Could Chew and Snuff Help End Smoking?

(Smokeless tobacco. Image via Wikipedia.)

With U.S. smoking rates at historical lows, it would seem that the anti-tobacco message has triumphed. Not all tobacco, however, is smoked, and some reformers are pushing a new type of tobacco harm reduction policy: one that encourages smokers to take up smokeless tobacco instead, before quitting altogether.

Smokeless tobacco (chewing tobacco or snuff tobacco) is as addictive as cigarettes, and has the same amount of nicotine. But smokeless tobacco proponents are insisting that getting smokers to switch to chew or snuff can lower smoking-related cancer rates and save lives.

The 2009 Waxman-Kennedy Family Smoking Prevention and Tobacco Control Act gave the FDA the authority to regulate the tobacco industry, and approve or block new tobacco products. The FDA considers smokeless tobacco just as harmful as cigars and cigarettes. Former Indiana representative and current Reynolds American consultant Steve Buyer, however, has been boosting smokeless tobacco as a means to help smokers quit.

In a September 19 testimony before the Indiana Health Finance Commission, Buyer cited research conducted by the World Health Organization to show that smokeless tobacco has aided in lowering Swedish male mortality rates from tobacco-related causes. Sweden now has the lowest rates of tobacco-related male mortality of any country in the European Union. According to the WHO, Smokeless tobacco has also contributed to lowering the rates of male lung, oral and pancreatic cancers, as well as lowering the percentage of Swedish adult male smokers (Sweden’s rate is under 15 percent, with the next lowest EU country at just under 25 percent). The research shows that smokeless tobacco products like snus or moist snuff can eliminate roughly 98 percent of the health risks of smoking. By putting those findings into practice, Buyer has concluded, more lives could be saved and faster.

Buyer and others who support smokeless tobacco as an alternative, such as Brad Rodu, who holds an endowed chair in tobacco harm reduction research at the University of Louisville, are facing an uphill battle. They have received pushback from institutions such as the American Lung Association, the American Cancer Society, and the American Heart Association, which have found their claims and research to be problematic. The Indiana State Department of Health, along with others, has indicated it would not enact a policy that would push smokers toward smokeless tobacco products. Similarly, the FDA would not promote it as healthier alternative.

Daniel McGoldrick, vice president of research for the Campaign for Tobacco-Free Kids, poked a hole in Buyer’s thesis in a testimony submitted to the Indiana Health Finance Commission. McGoldrick wrote that not only is tobacco use declining at the fastest rate in history, but, according to the U.S. Public Health Service, there is also no evidence to suggest that smokeless tobacco use is an effective way to promote cessation. McGoldrick also pointed out that the U.S. is not Sweden: states won’t be able to regulate smokeless tobacco as tightly as Sweden has. McGoldrick additionally cited a 2009 study that found that American smokers’ quit rates are unaffected by smokeless tobacco use.

So the first task for the pro-smokeless tobacco camp will be addressing the transition between smokeless tobacco use and quitting. After all, if smokers switch to chew and snuff because they see smokeless tobacco as less risky, they might be less likely to quit.

Smokeless tobacco may have potential as a tool for tobacco harm reduction, but with the opposition it faces and without FDA approval, don’t expect it to become popularized in the near future.