What You Need to Know About Snus and Its Health Hazards

Throughout the world, many cultures have a history of using tobacco in a non-smoking form, primarily by sniffing, chewing, or sucking. This practice varies across different regions and goes by various names. For instance, in Africa, it’s referred to as “tumbak” while in South America, “chimo” is the choice. Australians have “pituri” Swedes use “snus” and Asians opt for “nasvay”.

Snus is a smokeless tobacco product that’s widely used in Sweden and the United States. However, it’s prohibited in most European countries due to health concerns. The primary active component in snus is tobacco, which contains nicotine. Snus doesn’t contain other psychoactive compounds. Nevertheless, it’s considered risky due to its potential for rapid nicotine addiction and adverse health effects.

What is Snus Exactly?

Snus, also known as moist snuff, is a moist powdered tobacco product designed for smokeless consumption. Users place it between their gum and upper lip, avoiding the need for smoking or chewing.

The history of snus production dates back to Sweden in the 1820s, and it was initially popular. However, it lost ground to cigarettes in the mid-20th century, becoming associated with elderly rural men. Efforts to combat smoking and strategic marketing campaigns have since revived its popularity, particularly among young people.

Snus is primarily produced in Sweden and the USA, with its sale limited to Sweden, Denmark, and Norway in Europe. All other European countries have banned it.

Key Components of Snus

The primary components of snus are:

1. Ground tobacco, similar to the type found in cigarettes.
2. Sodium carbonate or calcined soda.
3. Salt, water, and moisture-retaining agents.

Additional ingredients include flavorings. Swedish snus manufacturer, Swedish Match, offers more than 240 flavor options for its products, including plant extracts, menthol, spices like ginger and basil, mint, and even alcohol, such as whiskey.

The tobacco used in snus undergoes pasteurization, which reduces the presence of tobacco-specific compounds like nitrosamines, known for their carcinogenic properties. Furthermore, pasteurization sterilizes the tobacco, lowering the risk of stomach issues from swallowing saliva while using snus.

Visual Characteristics of Snus

There are two common forms of snus available:

1. Loose Snus – This is a moist powder that’s hand-shaped into either a cylinder or a sphere using your fingertips. The resulting shape is known as a “pris.”
2. Portion Snus – In this form, the snus is placed in paper packets for easy use.

Both varieties are typically sold in round metal cans or plastic boxes.

In the portioned snus packets, you’ll find different options:

• Mini-portions, designed for beginners, contain no more than 0.5 grams of tobacco.
• Standard portions, weighing about 1 gram, are the preferred choice for most users.
• Maxi-portions, with up to 1.7 grams of tobacco, are for the most dedicated snus enthusiasts.

Using Snus: Methods and Effects

Snus, whether in portioned or loose form, is placed under the upper lip against the gum and held there for 30 to 60 minutes. Nicotine from snus is absorbed through the mucous membrane in the mouth. After an hour, the snus is removed, and the used portions are not reused. The saliva produced while using snus is typically swallowed.

The effects of snus are primarily due to nicotine, which produces effects similar to smoking a cigarette. For some, it can be relaxing, while for others, it can be stimulating. There are no specific effects uniquely associated with using snus.

For instance, in various experiments¹ involving both experienced snus users and individuals who had never used tobacco products before, they were asked to describe their experiences after using standard snus portions. Here are the findings:

• All participants noted a mild tingling sensation on the gum, lips, and throat.
• Regular snus users mentioned that the overall sensation, often referred to as a ‘buzz,’ was generally pleasant but mild.
• Individuals who had not used nicotine before had varying experiences. Some found it unpleasant, leading to nausea and dizziness, while others reported a sense of satisfaction and a pleasant taste. In any case, the sensations were not very intense.

It’s hard to predict whether the first use of snus will lead to a more positive or negative reaction, as these sensations are subjective and not influenced by factors like age, gender, or lifestyle. Genetic factors and anxiety levels may play a role.

Since nicotine is a mild stimulant, it can increase heart rate and blood pressure. In experiments, volunteers experienced an 8-13 beats per minute increase in heart rate, a 3-10 mm Hg increase in systolic blood pressure, and a 4-10 mm Hg increase in diastolic blood pressure after using a standard snus portion. No adverse effects were observed in healthy volunteers, although the effects on individuals with cardiovascular diseases were not studied.

The Nicotine Levels in Snus

A standard 1g portion of snus contains 10mg of nicotine, with about one-third (a little over 3mg) being absorbed. For comparison, an average cigarette contains 14mg of nicotine, but only 1.0-1.5mg is absorbed. In other words, a standard snus portion provides two to three times more nicotine than a cigarette.

The amount of nicotine absorbed into the bloodstream when using snus can vary depending on individual behaviors, such as moving the snus packet in the mouth, swallowing or spitting saliva, and swallowing the snus itself. The exact impact of these behaviors on nicotine absorption remains uncertain.

How Long Do Snus Effects Last?

Typically, snus is placed against the gum for 30-60 minutes. During this time, nicotine gradually enters the bloodstream. The highest concentration in the blood is usually observed about an hour after use, coinciding with the peak of the sensations, whether positive or negative.

After an hour, the concentration of nicotine starts to decrease. Most of it is eliminated within two to three hours. While nicotine metabolites may be detectable in the body for several days, the individual no longer experiences their presence.

The Risks Associated with Snus

Similar to any nicotine-containing product, snus can lead to nicotine addiction, dependence, and pose risks to one’s health. Just like there is no safe level of cigarette smoking, there is no safe level of snus consumption. The best course of action is to avoid it altogether.

Research on snus has been actively ongoing since 1990, with several studies examining the health effects of snus use. In 2022, a comprehensive review summarized 30 years of snus research from 1990 to 2020. Here’s what it revealed:

• Studies in the United States indicate that for non-smokers, snus use increases the risk of five major diseases associated with smoking: lung cancer, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), acute myocardial infarction, and stroke. However, the increase in risk is lower than that associated with smoking.
• Studies in Scandinavia do not show a clear link between snus use and an increased risk of IHD, myocardial infarction, stroke, or lung cancer. Data on COPD is inconclusive.

In 2019, the Norwegian Institute of Public Health analyzed the same snus studies and reached different conclusions. According to Norwegian researchers, the data suggest that snus increases the risk of cancer, cardiovascular diseases, metabolic syndrome, type 2 diabetes, obesity, and psychosis. Using snus during pregnancy is harmful to the child, and they call for close attention to the increasing use of snus, especially among individuals under 40.

In 2020, an analysis of the same long-term snus studies, conducted by Norwegian and British scientists, was published in the International Journal of Epidemiology. This time, the study was conducted by Swedes, focusing on the increase in mortality among users of smokeless tobacco. They looked at deaths from cardiovascular diseases, cancer, and other causes, and they concluded:

• Snus increases the risk of long-term mortality from cardiovascular diseases. The longer a person uses snus, the higher the likelihood of dying from heart and vascular diseases. Snus consumers experience myocardial infarctions at roughly the same frequency as non-users, but they have a lower survival rate.
• The increase in the risk of death from cancer among snus users is slight. The main contribution to the increased mortality comes from lower survival rates among snus users diagnosed with rectal or esophageal cancer.
• Other causes of death include accidents, violence related to alcohol, and car accidents, which are more likely among snus consumers.

There is also evidence suggesting² that smokeless tobacco products significantly increase the risk of oral cavity cancer and gum diseases.

Assessing Snus versus Cigarettes

The harmful effects of cigarettes are well-established, significantly increasing the risk of cardiovascular, oncological, pulmonary, metabolic, and other diseases. Snus also has health risks, but the body is exposed to fewer toxic compounds compared to cigarette smoking. Snus does not burn like cigarettes, which means it does not produce the toxic substances that result from combustion. The pasteurization process during snus production removes some harmful compounds, but some toxins still remain and can be absorbed through the gums, affecting health.

In 2019, the U.S. Food and Drug Administration (FDA) classified eight varieties of snus as products with lower health risks compared to smoking cigarettes. However, it’s important to note that these “approved” products are not safe; they are still considered harmful to health. They are simply considered less hazardous than cigarettes and other tobacco products.

Why is Snus Banned Despite Its Comparable Harmlessness to Cigarettes?

Smokeless tobacco is often viewed as a potential pathway to nicotine addiction. A standard serving of snus contains 3 mg of nicotine, whereas a cigarette has 1.0–1.5 mg. In countries where snus is legal, it is frequently used by teenagers and even children, who become addicted rapidly.

Snus, being smokeless, gives the false impression of safety. Nowadays, most people are aware of the dangers of inhaling tobacco smoke due to its many toxic compounds. But when using snus, there’s no smoke, leading many to believe it’s harmless. Furthermore, it doesn’t leave a lingering odor, which is crucial, especially for teenagers.

Snus manufacturers employ a clever marketing strategy for “entry-level” products. They intentionally create variants with low nicotine content and a variety of flavors and scents. Teenagers, and sometimes even children, are enticed by these “candies.”

Since the nicotine concentration in beginner smokeless tobacco products is low, its impact is minimal. Most first-time users either feel nothing, simply enjoying the taste, or experience mild, pleasurable excitement. The likelihood of unpleasant sensations that might deter people from snus is minimized. Young folks enthusiastically sample one variety after another, one flavor after another.

Regular use of even small amounts of nicotine leads to habituation, resulting in the need to increase the dose and addiction—a constant craving for nicotine. Individuals swiftly progress from starter doses to standard ones.

Often, nicotine addiction from snus can lead to smoking regular cigarettes, as nicotine from cigarettes is absorbed more rapidly. But there are other risks. Nicotine is recognized as a gateway substance, and developing an addiction at a young age increases the risk of alcoholism and the use of more potent drugs.

Eighty percent of young people with substance abuse issues have nicotine addiction. While it can develop from cigarettes, it may occur more rapidly and subtly with snus.

Is it Possible to Experience an Overdose from Snus?

Accidentally poisoning yourself with snus is nearly impossible. The only substance in it that can be lethal is nicotine. The lethal dose for a 154-pound adult is 60 mg. For people with less body mass, it’s around 30 mg.

A single standard serving of snus contains 3-4 mg of nicotine. This means that for an adult to be fatally poisoned, they’d need to put around 15-20 servings in their mouth at once. At the very least, 7-10 servings.

If you accidentally swallow one snus pouch, nicotine will be absorbed in a larger amount. But the maximum dose will be 10 mg, the same as in one serving. Therefore, to be poisoned, you’d have to ingest six of them.

The risk of overdose is slightly higher when using loose snus, which is challenging to measure precisely. But even in this case, a person would need to intentionally use a much larger quantity than usual.

Breaking Free from Snus Addiction

Overcoming snus addiction is similar to quitting smoking. You’ll need to tackle your addiction to tobacco. Effective methods for dealing with it include behavioral therapies and medication.

Behavioral methods encompass cognitive-behavioral therapy, motivational interviewing, and mindfulness practices.

In medication treatment, nicotine replacement therapy can help gradually reduce your nicotine consumption.

There aren’t specific methods for quitting snus, but these general approaches can be effective.

Footnotes

1. The acute effects of snus in those who have never used tobacco – American Journal of Substance Abuse and Alcohol Misuse ↩︎
2. Smokeless’ does not mean ‘safe’ – FDA ↩︎