Swedish Snus: A Less Risky Alternative

Swedish Match, the world’s leading manufacturer of Swedish snus, applied to the Food and Drug Administration (FDA) for a reduced harm warning label for their product; however an FDA advisory panel recommended rejecting the application late last week. The current label states that snus causes gum disease, mouth cancer and tooth loss and is addictive. Swedish Match’s requested labeling reads – Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes. Swedish Match is amenable to including language referencing snus’ addictive properties. While the FDA is not obligated to follow the panel’s recommendation, it typically does.

Swedish Match’s modified risk tobacco product application is the first accepted for consideration by the FDA. Manufacturers must meet two criteria in order to qualify.

• The product must “significantly reduce harm and the risk of tobacco-related disease to individual tobacco users” and
• The product must benefit “the health of the population as a whole.”

Swedish snus meets both of these criteria. It is a significantly less risky alternative to traditional tobacco products and has a proven track record as an effective smoking cessation tool.

Swedish snus, not to be confused with other oral tobacco products like chewing tobacco and American snuff, is a moist, smokeless tobacco that comes in small, teabag-like pouches that are placed beneath the upper lip. Because of the way Swedish snus is pasteurized, it has very low levels of nitrosamine– the naturally occurring carcinogenic compounds in tobacco.

The European Union (EU) Commission’s Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) has conducted exhaustive studies on the health risks and smoking cessation benefits associated with Swedish snus. Findings include:

• When tobacco consumers switch from cigarettes to Swedish snus, their risk of cardiovascular disease diminishes by at least 50 percent and there is also a substantial decrease in the risk of oral and pancreatic cancers.
• Swedish snus can aid in smoking cessation. SCENIHR observes, “Low nitrosamine smokeless tobacco products may have a positive role to play in a coordinated and regulated harm reduction strategy which maximizes public health benefit …”
• Substituting smokeless tobacco for cigarettes would prevent nearly half of all deaths caused by smoking.

The Scandinavian Experience

Because Sweden is the only EU member nation where snus is manufactured and sold legally, Sweden and non-EU member Norway offer insights into Swedish snus’ potential risks and benefits. Snus was commonly used in Sweden but was supplanted by cigarettes after World War I. Swedish snus consumption rose dramatically in the 1970s because of health concerns over cigarette smoking, appearing to spur a reduction in cigarette use and leading to a decrease in smoking and tobacco-related diseases including lung and oral cancer. Between 1980 and 2011, the number of Swedish males who are daily smokers dropped from 35.1 percent to 12.7 percent; significantly lower than the EU’s average male smoking rate of 29 percent. At the same time, the number of daily male snus users in Sweden climbed to 19 percent. According to a National Institutes of Health (NIH) report on Swedish twins, “Snus use was the strongest independent correlate of smoking cessation,” suggesting that using snus helped Swedes to quit smoking.

Norway’s experience has mirrored Sweden’s. According to Karl Lund, Research Director at the Norwegian Institute for Alcohol and Drug Research, increased snus use has led to a drop in smoking from 37 percent in 1985 to 15 percent in 2013 among those aged 16-74. The UK’s Royal College of Physicians reported that, “in relation to cigarette smoking, the hazard profile of the lower-risk smokeless product is very favourable.”

Product labeling should provide consumers with accurate information to make informed purchasing decisions. Warning labels are appropriate for risky products. However, information about a product’s risk reduction properties also helps the public to make solid choices. While the EU has not lifted its Swedish snus ban, it has altered snus warning labels to read, “Snus can damage your health and is addictive.” Swedish Match has applied for similar wording from the FDA, which seems a reasonable request as Swedish snus is a significantly less risky alternative to traditional tobacco products and can aid with smoking cessation. The American people have a right to know both the risks and benefits associated with the products they buy.