Snus Beats the Pharmaceutical Competition in Norway

A study recently published online by the journal Nicotine & Tobacco Research finds that switching to snus (Swedish-style oral snuff) is by far the most popular method for quitting smoking in Norway. Furthermore, it is much more effective than using nicotine replacement products sold by pharmaceutical companies. Examining survey responses from about 1,800 current cigarette smokers and about 1,800 former smokers, researchers led by Karl Erik Lund of the Norwegian Institute for Alcohol and Drug Research found that nearly one-third had used snus in their last quit attempt. They were almost three times as likely to have succeeded as the smokers who used the next most popular method, nicotine gum (used by 18 percent of the respondents). The only method that looked more effective than snus was varenicline (sold in the U.S. as Chantix), a prescription drug that is designed to block nicotine's psychoactive effects (and that now carries a daunting FDA warning). Measured by abstinence rates, varenicline was about five times as effective as nicotine gum, but it was used by only 1 percent of the respondents.

Lund and his co-authors speculate that snus—which is banned in most of the E.U. but available in Norway, Sweden, and the U.S.—is more popular and more effective than the pharmaceutical products because "the nicotine dose is almost the same as for cigarettes," because snus "tastes of tobacco and thus has a sensory effect that medicinal nicotine products perhaps lack," and because "the choice of brand, aesthetic rituals of use, and visibility can represent social positioning and self presentation." In short, snus is a closer substitute for cigarettes. Not surprisingly, people who quit smoking by switching to snus are also more likely to continue using the substitute than people who quit with nicotice replacement products. But since the hazards posed by snus are tiny compared to the hazards posed by cigarettes, the health benefit is undeniable—unless you are one of the many anti-smoking activists and public health officials who continue to deny or obscure this truth because you're afraid of what consumers will do with the information.

"In light of all the available evidence," two prominent American tobacco researchers concluded in 2007, "the banning or exaggerated opposition to snus in cigarette-rife environments is not sound public-health policy." Now that the Food and Drug Administration is in charge of regulating tobacco products, it will be making decisions that determine the extent to which snus can compete not only with cigarettes but with pharmaceutical products such as nicotine gum. If it really is guided by science and by public health principles, it will allow snus to be marketed as a safer alternative to cigarettes, and it won't try to suppress information like the results of this study. But I wouldn't bet on it.

Addendum: A commenter claims "the heart is still at just as great a risk with snus as it is with cigarettes." This is just the sort of misinformation that snus alarmists tend to foster. While some research has indicated a link between snus and heart disease, the level of risk found in those studies is substantially lower than the risk associated with cigarette smoking. More-recent research suggests the use of snus does not measurably raise the risk of heart disease: A 2009 study reported in the Journal of Internal Medicine found "there was no association between use of snus and risk for cardiovascular disease." In any case, there is no denying that the overall hazard posed by snus is far lower than the hazard posed by cigarettes. A 2007 Lancet study found "there was little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus." The authors of the study discussed in this post note that "nicotine uptake from snus instead of from cigarettes has the potential for reducing harm by at least 90%."

[Thanks to Bill Godshall for the tip.]