established treatment procedures.

For anyone who wishes to use a product such as snus as a replacement for cigarettes to meet their nicotine addiction, the problem of availability arises. Because of the EU directive, Swedish snus cannot be legally distributed outside Sweden. This also creates obstacles for therapists who wish to offer it to their patients, because the treatment providers themselves may even face legal problems. All these factors considered together have rightly given rise to a political and legal debate regarding snus. Many experts feel that since much more dangerous tobacco products like cigarettes are freely available, it is hard to understand why Swedish snus can only to be used in Sweden and not in the rest of the European Union.

However, the unconditional lifting of the existing ban is not necessarily the solution. Under such a scenario, even more dangerous products such as smokeless tobacco from India might be brought into the EU countries to a much great extent than before. By the way, those products are already available and not sanctioned by a ban.

Given this, it would be wise for the European Community to review the existing ban on snus, while at the same time imposing much more strict regulations on all kinds of nicotine delivery products, especially smoked tobacco. From a public health point of view, the availability of snus will offer another possibility to help those who cannot stop smoking -- or who don't want to do so in the near future. Of course it will be necessary to monitor the possible consumption patterns in the case of the availability of Swedish snus in countries outside Sweden.

But in any case, the EU ban on snus is beginning to make less and less sense. In fact, lifting or modifying it is something that must be considered because it may very well be an effective tool in helping reduce the ill effects of tobacco.

Dr. Michael Kunze is a professor of public health at the University of Vienna. He represents Austria as the WHO National Counterpart for Smoking Control, and is a member of the EU Tobacco Expert Working Group, serving on the EU Regulatory Committee on Tobacco. His recent publications on tobacco issues can be found on www.nicotineinstitute.com.
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