Should Doctors Advocate Snus and Other Nicotine Replacements? Yes

Smoking is the biggest avoidable cause of death and disability, and of social inequalities in health, in the United Kingdom. Smoking currently kills over 100 000 UK citizens each year, predominantly from lung cancer, heart disease, and chronic obstructive pulmonary disease. Half of all lifelong smokers die from smoking, typically losing 10 years of life. Non-smokers are victims too. Although smoking is prohibited in public and workplaces throughout the UK, smoking in the home remains an important cause of morbidity and mortality through passive exposure, especially in young children. Stopping smoking reverses or prevents progression of these problems.

The tragedy is that nicotine addiction itself is not especially hazardous. Nicotine is not harmless, but in practice accounts for little if any of the morbidity and mortality caused by smoking. It is the hundreds of other toxins
in tobacco smoke, not nicotine, that make smoking so deadly. So if smokers who are unable, unwilling, or simply unlikely to quit were to switch from cigarettes to other, less hazardous sources of nicotine, millions of lives could be saved.

Recent data from Sweden, where snus has been available for years, indicate that habitual smokers and young people experimenting with tobacco products have substituted snus for cigarettes, resulting in low levels of smoking.
This suggests that smokeless tobacco is an acceptable smoking substitute for some smokers and therefore snus may be effective in this role in other populations.