Snus Explained

Snus should not be confused with SNUS.

Snus (in Swedish ˈsnʉːs/) is a Swedish tobacco product (in Scandinavia) and non-tobacco nicotine product (outside of Scandinavia; often marketed as nicotine pouches) consumed by placing a pouch of powdered tobacco leaves or powdered non-tobacco plant fibers under the lip for nicotine to be absorbed through the oral mucosa.[1] Whereas the nicotine in tobacco-based snus derives from tobacco leaves, the nicotine in non-tobacco snus can be either naturally or synthetically synthesized.[2] [3]

Tobacco-based snus carries many of the same health risks as smoking, although to a considerably lesser degree.[4] Long-term oral tobacco use is correlated with a variety of harmful effects such as oesophagus cancer, pancreatic cancer, stomach cancer, colorectal cancer,[5] cardiovascular disease, stroke[6] [7] and adverse reproductive effects including stillbirth, premature birth, and low birth weight.[8] Conversely, non-tobacco based snus, or nicotine pouches, are currently classified as non-carcinogenic.[9] [10] [11] However, they are still harmful to cardiovascular health due to their nicotine content, and are associated with moderately higher risk of cardivascular disease, stroke, and reproductive harms.[12] [13] The sale of both tobacco based and non-tobacco based snus is illegal in several countries, including Australia, New Zealand and all European Union (EU) countries except for Sweden.[14] [15] It is the most common type of tobacco product in Sweden[16] and Norway[17] and is also available in Switzerland. Some European countries, such as the United Kingdom[18] and Estonia,[19] allow the sale of non-tobacco based snus. Snus is also available in the United States.

Tobacco-based snus

Tobacco-based snus is made from air-dried tobacco from various parts of the world. In earlier times, tobacco for making snus was laid out for drying in Scania and Mälardalen, Sweden. Later, Kentucky tobaccos were used. The ground tobacco is mixed with water, salt, an alkalizing agent (typically, E500), and aroma, and is prepared through heating. After the heating process, food grade aromas are typically added. In Sweden, snus is regulated as a food product and, for this reason, all ingredients are listed on the label of each individual package (can) of snus. Moist snus contains more than 50% water, and the average use of snus in Sweden is approximately 800 grams (16 units) per person each year. About 12% (1.1 million people) of the population in Sweden use snus.[20] Unlike dipping tobacco and chew, most snus today does not undergo the fermentation process, but is instead steam-pasteurized. Pasteurization inhibits the growth of bacteria that facilitate the formation of tobacco-specific nitrosamines, while preserving the desired texture and mouthfeel of the snus. The absorption of nicotine, the addictive substance in tobacco, from snus depends on the level of nicotine in the snus and the pH level in the box.[21] A voluntary quality standard for snus products has been introduced (Gothiatek) that sets maximum levels for certain controversial constituents including nitrosamines, heavy metals, and polyaromatic hydrocarbons. Most manufacturers of Scandinavian type snus adhere to this standard.

Snus is sold in small tins which, in the earlier years, were made of porcelain, wood, silver, or gold. Portioned snus usually comes in plastic tins of 20 to 24 portions, containing about 0.75 to 1 gram of snus each, while loose snus is mostly sold in wax coated cardboard containers with plastic lids (similar to dip snuff), at 42 g (50 g before 2008). Mini-portion and medium-portion snus are increasingly popular formats. Most of these products come in tins containing 20 portions, of either 0.65 or 0.5 grams each for a total of just under 13 or 10 grams, particularly with those for whom concealing their use of smokeless tobacco in places is of utmost importance.

Tobacco-based snus is available in two main types:

Portioned snus comes in three sizes: mini, normal/large, and maxi. The weights vary, but most packages disclose the net weight. Mini portions weigh around 0.5 g, normal portions weigh 0.8 to 1 g, and maxi portions weigh up to 1.7 g. Some brands offer regular and long versions of the normal size sachet.

The nicotine content varies among brands, with the most common strength being 8 mg per gram of tobacco. Stark and extra stark varieties have higher nicotine content, with stark varieties containing 11–14 mg and extra stark varieties containing up to 22 mg. Siberia brand has an "Extremely Strong" snus with 43 mg of nicotine per gram of tobacco, the highest available.[23]

Usage

Snus is typically used by being placed under the upper lip. This is true for both loose snus and portion snus. The pris (pellet of loose snus) or pouch is typically left in place for anywhere between 30 and 120 minutes. No spitting is required.

Snus is not cured, so it can spoil much faster than cured tobacco. While tobacco-based snus is typically refrigerated for short term storage (up to a few months), it is typically frozen for longer term storage of a year or more. It can stay unrefrigerated for a week or more without spoilage. Some tobacco-based snus products are shipped very dry, so they have extended shelf life without needing any refrigeration. This makes them slower to initially "drip", as there is no appreciable moisture in the packet.

Differences to other oral tobacco products

See also: Smokeless tobacco. Some forms of tobacco consumed in the mouth may be categorized as:

Swedish snus: A moist form of smokeless tobacco which is usually placed under the upper lip, and which does not result in the need for spitting. It is sold either as a moist powder known as loose snus, or packaged into pouches known as portion snus. Snus is often mildly flavored with food-grade smoke aroma, bergamot, citrus, juniper berry, herbs and/or floral flavors. Most Scandinavian snus is produced in Sweden and regulated as food under the Swedish Food Act.[24]
  • American snus: Available since the late 1990s, this is similar to the Scandinavian form, but usually has a lower moisture content and lower pH, resulting in lower bioavailability of nicotine than Scandinavian varieties, meaning less is available for absorption.[25] American snus is often flavored, e.g., with spearmint, wintergreen, vanilla or fruit (e.g. cherry), and may contain sugar.[26]
  • Nasal snuff
  • Mostly English, German, and Scandinavian, this is referred to as in Swedish and in Norwegian, and as "Scotch snuff" in the US, is a dry, powdered form of snuff. It is insufflated – "sniffed" but not deeply "snorted" – through the nose. It is often mentholated or otherwise scented.
    Chewing tobacco
  • North American and European product, also known as chew (or in some Southern US dialects as chaw or dip). It is tobacco in the form of short or long, loose leaf and stem strands (like pipe tobacco or longer), or less commonly of chopped leaves and stems compressed into blocks called plugs, or even finely ground pieces compressed into pellets. A few brands are cut into much finer loose strands, like cigarette rolling tobacco. Chew is placed between the cheek and the gums, or actively chewed. It causes copious salivation, especially when chewed, and due to its irritant (even nauseating) effect on the esophagus, this "juice" usually requires spitting. Chewing tobacco is a long-established North American form of tobacco (derived from traditional use of raw tobacco leaf by Indigenous peoples of the Americas), and is also legal in the European Union. Chewing tobacco is sometimes flavored, e.g. with wintergreen, apple, or cherry.
    Dipping tobacco
  • Also known as dip, spit tobacco or, ambiguously, as moist snuff, this is a common American form of tobacco. It is moist, and somewhat finely ground, but less so than snus. Dipping tobacco (so called because users dip their fingers into the package to pinch a portion to insert into the mouth) is placed between the lower lip or cheek and the gums; it is not used nasally. As with chewing tobacco, salivation is copious, and usually spat out. Dipping tobacco is usually flavored, traditionally with wintergreen or mint, though many other flavorings are now available, while some unflavored brands remain popular. Beginning in the mid-1980s, several brands have packaged American dipping tobacco in porous pouches like those used for many brands of Scandinavian and American snus.
    Chema: This Algerian product is a moist tobacco similar to Scandinavian snus in many respects. Outside of Algeria, it is most widely known as "Makla", a name that originates from the Algerian brand "Makla El Hilal", which first produced this type of smokeless tobacco during the French colonization.[27] It is placed in the upper lip in a manner similar to snus; it differs in that it is more finely ground and has an even higher nicotine content and pH level. Sales within the European Union are legal due to its classification as a chewing tobacco. Its safety in comparison to snus has not been studied sufficiently.
  • Naswar
  • A central Asian product which is a moist, powdered form of tobacco, often green and sometimes caked with the mineral lime and/or wood ash. It is used like dipping tobacco or put under the tongue, and is pungent and often heavily flavored, e.g. with culinary oils (cardamom, sesame), the fruit lime, menthol, etc.

    Snus, dry snuff, and dipping tobacco are distinct products that some English speaking people may refer to as snuff but are all processed and used in very different ways, each with their own sets of risks.

    Health risks

    Various national and international health organizations stated that using snus is addictive, represents a health risk, has no safe level use, and is not a safe substitute for smoking.[28] [29] [30] [31] Using snus can cause a number of adverse health effects such as oesophagal cancer, pancreatic cancer, stomach cancer, colorectal cancer, cardiovascular disease and stroke. Snus can also cause adverse reproductive effects including stillbirth, premature birth, low birth weight. Nicotine in snus products that are used during pregnancy can affect how a baby's brain develops in the womb.

    Quitting snus use is as challenging as smoking cessation.[32] There is no scientific evidence that using snus can help a person quit smoking, although widespread snus-usage is correlated with lower rates of smoking.[33]

    Nicotine pouches & non-tobacco based snus

    The first tobacco-free snus product was developed in the beginning of the 2000s by a small start up company named Niconovum. Niconovum registered the non-tobacco snus in 2008 as a medicinal nicotine replacement product (Zonnic) with 2 mg of nicotine. In 2009, RJ Reynolds (now British American Tobacco) bought Niconovum. Thereafter tobacco companies, particularly Swedish Match, became active in the pouch category. Many of Sweden’s leading snus manufacturers, such as Swedish Match, Skruf and AG Snus created their nicotine pouch brands as a direct response to demand for a non-carcinogenic nicotine option with less health-risks.[34]

    In addition to nicotine, non-tobacco nicotine pouches typically contain food-grade fillers, sweeteners, and flavorings.[35] The main ingredient in nicotine pouches in terms of volume is plant fiber. Plant fibers are used to fill the pouch and give it the desired shape, fit, and properties. Different brands use different fibers, but some of the most common derive from eucalyptus and pine.[36] Nicotine pouches are sold in an array of flavors, such as peppermint, black cherry, coffee, citrus, and many others. The nicotine content among nicotine pouch brands typically varies from 1 mg/pouch to 10 mg/pouch[37] although some have much more. Nicotine pouches usually have a longer shelf-life than traditional snus.[38]

    Since 2021, sales of nicotine pouches have grown exponentially with Zyn as the global leader.[39] This popularity has led to controversy among government regulators who view the product's appeal to youth as concerning.[40] In April 2024, the UK's Department of Health and Social Care announced new regulations banning the sale of nicotine pouches to children[41] as part of the Tobacco and Vapes Bill which was announced in the King’s speech on 7 November 2023 and introduced to Parliament on 20 March 2024.

    Regulation

    Non-tobacco nicotine pouches are regulated differently around the world. In some countries, like Norway, the sale of tobacco-free nicotine pouches is prohibited, as it would constitute the sale of a new nicotine-product in addition to cigarettes, snuff, and tobacco-based snus. In June 2018 the Norwegian Directorate of Health forced British American Tobacco Norway to remove the tobacco-free snus Epok, having been sold as the sole tobacco-free brand in Norway since 2014, since as it didn't contain any tobacco, it was a new form of nicotine product, distinct from the other forms of snus approved in Norway. Approval for the nicotine pouch brand ZYN had already been rejected twice for a very similar product.[42] Within days of the ban, Epok was re-introduced to the Norwegian market, with a minute amount of bleached tobacco added, to qualify as snus, an already approved form of nicotine product.[43] As of July 2024, Epok is still sold by Norwegian grocery stores.[44] [45]

    In Finland, until April 2023, nicotine pouches were classified for medicinal use.[46] The Finnish Medicines Agency (FIMEA) stated that nicotine pouches cannot be classified as medicinal products unless they are specifically marketed for a medicinal purpose or it can be demonstrated in some other way that they are typically used as medicinal products.

    In some countries in Eastern Europe like Poland and the Baltics, nicotine pouches are sold freely, because they do not classify as a tobacco product [47] although in Estonia, a special classification of "products related or similar to tobacco products" has been in place since 2020 and the same laws apply as for tobacco products.[48] Although nicotine pouches are not heavily regulated in the European Union, some regulatory characteristics fall under the European Union CLP-Regulation (EC) 1272/2008.[49] [50]

    In Canada, 4 mg nicotine pouches are widely available for sale in gas stations and convenience stores as a form of nicotine replacement therapy under the Zonnic brand.[51] [52] Nicotine products in Canada with a standard dosage exceeding 4 mg are considered a prescription drug, therefore personal imports of nicotine pouches containing over 4 mg of nicotine per pouch are prohibited.[53] Exceptions exist for those who are a health practitioner or medical practitioner, a drug manufacturer, a wholesale druggist, a pharmacist, or a resident of a foreign country while a visitor in Canada.[54] [55]

    The pouches are sold in supermarkets in the United Kingdom, and are not covered by tobacco or medical laws there. In 2022, the Action on Smoking and Health group called for a regulatory framework covering all nicotine products.[56] It is assumed nicotine pouches are classified as tobacco products in the US because they contain nicotine obtained from tobacco.[57]

    Health risks

    There is limited independent testing of the constituents, exposure, or biomarkers of effects for nicotine pouches,[58] although independent research is now emerging.[59] Nicotine itself is currently classified as non-carcinogenic according to the International Agency for Research on Cancer, and according to the Royal College of Physicians nicotine in itself is not a hazardous drug.[60] [61] In turn, it is hypothesized that if nicotine can be delivered without tobacco and smoke inhalation, most, if not all of the harm of smoking can be avoided.[62] However, if not carcinogenic, nicotine is still moderately harmful to cardiovascular health, and long-term use of non-tobacco nicotine pouches thus give higher risk for cardivascular diseases, stroke, and reproductive harms.

    A meta-analysis from 2015 by members of Tata Memorial Hospital in Mumbai, India, argues that nicotine may be carcinogenic through indirect effects on a range of organ systems in the body. Specifically, they claim that nicotine "affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms, which leads to cancer."[63]

    Advocacy groups opposed to the introduction of nicotine pouches in Kenya have protested that they may raise the risk of cancer, heart disease, and reproductive or developmental harms.[64] The Kenya Tobacco Control Alliance alleged that given the higher levels of some toxic chemicals, and what the U.S. Food and Drug Administration said was a lack of medical data showing the pouches are safer than cigarettes (as claimed by manufacturer British American Tobacco), the government should not license the product.

    History

    Snus has a long history of use, reaching back to the 16th century and concentrated in Sweden. Its origin lies in an invention by Jean Nicot (1530–1600), a French diplomat residing in Portugal who cultivated tobacco in his garden, and was one of the pioneers in recognizing the medicinal properties of tobacco. Nicot is also the originor of the word nicotine.[65] Nicot meticulously dried and ground the tobacco leaves into a fine powder, which could be inhaled as snuff. He presented this powder to Catherine de’ Medici (1519–1589), the Queen of France, in an effort to alleviate her migraines. The use of snuff quickly gained popularity among the French court and the upper-class citizens, becoming a fashionable trend. By the early 17th century, the practice of using nasal snuff had also spread to Sweden.[66]

    Tobacco use became so prevalent in Sweden that in 1724, King Fredrik I issued a decree mandating that Swedes cultivate their own tobacco. Consequently, farmers and homesteaders started grinding their own locally grown tobacco. However, rather than snorting it, they opted to mix it into a paste-like consistency and allowed it to ferment in jars for several weeks. The final product was then portioned and placed under the lip, eventually gaining popularity as snus.

    Ettan is the still extant snus brand, which dates to 1822. Its founder, Jakob Fredrik Ljunglöf, introduced pasteurization into snus making, reducing production time by several weeks and preventing microbial contamination.[67] [68] In the years that followed, numerous manufacturers further improved of snus manufacturing, leading to the flourishing of many brands. Several of these brands from that era continue to exist.

    In 1914, the Swedish parliament made the decision to nationalize the entire tobacco industry. This led to the transformation of numerous tobacco companies into the state-owned monopoly known as AB Svenska Tobakmonopolet. As a result, the number of available tobacco products decreased significantly from approximately four hundred local brands to just seventeen, although these were now distributed nationwide. Consequently, employment within the industry experienced a fifty percent decline. In the 1960s, Sweden decided to abolish the import and sales monopoly on tobacco.[69] AB Svenska Tobaksmonopolet later merged with the match manufacturer Swedish Match and was listed on the stock market in 1996.

    See also

    Notes and References

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