In the quest to find safer alternatives to smoking, snus and nicotine pouches have emerged as promising options. Snus, a moist smokeless powdered tobacco, and nicotine pouches, which contain nicotine extracted from the Nicotiana tabacum plant, offer a reduced-risk alternative to traditional cigarettes. These products have gained popularity, particularly in Scandinavian countries where they have contributed to declines in smoking and smoking-related diseases. Researchers have conducted extensive studies on snus and its health effects, leading to compelling conclusions regarding its harm reduction potential.
So, what exactly is snus?
Snus is typically sold as a loose powder or pre-packaged in small sachets similar to mini tea bags. It consists of ground tobacco, salt, and may contain food-grade smoke aroma flavorings, such as citrus, bergamot, juniper, or floral flavors. Snus can be made from fermented and/or pasteurised tobacco.
The use of snus involves placing it between the upper lip and gum, where the nicotine is released into the saliva. New users often experiment to find the optimal rate of nicotine release that suits their preferences. To ensure quality standards, the Gothiatek standard—a voluntary quality standard for snus products—has been established. It sets maximum levels for various constituents, including nitrosamines, metals, nitrite, agrochemicals, mycotoxins, and aldehydes. The sale of snus has been banned in Britain since 1992 however, the sale of nicotine pouches is currently allowed.
Is it safe to use nicotine pouches?
One of the key questions surrounding snus and nicotine pouches is its safety and potential long-term health effects. Scientists consider them to be 95% to 99% less risky than smoking, making it a significantly safer option. Unlike cigarettes, nicotine pouches pose no respiratory risk, which is responsible for a significant portion of smoking-related deaths, including lung cancer, chronic obstructive pulmonary disease (COPD), and pneumonia. A systematic review and meta-analysis examined the evidence from several major studies across Sweden, Norway, Denmark, and Finland, up until 2010. The review found scant support for any major adverse health effects of nicotine pouches, indicating that it is not associated with cancers of the oropharynx, esophagus, pancreas, heart disease, or strokes. In fact, compared to smoking, snus carries approximately 1% of the risk of cancer or cardiovascular disease.
Moreover, a recent study from the Swedish Karolinska Institutet confirmed that snus, tobacco pouches and nicotine pouches use is not linked to an elevated risk of pancreatic cancer. The study utilized cohort studies and linked survey data with registers of disease and mortality, analyzing a total of 424,152 men from nine cohorts. During a cumulative 9,276,054 person-years of observation, current snus use was not associated with an increased risk of pancreatic cancer.
These findings have significant implications, suggesting that nicotine pouches are a compelling harm reduction alternative to cigarettes. Nicotine pouches fulfill the criteria for a tobacco harm reduction product, delivering acceptable doses of nicotine to users while posing significantly lower health risks. It has the potential to contribute to a substantial reduction in the incidence of lung cancer and cardiovascular diseases, both of which are well-known consequences of smoking.
The conclusion drawn from a study published in the Harm Reduction Journal in November 2019 further supports the harm reduction potential of snus, tobacco and nicotine pouches. The review emphasized that nicotine pouches, with nicotine decoupled from harmful tobacco smoke, presents considerably lower health risks compared to smoking. It also highlighted that the pouches do not act as a gateway product to smoking cigarettes and should be regarded as a reduced-risk product