© Pouches.eu

Has anyone ever offered you a Röda Lacket, a Generalsnus or an Ettan? Or how about a Swedish Match? Or a Zyn? It’s a new and increasingly trendy way to consume tobacco that is catching on amongst young consumers and spreading across Europe. Actually, when I say “new”, that’s not strictly true; the tobacco companies have only just started to market snus heavily across Europe, but they’ve been a popular way to consume tobacco, especially in Scandinavian countries, for a long time. In Sweden, for instance, it was more common to see somebody using snus than smoking a hundred years ago. The snus is a traditional product but it’s just starting to catch on, especially among young people, across the rest of Europe. What is it? You may well be wondering. Clearly, it’s a tobacco-based product, which would seem to go against government policies based on the idea of having “tobacco harm reduction” (THR) as an aim, but Sweden is claiming a good measure of success, with smoking rates having dropped to 5.6%. Within the European Union (and in the UK) if a government can get consumption below 5% it can claim to be “smoke free”. I write from experience, having given up cigarettes, then a pipe and finally snuff (which is messy and gets everywhere) many years ago. I certainly do not miss the taste of tobacco, so I’m not attracted by the idea of sucking the stuff.

Snus is a tobacco product, sold in small pouches after the tobacco itself has been ground up very finely, then packed into a small porous pouch. Whether the word “snus” is singular or plural is a matter of on-line debate, it seems. The user tucks the little bag under his or her top lip, pressed against the gum between the lips and the teeth, from where they can get it to release a strong ‘kick’ of nicotine (the manufacturers claim). It may sound revolting (at least, it does to me) but sales in Belgium and Switzerland are picking up fast.

The pouches contain a bulking agent mixed with nicotine and are thought to be growing in popularity because they don’t cause bad breath, nor do they stain the teeth, qualities that are both popular selling points when compared with other forms of tobacco use. The “Big Four” tobacco companies are now engaged in fairly aggressive marketing campaigns to boost sales further and the global market for the product is now predicted to reach $21.84-billion (€20.35-billion) by the end of 2027. It’s easy to understand why the tobacco companies are so keen on it and I suspect that enthusiasm has little to do with THR policies, other than in finding a way to sell the product that doesn’t break the law.

Snus is distributed to Germany and many other EU countries. An on-line promotion boosts that one German vendor has over 20 years of experience and expertise “in the online distribution of smokeless tobacco products, tobacco-free nicotine pouches, snus (similar in a way to chewing tobacco) and chewing bags”. It’s certainly catching on in a big way: the Swedish government has confirmed that actual smoking rates have fallen to just 5.6%, from 40% in 1976. That’s getting close to being able to claim the country is “smoke free”, which only requires the figure to drop to 5% or below (at least, in the EU and the UK). In the UK, cigarettes are most frequently being replaced by e-cigarettes. In this case, instead of a paper tube filled with tobacco which the smoker lights, drawing the smoke into their lungs, they inhale from a tube containing tobacco derivatives that are heated to release the fumes of combustion. The problem is that with ordinary cigarette smoking, along with the tobacco smoke, the user inhales more than 4,000 different chemicals, none of which have any health benefits and in fact are potentially harmful to the smoker. Clearly, then, bad for the user’s general well-being, or at least offering no health benefit.

An e-cigarette, on the other hand, doesn’t contain tobacco and neither does it involve the burning of tobacco or any other substance. Instead, e-cigarettes are filled with a liquid that most often (but not always) contains nicotine. Inside each of them there is a small battery-powered heating element which turns the liquid into a vapour. This is what is then inhaled through a mouthpiece. As a consequence, there’s no combustion, so there’s no smoke. Using e-cigarettes is called “vaping” and it has caught on mostly in the UK. Usually, there is a choice of flavours available. Snus, of course, is a quite different product, but where they have caught on – chiefly in Scandinavia – cases of lung cancer and heart disease have dropped, quite considerably.

| SMOKE SIGNALS

The consumption of snus which is already popular in Scandinavia is now on the increase elsewhere, especially in the United States and increasingly in Finland. Research at Oxford University has shown that as the popularity of snus has increased, so has the nicotine content. The researchers found that the average amount of nicotine per gram of snus sold in Norway, for instance, increased from 16.3 milligrams per gram of snus to 24.1 between 2005 and 2020. Meanwhile, Sweden’s leading producer of snus, Swedish Match, has now obtained approval from the US Food and Drug Administration to market eight snus products in the US as “Modified Risk Tobacco Products”. It’s not modified to the point at which medical practitioners might describe it as wholly “safe”. One on-line advertisement, for White fox snus, describes its products as “mainly made for the experienced user, this is due to the higher nicotine levels.” Those words will undoubtedly attract some potential buyers, as will the following, for the same producer: “KILLA Snus is extremely popular and is mainly used by experienced users. All Snus that KILLA Snus produces contains only high nicotine levels.” We must assume that the name “KILLA” is not to be taken literally?

Norway has seen a massive growth in sales, from 286 tons per year in 1985 to 1,487 tons in 2019, and that’s without counting snus bought over the border in Sweden or from tax-free and other sources. There has also been a massive proliferation of products available on the market, with new flavours and more elaborate packaging to attract buyers. This ended in 2017, when a new law was brought in, enforcing plain packaging on all tobacco products. Manufacturers have proved quite inventive in their ways of marketing snus. A study published in 2007 showed that both nicotine content in milligrams per gram and nicotine yield, measured in smoke generated by a smoking machine based on the Massachusetts smoking regimen, increased in all major cigarette brands from 1997 to 2005, but there have been no market-based studies of changes to nicotine content for Swedish snus.

In Belgium, the most recent data shows the number of deaths from smoking each year to be 18,736. Of those, in round figures, 13,200 were men and 5,500 women, which means that Belgium has 2.4-million smokers. 26.9% of men smoke, as do 23.1% of women. Belgium has no specific law on the use of heated tobacco products like snus. It’s illegal to sell them to anyone younger than 18. Strangely, buying or selling snus is illegal in Belgium, but it’s legal to use the product if you can obtain it in some way that doesn’t contravene the law. In fact, it is illegal to buy or sell snus anywhere within the EU except in Sweden. The law is ridiculously complicated. While it is against the law to import snus for trade or to buy the product on line, it is legal to import it for personal use. However, Nicotine Replacement Therapy (NRT) can be bought legally in Belgian pharmacies and the market in Belgium is worth €18.7-million. In case you’re wondering, US Daily Med explains it on Wikipedia like this: “Nicotine replacement therapy is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the chance of quitting tobacco smoking by about 55%.” This includes things like stick-on skin patches to reduce cravings.

| SNUS AND HEALTH

According to Marjut Salokannel from the University of Helsinki and Eeva Ollila from the Cancer Society of Finland and University of Tampere, Helsinki, Finland : « It has been argued that it is less harmful for young people to use snus than to smoke. A systematic review found few primary studies investigating the possible association between snus and changes in smoking behaviour. However, it is noteworthy that (1) snus may serve as a gateway for smoking, at least among Finnish adolescents (2) many school children end up as dual users (3) nicotine is also harmful in itself, especially for the developing body, including the brain and (4) that snus carries considerable health risks”

In a study published The BMJ Peer-reviewed journal published by the trade union the British Medical Association, the now deceased President of the British National Heart Forum, Alexander W Macara wrote in 2008 : « the expert group of the International Agency for Research on Cancer has concluded that smokeless tobacco is carcinogenic to humans, and the European Commission report cites studies by the Swedish Institute of Public Health and the Karolinska Institute as evidence that snus is carcinogenic ».

Control of tobacco and tobacco product sales was introduced across the EU under the EU Tobacco Products Directive (TPD) in 2014. The law made it illegal to buy on-line and also imposed health warnings in Dutch, French and German, while advertising is banned. The TPD may exclude Sweden, but it is applied vigorously elsewhere, with the following wording: “The prohibition of the sale of tobacco for oral use should be maintained in order to prevent the introduction in the Union (apart from Sweden) of a product that is addictive and has adverse health effects.” So, you cannot buy it or import it, but if you can get hold of it there is nothing to prevent you from using it. As one website puts it: “There is no specific law on heated tobacco products and the situation is quite complicated for snus.” It then causes further confusion by adding that: “While it is illegal to import snus for trade or buy the product online, it is possible to import it for personal use.” As an old aunt of mine used to say, that makes it as clear as mud. Another website, run by “Global State of Tobacco: Harm Reduction”, says: “No information about regulation of HTP is available for Belgium. HTP is illegal to be marketed.” In its own report, the University of Bath states clearly that: “With the exception of Sweden, the sale of snus is prohibited in the European Union (EU).”

The EU ban on snus dates from 1992 and it came in response to aggressive attempts to introduce into Europe US-style smokeless tobacco known as “Skoal bandits”. According to a report by University of Bath in the UK, the US Smokeless Tobacco Company (UST), in partnership with British American Tobacco (BAT) began to market the product in several European countries, including the UK and Ireland. The report states that: “A peer-reviewed study from the University of Bath, analysing internal tobacco industry documents, demonstrated that tobacco companies saw smokeless tobacco as having the potential ‘to generate new profits without cannibalising existing profits from cigarettes’ in Europe, and that young people were a key target.” The health concern that seems to interest the producers most would appear to be their bottom line.

| TRYING TO BAN A BAN

All of the ‘big four’ tobacco companies: BAT, JTI, Imperial Brands and Philip Morris International have invested in certain types of smokeless tobacco, and that includes the production of snus, a key product of Swedish Match, a tobacco company that doesn’t sell cigarettes. It’s worth noting, though, that Swedish Match was acquired in 2022 by Philip Morris International.

Bizarrely, the promotion of Skoal Bandits in the UK mainly employed students to encourage their peers to try them. A 1985 BAT internal memo referred to the method as “working the universities”, which included paying students to promote them to other young people. In view of these tough sales tactics, the European Parliament called for an EU-wide ban on the sale of “oral tobacco” in September 1987. Just before this, the World Health Organisation (WHO) urged countries with no history of smokeless tobacco being consumed to ban it pre-emptively. In 1998, Ireland became the first country to do so, followed two years later by the UK and Belgium. In 1992, an EU-wide sales ban was imposed on oral tobacco, and it was reimposed in 2001 and again in 2014. Suddenly, the big tobacco companies started to sit up and take notice, questioning the legality of legislation to restrict sales of tobacco products.

The tobacco industry was slow to respond to the proposed ban, initially dismissing the idea and probably because the big companies had very little investment in smokeless tobacco, although that changed. Despite this apparent lack of concern, the tobacco companies did get together to found the European Smokeless Tobacco Council (ESTOC), which briefly lobbied members of the European Parliament’s Legal Affairs Committee to question the legality of the proposed new Labelling Directive. In a series of complex manoeuvres, the issue came before the European Court and a bitter and, at times, divisive row ensued as some groups tried to get the snus ban lifted. The national bans on smokeless tobacco in Ireland and the UK were overturned, but the challenge to the ban in Germany and the UK, brought by Swedish Match and the German cigar maker Arnold André (Swedish Match is one of its shareholders) failed to convince the European Court of Justice (ECJ) that the ban was in breach of the EU principle of subsidiarity. The Court upheld the ban, and Swedish Match decided to make it an EU-wide political issue, claiming that it was a violation of the principles of free trade. “The scope of the Directive should be reviewed so that all tobacco products are treated in the same way on the internal market regardless of nationality,” said the submission to the court. The argument was that it amounted to an export ban on snus, leading to cross-border market distortion. The submission also claimed that the insistence on plain packaging infringed the makers’ rights to use their trademarks. That, they argued, undermined their intellectual property rights. Despite a threat of “all-out war” by Sweden’s Trade Minister of the time, Ewa Björling, in June 2013 the Swedish government abandoned its efforts to get the snus ban lifted. The big tobacco companies have made other attempts to get the EU’s decision lifted, but so far without success.

For now, that’s where we are, although things could yet change. With public concern mainly focused on measures to keep people – especially the young – healthy, it seems likely that the current rules will stay in place. That doesn’t mean, of course, that the big manufacturers won’t come up with a new product and try to get that past the legislators and onto the market. They may claim that they won’t, but that could be just a smokescreen.