Tobacco harm-reduction strategies, such as the use of Swedish snus, have been suggested as a way to further reduce this disease burden. In Australia, the most dangerous tobacco products cigarettes are the least regulated, while oral tobacco products, including snus, cannot be sold legally.
Recent epidemiological modelling indicates that there are only small differences in life expectancy between smokers who quit and those who switch to snus. There is a case on public health and ethical grounds for allowing inveterate smokers who want to reduce their health risks to access snus.
At a minimum, the recent increase in tax on smokeless tobacco should be reversed, and the ban on the commercial importation and supply of low nitrosamine smokeless tobacco should be reconsidered in light of the epidemiological evidence on its potential to reduce tobacco-related disease in smokers. A ustralia currently has one of the lowest rates of daily smoking in the world thanks to high taxation, comprehensive advertising bans, restrictions on smoking in public places and workplaces, and funding for smoking cessation programs.
Nonetheless, 2. The key to reducing the health burden of tobacco in the medium term is increasing cessation among smokers. On the available evidence, Swedish snus low nitrosamine, moist oral snuff appears to be a good candidate for achieving this aim.
As a smokeless tobacco SLT product, snus does not produce any of the combustion products of smoking and it is manufactured in a way that produces low levels of tobacco-specific nitrosamines, the main carcinogens responsible for oral cancers in users of other SLT products.
The increased use of snus in Sweden over the past 20 years has coincided with substantial reductions in smoking prevalence and tobacco-related mortality. Snus use may increase the risk of pancreatic cancer, 14 and there remains the possibility of some residual risk of cardiovascular disease from the direct effects of nicotine. In Australia, the most dangerous tobacco products cigarettes are the least regulated, while oral tobacco products, including snus, cannot be legally sold because in the federal government banned the manufacture, importation and commercial supply of chewing tobacco and oral snuff in Australia under the Trade Practices Act Cwlth.
Individuals are permitted to import SLT for personal use without a permit in amounts up to 1. The levels of carcinogens and other toxins in smoked tobacco products are currently unregulated, and tobacco manufacturers can introduce new tobacco products into Australia so long as they are smoked.
For example, the federal government publicly welcomed the introduction of a new form of cigarette by Philip Morris that makes implied claims of lower health risks than traditional cigarettes 22 , 23 in the absence of any supporting evidence. Dissemination by governments of misinformation on the relative harms of snus creates scepticism and mistrust of public health messages.
Public health legislation should be reviewed when new evidence contradicts its underlying assumptions. Snus needs to be regulated in ways that address a number of legitimate concerns that have been raised. One concern is that promoting snus use may reduce overall tobacco-related mortality and morbidity among smokers who switch, but at the cost of increasing tobacco-related disease in the non-smoking population.
We think this unlikely, because epidemiological modelling suggests that the health gain from one would-be smoker who uses snus instead of cigarettes would only be offset if 17 non-smokers who would not otherwise have smoked started to use snus and did so for the rest of their lives. A second concern is that increasing snus use would reduce rates of smoking cessation. That is, smokers who may otherwise quit because of the inconvenience of smoking bans may use snus when smoking is not allowed and smoke when it is.
In Sweden, however, smoking prevalence and tobacco-related mortality have both declined as snus use has increased. This is because people who start to use snus are much less likely to start smoking than those who do not use snus, and smokers who start using snus are more likely to quit than those who do not.
A third concern is that tobacco companies may use lower risk tobacco products to undermine tobacco advertising bans. Rather, factual information and advice could be provided via QUIT lines, general medical practitioners and pharmacists, who could recommend snus use as an additional path to quitting, or as a second-best option to quitting. Mandatory warning labels on snus packs could also advise of the probable health gains and risks of snus eg, oral and pancreatic cancers and possibly cardiovascular disease.
As a new product, the nitrosamine content of SLT products could also be controlled by specifying maximum permissible levels of carcinogens. We could also reduce the attractiveness of these products to non-tobacco users eg, children by banning the importation and sale of flavoured snus. A fourth objection is that snus will not be an attractive alternative to cigarettes because Australians have never had a tradition of SLT use.
We think it unlikely that no Australian smokers will be interested in snus, as the market for SLT products appears to be growing in both the US oral snuff and the United Kingdom nasal snuff. Insisting on a continuation of the current ban on SLT will prevent this claim from ever being tested. We see four policy steps that would allow an exploration of the public health benefits of increasing snus use in Australia.
We should reduce the absurdly high customs tax on SLT products to make snus more affordable and easier to import. We should allow SLT products that comply with set standards of carcinogens to be sold under the counter in a limited range of licensed outlets eg, tobacconists or pharmacies.
If smokers do use these products, we should allow SLT products to compete with smoked tobacco under the same restrictive conditions of sale, but with lower rates of taxation on SLT products. Medical practitioners and QUIT lines could encourage inveterate smokers to switch to SLT as a way of reducing the harm caused by their tobacco use.
As the Royal College of Physicians has recently concluded, 29 there is a strong case on public health and ethical grounds for allowing inveterate smokers who want to reduce their health risks to have access to snus.
This could be achieved immediately by reducing the prohibitive import duty on SLT to make importation for personal use more affordable. Legislation is also needed: to reverse the Australian ban on the commercial importation and supply of low nitrosamine SLT; and to allow its sale under restrictive conditions that address the legitimate concerns raised about the promotion of these products to non-smokers.
Mortality rates in male smokers who continue smoking, switch to snus, or quit all tobacco. A: Smokers who switch to snus or quit all tobacco at age 35 years. B: Smokers who switch to snus or quit all tobacco at age 55 years. Neither author has had any past connection, and neither has any present connection, with the tobacco industry. We have never accepted funds from a tobacco company, including manufacturers of snus or other smokeless tobacco products.
Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.
Basic Search Advanced search search. Melbourne: Cancer Council Victoria; Oral tobacco was briefly marketed in Australia during the s, however all smokeless tobacco products were subsequently banned in several states during the late s. A permanent federal ban on the manufacture, importation and commercial supply of the products came into effect in June , 4 although consumers are able to privately import up to 1.
This regulatory framework allows current users to access smokeless tobacco, while discouraging uptake by non-tobacco users especially young people. Reducing taxes and allowing commercial importation and supply could potentially promote reduced harm among smokers who switch to smokeless products. For recent news items and research on this topic, click here.
Last updated August Benowitz N. Smokeless tobacco as a nicotine delivery device: harm or harm reduction? National Cancer Institute, Smokeless tobacco and cancer. Bethesda, MA: U. Note: The sale of snuff is banned in Australia. You can import snuff for personal use as long as you do not sell or supply it to others. Duty still applies to snuff that is entered into the Australian market. Historical excise duty rates External Link are listed on the Australian Government data.
Imported tobacco is a type of excise equivalent good EEG. Instead of paying excise duty on EEGs, you generally pay an equivalent customs duty. Show download pdf controls.
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