Snus are small pouches of tobacco that have been processed and sometimes flavoured. The pouch is held in the mouth, against the user’s gum, and it releases nicotine. They are a much safer source of nicotine than cigarettes, so switching from smoking to snus reduces a smoker’s health risks. They are very popular in Sweden, where they have been used for over 30 years, contributing to very low smoking rates and cancer rates in that country.

In “Patterns of smoking and snus use in Sweden”, the authors explain –

“Snus has contributed to decreasing initiation of smoking rather than serving as a gateway to smoking. Smokers who have taken up snus use have quit smoking to a significantly greater extent than smokers without snus use, and a substantial proportion has eventually quit snus use as well and become tobacco-free. These effects have been consistent across five decades. Dual use appears to be a transient state that serves as a stepping-stone to cessation. Snus is the most commonly used self-treatment aid for smoking cessation. Snus has been a major factor behind Sweden’s record-low prevalence of smoking and its position as the country with Europe’s lowest level of tobacco-related mortality among men”

The graph above shows how Swedish men (on the left) and women (on the right) have transitioned from smoking to using Snus as a source of nicotine. By 2021 the smoking prevalence had dropped to 6% in both men and women according to the Public Health Agency of Sweden.

In Sweden, overall nicotine use is higher than in most European countries, but tobacco smoking is rates are the lowest level in all of Europe by a considerable margin. This has resulted in measurable health benefits:

Lowest rate of tobacco-related mortality

Lowest incidence of male lung cancer – less than half the EU average.

Lowest rates of oral and pancreatic cancers in Europe.

WHO: Sweden

Sweden boasts Europe’s lowest male lung-cancer death rate — as well as the lowest male death rate from smoking-related cardiovascular diseases, and the lowest male death rate from other cancers that are attributable to tobacco” –  Kenneth Warner and Harold Pollack .

Snus in America

Oral tobacco use has a bad history, and other forms of oral tobacco are associated with cancer, especially oral and pancreatic cancer. Swedish Snus are highly evolved, and better than American equivalents. Swedish Snus actually contains less nicotine than American snus, but the higher pH and greater moisture content mean they can deliver nicotine more rapidly, closer to the effect of a cigarette. They are pasteurized to prevent tobacco degradation into harmful byproducts.

The FDA determined that the levels of N-nitrosonornicotine (NNN) and nicotine-derived nitrosamine ketone (NNK), two potent cancer-causing chemicals, in Swedish Match’s “General” Snus products are lower than those in most smokeless tobacco products sold in the U.S. The FDA has therefore granted “Modified Risk Tobacco Products” status to eight of their “General” brands of Snus. This allows them to say that “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.”

Why don’t other countries embrace snus?

In 1985 a World Health Organization (WHO) study concluded that “oral use of snuffs of the types used in North America and western Europe is carcinogenic to humans”. This may not be true of modern Swedish Snus. More importantly, when used as an alternative to highly carcinogenic cigarettes, Snus are clearly very much less harmful and lead to a reduction in cancer rates.

Snus are banned in the rest of the EU

American tobacco companies tried to market smokeless tobacco products such as “Skoal Bandits” in Europe. A peer-reviewed study from the University of Bath, analyzing internal tobacco industry documents, demonstrated that tobacco companies saw smokeless tobacco as having the potential ‘‘to generate new profits without cannibalizing existing profits from cigarettes’’ in Europe and that young people were a key target. (https://tobaccotactics.org/wiki/snus-eu-ban-on-snus-sales/).

The EU snus sales ban has been in place since 1992. Article 17 of the 2014 EU Tobacco Products Directive (TPD) states that: “Member States shall prohibit the placing on the market of tobacco for oral use”. The rationale is ‘The prohibition of the sale of tobacco for oral use should be maintained in order to prevent the introduction in the Union (apart from Sweden) of a product that is addictive and has adverse health effects”. This is an unfortunate interpretation of the facts. It may be reasonable to say that if snus were introduced into a population where cigarettes were not available, they would be harmful. But in a world where 8 million people die every year from tobacco use, largely because they are dependent on nicotine, snus would seem to be an enormous health benefit.

The EU ban has been challenged in court but the challenge failed. In the United Kingdom, some people hope that “Brexit” will free the UK from the EU ban and that the UK will allow the sale of Snus, but this seems unlikely at present.

For the present, Snus will continue to be popular in Sweden and Norway (which is exempted from the EU ban). Sales may increase in the USA after the FDA announcement.

It is ironic that while the USA has recognized that Snus have improved and is now much less dangerous than previous versions of oral tobacco, Europe still bans them as a dangerous carcinogen even though the evidence is that widespread use of Snus in Sweden results in a lower prevalence of both smoking and of cancer.

Governments and tobacco control experts seem to have a difficult time understanding that any form of treatment has a risk. Penicillin is a great antibiotic and should not be banned, even if a few people die of penicillin allergy. There is a possibility that some people may use Snus who would otherwise never have used any nicotine product, but this small risk is far outweighed by the benefit of smokers switching to Snus, as demonstrated by the tobacco-related disease rates in Sweden.