Snus

Snus in Norway and Sweden is a common form of finely ground oral tobacco pushed under the lips with salt and often different flavors. Especially in Scandinavia, it is extremely popular and has a long tradition due to limited cigarette regulations. There are records that snus was being consumed as early as 1822. One of the oldest types of snus is Ljunglöfs Ettan. In Austria, one often comes across the term snüs. However, snus should not be confused with dry tobacco product snuff.

Manufacturing

The tobaccos used to make snus are air-cured and come from various sources. These are first ground; then, they add water. Before one changed the snus manufacturing process to heat treatment (since the 19th century), fermentation was commonplace. After the heat treatment, one adds salt and often different flavors to the tobacco.

Contents

Snus or snüs contains the following ingredients: tobacco, water, salt, and – depending on the type – aromas. Nicotine is naturally present in tobacco. One adds salt to snus to maintain the pH level in the consumer’s mouth. This favors the absorption of nicotine. In Sweden, for example, snus is subject to the Food Act, which means that the same high-quality standards apply to other foods (e.g., fruit). One must declare the ingredients and the expiry date.

Consumption and impact

One consumes snus by tucking the small sachet behind the upper or lower lip. Depending on the variety or personal preference, it remains for between 15 and 60 minutes until the sachet loses its effect. Meanwhile, the tobacco contained in the snus releases its flavor and nicotine. One absorbs nicotine through the oral mucous membranes and thus enters the bloodstream. The nicotine gets into the blood more slowly with the form of consumption “snusing” than smoking a cigarette, but the concentration of nicotine also falls more slowly. This means that snus users have high nicotine levels for longer than smokers. However, one cannot assess the effect snus has on consumers in general terms; some are calmed down, while others seem activated by it.

Since snus contains an enormous amount of nicotine and a tobacco concentration of several cigarettes, dizziness and nausea can occur, mainly when used for the first time. Similar to smoking, repeated consumption leads to habituation and rapid physical dependence. Because the airways and lungs are not additionally burdened with toxic combustion products, consuming snus is considered less harmful to health than smoking cigarettes.

Snus can be roughly divided into two different forms of consumption:

  • Loessnut
  • portion snus

Loessnut

Loessnut is a moist, loose powder packed in plastic or waxed cardboard jars of 50 or 42 grams. One must portions it before consumption.

The following methods are used to portion the loessnut: Either a heap is taken and kneaded into a kind of spherical ball before it is clamped under the lip. Or you can use a Prismaster (made of plastic) or Icetool (made of steel or aluminum). These tools help shape a snus pinch.

Portion

When we talk about portion snus, we talk about small bags made of cellulose. You can find this so-called portion snus in four different sizes; these are:

  • slim
  • normal
  • long cut
  • long slim

There is also another distinction:

  • white portions
  • original portions

The sachet is dry for the white portions, but the snus is not; this should not allow any leakage. With the “white-dry” snus portions, on the other hand, both the tobacco and the pouch are dry; you can keep the snus in the mouth longer. The difference with the white portion is that the pouch is also moist with the original parts.

There are various flavors of the snus packed in packets: melon, wintergreen, and peppermint are just a few of many examples. Cans, where the portion snus is stored, are mostly made of plastic, sometimes metal. Many of these plastic cans have a Combi-Lid or Double-Lid in the lid. You can put used packages in there and dispose of them later.

Health aspects

Because when consuming snus, the tobacco is not smoked, no other additional harmful substances are produced; snus is classified as less detrimental to health. The manufacturers further reduced the low content of nitrosamines (organic chemical compounds, some of which are carcinogenic[1]) contained in snus.[2]

Inflammation of the oral mucosa where the snus is lying is quite possible, but it resolves itself after the end of consumption. One aspect one should not disregard is that there is no secondhand smoke when using snus. Various scientific studies have shown that snus can help with smoking cessation, but snus, like tobacco smoking, can lead to addiction.[3][4]

A link between some types of cancer and the use of snus has been confirmed in some studies and refuted in others, so it is difficult to make a general statement about it.

Over 120,000 snus users were examined in a study by the Karolinska Institute who had never smoked tobacco before. It was found that they have an increased risk of developing pancreatic cancer. However, these subjects were not diagnosed with oral or lung cancer.[5]

In 2011, a meta-analysis examined eleven studies on the association between different forms of tobacco use and pancreatic cancer. Contrary to the meta-analysis from 2007, they found no connection between pancreatic cancer and snus use.[6]

In 2003, scientists (including the contribution of WHO-awarded nicotine researcher Karl Fagerström) found that because snus is available in Sweden, the smoking rate is unusually low among Swedish men. The surveyed Swedes switched to a less harmful form of addiction to nicotine because of snus.[7] The EU average of smokers has stagnated at 26% since 2014; in Sweden, the proportion of tobacco smokers is only 7%.[8]

In 2008, a study of 10,000 Swedish men was published in the International Journal of Cancer, which found a statistically significant increase in combined mouth and throat cancers with daily snus use.[9] However, other renowned studies in specialist journals such as “The Lancet” and the “British Medical Journal” have not found any correlation between the use of snus and oral cancer; however, another study suggests an increased risk of pancreatic cancer as a result of snus use. [10][11] However, in 2017, a pooled analysis of nine prospective studies involving more than 400,000 men found that snus use was not associated with an increased risk of developing pancreatic cancer.[12]

One examined the health effects of snus consumption in many scientific studies. Based on this, one can make the following statements:

Smokeless consumption carries only a small part of the risks of smoking tobacco. This applies to cancer, stroke, lung, heart, and circulatory diseases. Scientists concluded that using the product snus is about 90-95% less dangerous than smoking tobacco.[13][14][15][16]Dramatic reduction of health risks comes with the switch from smoking cigarettes to using snus.[15][13]Furthermore, the much-claimed statement that oral cavity cancer is related to snus consumption could not be proven.[17][18]

History

In the 16th century, the French diplomat Jean Nicot introduced the precursor to snus (moist snuff) when he recommended snuff to the wife of King Henry II of France as a remedy for migraines. Due to social reasons, this became a fashion trend among the French court and upper bourgeoisie, and the product was top-rated among women.

The use of snuff also spread to Sweden in the early 17th century. In the 19th century, Swedish producers first produced snus placed under the upper lip and did not require spitting, which is when the term “snus” became established.

Myths

Confusion of snus and snuff

Snus, snuff, and so-called dip tobacco (popular in America) are different products that English speakers often refer to generically as snuff but are consumed and processed in very different ways. Each product has its risks. In Sweden, they translate the English word “snuff” into “snus.” Also, one uses “snuff” often when talking about snuff tobacco. The same applies to American dipping tobacco, referred to as snuff in America. In Sweden, they call it Torrsnus or Luktsnus. Dried, damp snuff is placed under the lower lip and implying spitting is American dip tobacco outside the United States.

Glass particles in snus

That snus contains fine fiberglass or splinters to help the blood absorb nicotine is a widespread myth that persists. This incorrect information arose because the salt in snus crystallizes after incorrect storage and can reflect under certain circumstances when the light falls on it. The consumer often feels a slight burning or tingling sensation caused by nicotine.

Tobacco Free Snus

One way to consume tobacco-free snus is a snus-like product from a blend of coconut and oat shells or tea leaves with salts and flavorings that do not contain tobacco. Like snus, this is available in bulk or, more commonly, in packets. In 2006, one introduced tobacco-free snus in Sweden. Initially made with corn starch, the formula was adapted in 2008 because the sugar produced caused tooth problems in consumers.

Weblinks

Reference

[1] https://www.ncbi.nlm.nih.gov/pubmed/16865769?dopt=Abstract

[2] L. E. Rutqvist, M. Curvall, T. Hassler, T. Ringberger, I. Wahlberg: Swedish snus and the GothiaTek standard. In: Harm Reduction Journal, 8(1), 2011, S. 11, PMID 21575206.

[3] Gordana Joksić, Vera Spasojević-Tišma1, Ruza Antić, Robert Nilsson, Lars E Rutqvist: Randomized, placebo-controlled, double-blind trial of Swedish snus for smoking reduction and cessation. In: Harm Reduction Journal, 2011, 8, S. 25, PMC 3186733

[4] Tom Wikmans, Lars Ramström: Harm perception among Swedish daily smokers regarding nicotine, NRT-products, and Swedish Snus. In: Tobacco Inducted Diseases, 2010, PMC 2928193

[5] J Luo, W Ye, K Zendehdel, J Adami HO, Adami, P Boffetta, O Nyrén: Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. In: Lancet, 2007, 369, S. 2015–2020, PMID 17498797

[6] P. Bertuccio, C. La Vecchia, D. T. Silverman, G. M. Petersen, P. M. Bracci, E. Negri, P. Boffetta: Cigar and pipe smoking, smokeless tobacco use and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (PanC4). In: Ann Oncol. 2011; 22: 1420–1426, PMC 3139985

[7] J Foulds, L Ramstrom, M Burke, K Fagerstrom: Effect of smokeless tobacco (snus) on smoking and public health in Sweden. In: Tobacco Control, 2003, 12, S. 349–359, PMC 1747791

[8] http://europa.eu/rapid/press-release_STATEMENT-18-3976_de.htm

[9] Gordana Joksić, Vera Spasojević-Tišma1, Ruza Antić, Robert Nilsson, Lars E Rutqvist: Randomized, placebo-controlled, double-blind trial of Swedish snus for smoking reduction and cessation. In: Harm Reduction Journal, 2011, 8, S. 25, PMC 3186733

[10] MacAra, A. W (2008). “Should doctors advocate snus and other nicotine replacements? No”. BMJ. 336 (7640): 359. doi:10.1136/bmj.39479.491319.AD. PMC 2244771. PMID 18276711.

[11] Rodu, Brad (2007). “Snus and the risk of cancer of the mouth, lung, and pancreas”. The Lancet. 370 (9594): 1207–8; author reply 1208. doi:10.1016/S0140-6736(07)61533-5. PMID 17920914

[12] Araghi, Marzieh; Rosaria Galanti, Maria; Lundberg, Michael; Lager, Anton; Engström, Gunnar; Alfredsson, Lars; Knutsson, Anders; Norberg, Margareta; Sund, Malin; Wennberg, Patrik; Trolle Lagerros, Ylva; Bellocco, Rino; Pedersen, Nancy L; Östergren, Per-Olof; Magnusson, Cecilia (2017). “Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies”. International Journal of Cancer.

[13] B. Rodu: The scientific foundation for tobacco harm reduction, 2006–2011. In: Harm Reduction Journal, 8(1), 2011, S. 19, PMID 21801389.

[14] K. Asplund: Smokeless tobacco and cardiovascular disease. In: Progress in cardiovascular diseases, 45(5), 2003, S. 383–394, PMID 12704595

[15] P. N. Lee, J. Hamling: Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. In: BMC medicine, 7(1), 2009, S. 36, PMID 19638245

[16] C. Bates, K. Fagerström, M. J. Jarvis, M. Kunze, A. McNeill, L. Ramström: European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health. In: Tobacco Control, 12(4), 2003, S. 360–367, PMC 1747769

[17] E. B. Schildt, M. Eriksson, L. Hardell, A. Magnuson: Oral snuff, smoking habits and alcohol consumption in relation to oral cancer in a Swedish case-control study. In: International Journal of Cancer, 77(3), 1998, S. 341–346, PMID 9663593.

[18] F. Lewin, S. E. Norell, H. Johansson, P. Gustavsson, J. Wennerberg, A. Biörklund, L. E. Rutqvist: Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck. In: Cancer, 82(7), 1998, S. 1367–1375, PMID 9529030