What if you didn’t smoke cigarettes, but you used snus instead? Would you be better off?
Snus -- pronounced "snoose," like “loose” -- is a smokeless, moist powder tobacco pouch from Sweden that you place under your top lip. It comes in flavors such as mint and wintergreen. You don’t burn it, and you don’t have to spit when you use it.
“Compared to cigarette smoking, the use of snus is probably less harmful,” says Michael Steinberg, MD, MPH, director of the tobacco dependence program at Rutgers University. “But there’s a big difference between ‘less harmful’ and safe.”
“I’d rather have a person do nothing, but of tobacco products, it’s down on the lower end” of the harm scale, says Eric Garrison, assistant director of health promotion at the College of William & Mary.
Compared to cigarettes, snus seems less dangerous. “It’s difficult to say that something is as toxic for you as smoking a cigarette unless you’re starting to talk about ingesting cyanide or rat poison,” says Erika Sward, assistant vice president of national advocacy for the American Lung Association.
In Sweden, the makers of snus have asked the FDA for permission to say on the product label that snus is safer than cigarettes. Currently, the warning on Swedish snus cans says, “This tobacco product damages your health and is addictive.”
Is It Different Here?
Snus got its start in Sweden as a way to preserve tobacco. In that country, it’s seen as something that has helped lower smoking rates. More than half of Swedish snus users are ex-smokers.
“They’ve reduced their chances of cancer,” Garrison says. “They’re not risk-free, but they’ve drastically reduced their risk by switching to snus.” Without snus, the argument goes, those people might still be smoking.
In Norway, snus has helped cut down on smoking as well. People there have either used it to help them quit cigarettes or as an alternative to cigarettes if they hadn’t successfully quit. And some Norwegian youth have taken up snus instead of cigarettes.
But in the U.S., that hasn’t been the case.
The snus here is made differently. While the Swedish have limited the number of chemicals that can be in their snus products, such as tobacco-specific nitrosamines, the U.S. has no such rules. “What we have seen is some of the tobacco companies calling their products snus, but that’s not quite the same as Swedish snus,” Sward says. “And those nitrosamines are carcinogenic.” In other words, they can cause cancer.
Plus, snus hasn’t taken the place of cigarettes in the U.S. The number of people using smokeless tobacco has remained about the same for the last few decades. Snus hasn’t changed that.
What Are the Risks?
Snus does contain nicotine, so it’s addictive -- you can get hooked on it. Quitting this habit has the same unpleasant side effects as when you stop smoking, including headaches and nausea.
Smokeless tobacco products also deliver more nicotine and nitrosamines than cigarettes, although snus generally has lower levels of nitrosamines than other smokeless products.
Pancreatic cancer rates are higher in snus users, although still low overall, and not every study shows that link. Snus is also tied to a greater chance of heart failure -- plus a greater chance of dying afterward if you continue using it -- and diabetes. Smokeless tobacco users in general are more likely than other people to get cancers of the cheeks and gum. Those studies don’t prove that snus caused those illnesses -- they show a link, not cause and effect.
Will It Help You Quit?
One of the big problems with snus, Sward says, is that it keeps people smoking who might otherwise quit. Instead of quitting, these smokers use snus when they can’t light up and cigarettes when they can.
Snus supporters suggest that promoting snus as a way to quit smoking would be a benefit to the public. But at least one study shows that this approach is not likely to work.
Steinberg talks about snus as a product on a spectrum. At the most harmful end of the spectrum are tobacco products you burn. At the least harmful end are medicinal nicotine products, such as patches and gum. Snus falls into the middle: safer than cigarettes but not as safe as nicotine gum.
Snus products “still contain thousands of chemicals,” Steinberg says. “They still contain nicotine. They’re addictive, and they affect the cardiovascular system and increase the risk of cancer. They’re still tobacco products.”