A safer alternative to smoking?

By Daniel Cook

Snus is popular in Sweden

Anti-smoking groups and tobacco companies alike are calling for the EU to relax its ban on a form of oral smokeless tobacco called "snus".

Widely used in Sweden, snus is moist tobacco which is placed under the lip.

It comes in pouches resembling miniature tea bags, or "loose", and releases nicotine into the bloodstream through the gums.

Since Sweden and Norway enforced smoking bans in public places, sales of snus there have rocketed.

And it is becoming increasingly popular among some smokers who use it to wean themselves off cigarettes.

But scientists around the world remain divided about how dangerous snus really is.

EU reluctance

Experts at one of Sweden's top medical universities say there is no doubt that snus causes cancer of the pancreas and mouth.

Snus 20% of Swedish men take snus. It is more popular in northern counties, where twice as many use it Only a few per cent of women take snus across Sweden, but in the north of Sweden it is as high as 10% Snus is available in various flavours, including liquorice, lemon, coffee, aniseed, elderflower, cranberry and mint It comes in one- and two-gram pouches, and half-gram pouches aimed at women

But other scientists claim snus is 100 times safer than smoking, while the Royal College of Physicians claims it is up to 1,000 times less harmful.

Around 20% of Swedish men use snus. It may be the reason that rates of smoking-related diseases are lower there than in any other EU country: 11% of Swedish men die from such illnesses, compared to 25% across the EU.

Anti-smoking charity Ash is one of the groups that wants snus to be legalised across the European Union.

Deborah Arnott, director of Ash, said: "Smokeless tobacco is much less harmful than smoked tobacco. It is smoking something which makes it really dangerous."

She said other forms of chewing tobacco originating in South Asia were readily and legally available in the UK - and were much more injurious to health.

"We currently have a situation where the safest form of smokeless tobacco in the EU is banned, and that's the form on sale in Sweden."

Another voice calling on the EU to legalise snus is British American Tobacco (BAT).

A year ago, BAT began selling snus in South Africa, where it is legal, under the Lucky Strike brand. It also owns a stake in a snus factory in Sweden.

But BAT has admitted it is unlikely to get approval to sell it in EU countries. A spokesperson for the tobacco giant told the BBC that the EU "had not been particularly welcoming" to its request to licence snus.

Serious concerns

Among the body of research available to the EU legislators is a report published late last year by the Karolinska Institute in Stockholm, one of Sweden's top medical universities.

Professor Goran Pershagen, who chaired the research, told the BBC: "An overall assessment of the experimental and epidemiological evidence indicates that snus is carcinogenic."

"The strongest evidence is for cancer of the pancreas and oral cavity."

He added that snus can cause hypertension, and increases the risk of fatality from heart attacks - although it could not be proven that it makes them more likely.

"I know there are groups working on risk assessment at the European level. Certainly our report will not endorse lifting the ban," he said.

"I think you should be careful about introducing a new narcotic into the population. You would see more people using tobacco overall."

Professor Pershagen points out that, compared to cigarette smoking, there has not yet been enough research into the dangers of snus.

"I would be very hesitant to come up with any figure on the absolute health risks associated with snus. With cigarette smoking, I would have no problem.

"But smoking is among the most dangerous things you can do. It's not a fair comparison."

"Cessation aid"

It seems unlikely that snus is as safe as some groups claim. It also seems unlikely that it is as dangerous as smoking. But as Professor Pershagen says, it's hardly a fair comparison.

This writer used "portionsnus" - tobacco in porous bags - on the recommendation of a Scandinavian friend, when giving up smoking.

In my case, using snus "worked". It made giving up smoking a breeze.

Every time I felt a craving, I slipped a pouch of snus under my top lip, a minute later the nicotine filtered through, and the urge to smoke subsided.

It didn't stain my teeth, it didn't give me bad breath, and it didn't make my gums bleed - in fact, the worst thing about it was enduring warnings that it would do all of the above, usually issued by smokers who had never heard of snus before.

But there were some immediate downsides. It was unpleasant at first, before I got the hang of "placing" it properly.

The "juice" would escape from the tobacco, causing nausea and a burning sensation in the throat.

Wearing a pouch under your lip gives you a faintly foolish appearance. It also seemed to cause mouth ulcers. And it aroused disgust among friends and family.

But as time wore on, I started doing more and more of it, until I seemed to have a pouch under my lip all the time. I sometimes fell asleep with one in.

Two years on, I can safely say I am over the cigarettes, and I'm trying to cut down on snus, which has proved to be just as addictive as smoking.

Professor Pershagen said that nicotine gum and patches, which do not contain harmful, cancer-causing nitrosamines, are more sound ways to replace cigarettes.

I'm planning to move on to patches soon.