Freddie Edlund started snusing when he was 7.
His initiation began the usual way: “My best friend’s older brother and his gang were all doing it. They were about four years older than us and we wanted to be tough guys like them, so we started doing it,” Edlund recalled.
He kept sneaking snus until he was 10. Then one day, on a dare, he swallowed a big wad of the stuff.
“I barfed my brains out. Never been so sick in my life. Couldn’t even look at snus again until I was 12,” said Edlund, a factory worker and part-time musician.
But aside from that brief preteen hiatus, Edlund, now 29, has been a daily and enthusiastic user of snus, a pouch tobacco product that in little more than a generation has radically transformed the tobacco consumption habits of Swedish men and, according to a growing stack of medical research, has significantly lowered their risk of smoking-related diseases.
The popularity of snus in Sweden has kindled a debate among public health officials here and elsewhere in Europe about whether snus should be encouraged as a safer alternative to smoking, or discouraged as just another harmfully addictive tobacco product.
And as Americans by the millions continue to turn away from cigarettes, the biggest cigarette marketer in the U.S., Philip Morris, is dipping its fingers into the market too, launching a snus product in Texas under its mega-cigarette brand name Marlboro.
Such a move is controversial but a necessity for U.S. tobacco companies as pressure mounts to find new avenues of growth in the face of a continual slide in the number of smokers in the U.S. Philip Morris says its interest in snus was “natural” because “the smokeless tobacco category in the U.S. market has been growing for a number of years.” Rival R.J. Reynolds already has introduced a similar product under its Camel label.
But at $3 billion, the smokeless market is still tiny compared to the $70 billion cigarette market, making it essential for companies to ramp up new products.
Snus — the Swedish word for snuff — is what the tobacco industry describes as a “spit-free smokeless tobacco product.” Swedish snus delivers a powerful nicotine punch, but with far lower levels of carcinogens than cigarettes.
Swedish snus is moist, finely ground tobacco typically sold in round plastic or metal containers about the size of a hockey puck. The actual snus comes in two forms: loose or in little paper sachets that look like miniature tea bags. You tuck the sachet or a glob of loose snus behind your upper lip.
Thirty years ago, 43 percent of Swedish males smoked; today the figure is 14 percent, the lowest in the industrialized world. Health experts credit the drop to aggressive anti-smoking campaigns and the growing popularity of snus as a replacement. During this same period, daily snus use among males grew from 9 percent to about 23 percent.
Overall tobacco consumption in Sweden has not dropped much, but researchers are impressed by a significant statistical decline in lung cancer and other smoking-related diseases among Swedish men.
In Sweden, the main argument in favor of snus is that it seems to help people quit smoking. It satisfies their nicotine craving with a tobacco product that is just as addictive but far less harmful than cigarettes.
“The trouble is, if we say that snus is less harmful than cigarettes, it is perceived as being a little less harmful. In reality, snus is much less harmful,” said Lars Ramstrom, director of the Institute for Tobacco Studies in Stockholm, a research organization that does not accept money from the tobacco or pharmaceutical industries.
Most of the smokeless tobacco products in the U.S. — one thinks of baseball players with a cheek puffed out with chewing tobacco — contain high levels of carcinogens, and studies have consistently linked these products to high rates of cancer of the mouth, head and neck.
But because of the way it is manufactured — dried rather than fermented — Swedish snus contains much lower levels of cancer-causing nitrosamines. Several recent studies in Sweden have shown no increased incidence of oral, head or neck cancers among snus users.
The bottom line, according to Ramstrom, is that while snus cannot be described as a healthy product, its use in Sweden has reduced smoking among males, lowered the risk of associated cancers and produced an overall public health benefit.
Eleven years ago, Susanne Svensk, 41, a medical secretary with a pack-a-day cigarette habit, began experiencing rapid heartbeat and other cardiovascular problems. Her doctor ordered her to quit smoking.
Without snus as an alternative, she said, “it would have been very hard.”
She smoked her last cigarette in 1996, and feels much better today. Although snus has generally been regarded as a “guy” thing, there has been a gradual increase in snus use among Swedish women along with a commensurate drop in female smoking rates. A new snus brand has been marketed toward women.
“I prefer snus. I’d never go back to cigarettes now,” Svensk said. Her partner, Gunnar Lindforst, 48, started sneaking snus when he was 10. At 18, he was a daily user and also smoked half a pack of cigarettes a day.
“I’d smoke a cigarette and then take a snus. The snus was the best,” he said. When Svensk had to quit smoking, Lindforst decided to join her.
“Quitting [cigarettes] was nothing, but I think it would have been a real problem without snus,” he said.
But not everyone thinks snuff is such great stuff.
“Snus is less dangerous than cigarettes, for sure, but it is very hard to find anything more dangerous than cigarettes,” said Goran Pershagen, a professor of environmental hygiene at Stockholm’s Karolinska Institute. Last year, he headed a government study into the supposed benefits of snus.
“We made the assessment that snus is carcinogenic and that it increases the risk of mortality through cardiovascular disease,” he said. The study also found evidence, though not conclusive, that snus can be harmful to pregnant women.
Pershagen rejected the argument that snus served a beneficial purpose as a nicotine substitute for people trying to quit smoking.
“That logic is flawed. I would rather people look at other products to stop smoking,” he said, mentioning nicotine gum and patches. “I cannot see any advantage of snus over these products.
“Also, there is no natural law that says 30 percent of the population should be nicotine addicts. Nicotine has profound negative effects on the cardiovascular system. I’d prefer a tobacco-less society.”
The European Union has banned the sale of Swedish snus, except in Sweden, since 1992. But many voices in the European anti-smoking lobby, including Ramstrom’s, say it is time to reconsider.
“It was a pre-emptive measure based on the evidence at the time,” Ramstrom said of the ban. “The EU reached its conclusions before knowing the modesty of the risks.”
For Ramstrom, it has been something of a road-to-Damascus conversion. In 1990, he co-wrote a paper on Swedish snus, published by the British Journal of Addiction, warning that snus “must be seen as an introduction to the tobacco habit and possibly a first step toward taking up cigarettes.”
“That’s outdated,” he said in a recent interview. “That was before major studies were available. I had to change my mind based on the evidence.”
In marketing its new Marlboro snus product, Philip Morris steers clear of any suggestion that it is a safer form of tobacco or that it may help with quitting smoking. “We are not making any reduced harm or exposure claims,” company spokesman David Sutton said.
Marlboro snus packages will carry the same grim warning labels all other smokeless tobacco products must display, including one that says the product “may cause mouth cancer.”
Swedish warning labels state that snus “can hurt your health and is addictive.” But that has done little to dampen Freddie Edlund’s enthusiasm for the product.
“I use both kinds, but I prefer the loose snus,” he said, using his fingers to scoop out a generous dollop of fragrant tobacco and compress it into a marble-sized ball.
Among the attributes of snus noted by Edlund is that because it is smoke-free, you can use it in restaurants, the workplace and other environments where smoking is prohibited. “It also leaves your hands free so you can do other things,” he said.
Edlund, a former ice hockey player, said he used to use snus during games. “Fine as long as you don’t get hit in the face.”
Another advantage over cigarettes is that snus lasts longer. Most users of the pre-packaged sachets spend 30 minutes to an hour with each sachet. Up to two hours is common. Edlund’s record is five hours during a bus trip to a hockey game.
The only negative that Edlund could think of was an ex-girlfriend who refused to kiss him when he was snusing.
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thundley@tribune.com
