Reduce the harm from nicotine use: Go Snuff.

Using modern smokeless tobacco products can reduce the risks of tobacco use by over 95% compared to smoking. These products include moist snuff (which is sometimes called by its Swedish name, snus), chewing tobacco, lozenges and of course Nasal Snuff.
And you do not have to chew or spit – many modern products require no spitting and are as easy to use as a breath mint. Using pharmaceutical nicotine products would probably work as well, but unfortunately the available nicotine patches and gums are not designed to be good long-term alternatives to tobacco.
Of course, this does not mean that someone who does not use nicotine should start using smokeless tobacco. It is easier, cheaper, and a bit healthier to not use nicotine at all. But if you like nicotine, smoking is the worst way of getting it. Switching from cigarettes to smokeless tobacco is almost as good as quitting entirely, and is certainly much better than trying to quit and failing.
Nasal Snuff has a 400 year history with no known health problems we know of. However you should be aware that there have not been many modern scientific trials done. Those trials that have been conducted (for example the Poschl study) have backed up the 400 year old anecdotal evidence. To be safe, follow the advice of the Surgeon General. We make no absolute claims one way or the other.

Take it Easy

What seems to work most of the time for successful switchers is a gradual shift from smoking to using nasal snuff. The products are different enough that it takes a little time to feel comfortable with the new product and for it to deliver the same satisfaction as smoking. So be patient with the process. Allow yourself time to get used to it and gradually shift
from one to the other. Of course, in terms of health, the sooner you can give up smoking entirely the better, but take consolation in the fact that even if you cannot do that, every little move in that direction works in your favor. Don't worry if it takes a little longer than you planned. Any major life change, and quitting smoking is a big one, takes time.

With minor amendments this information is borrowed from a website run by tobaccoharmreduction.org , a project run by the University of Alberta School of Public Health

Public health is all about harm reduction

Suggesting that nicotine users have an option other than quitting entirely is controversial, but it should not be. Almost all of public health is devoted to reducing risks and harms, not eliminating them entirely. The term "harm reduction" is most often used in the context of clean needles for injection drug users, or using condoms to make sex safer. But we think the best analogy is seatbelts. Instead of telling people that they should just quit driving, we try to make cars and roads as safe as possible. Similarly, we do not tell people to quit playing hockey or bicycling, but we try to get them to wear helmets.
But though we try to reduce the risks to recreational drivers, hockey players, heroin users, and sex workers, most health officials single out tobacco users and tell them they simply must quit. They go so far as to lie to people, to tell them that smokeless tobacco is about as bad as smoking. Anti-smoking advocates have gotten so focused on attacking tobacco and the tobacco industry that they have forgotten that the goal is to help people. They would rather have tens of millions of people make themselves miserable trying, and usually failing, to quit smoking, rather than to admit that switching to another form of tobacco might be a good solution for some of those smokers.
We are not so naive to think that everyone is just going to quit using nicotine and with that in mind we are working at finding and promoting actions that reduce the associated health risks. We also do not think it is acceptable to lie to manipulate people's behavior, or fair to just punish smokers with new taxes and regulations. By telling the truth about smokeless tobacco we can help nicotine users rather than punishing them.

What is Tobacco Harm Reduction?

Most people who smoke do so to get nicotine. But smoking is a terribly unhealthy way to get nicotine. You probably know smoking is very bad for your health. But what you probably do not know – because there are a lot of people trying to mislead you – is that nicotine is not very bad for you. Neither is tobacco, as long as it is not on fire. The danger from smoking is almost entirely due to inhaling concentrated smoke, which is bad for you no matter what is burning.
A lot of people want nicotine, and they do not realize they can get it without all the dangers of smoking. Tobacco harm reduction focuses on reducing the huge risks from tobacco use for people who choose to continue to use nicotine. Unfortunately, most major health organizations have only one message for smokers: Quit, or die. If you are unable or unwilling to quit using nicotine, they offer you nothing other than the severe health risks of smoking. We would like to offer you another option.

How can a smoker reduce his or her risk?

There are two ways a smoker can reduce their health risks. One is quitting nicotine entirely, quitting smoking and not substituting another source of nicotine. The other is getting nicotine from a much less harmful source. Unfortunately, neither one will immediately eliminate all of the health risks caused by their previous smoking, but both come very, very close.
Of the two, quitting entirely is probably the slightly healthier option for most people (we say "probably" and "most people" because there are some health benefits from nicotine that for some people might outweigh the very small risks from highly-reduced-risk nicotine products). This is because nicotine itself may slightly increase your risk of cardiovascular disease (heart attack and stroke), though not nearly as much as smoking does. But switching to a highly-reduced-risk nicotine product is almost as good as quitting entirely. Those products have only about 1/100th the risk of smoking.
We are sure that you are aware of the many programs, drugs, and therapies available to help smokers quit using nicotine entirely. You should have no trouble finding one of those if you want, and we very much hope that if you are a smoker and elect to quit entirely, that you do succeed. But since you are reading this, we assume that you or someone you know is among the large majority of smokers who have tried to quit and failed, or wants to use nicotine but wants to minimize the risk.

What are highly-reduced-risk nicotine products?

The most popular highly-reduced-risk nicotine product is smokeless tobacco, specifically modern Western moist snuff (the Swedish word for which is snus) and chewing tobacco, or other tobacco products such as snuff. The other class of products is pharmaceutical nicotine products (such as nicotine gums, lozenges, patches, and inhalers). Someone who uses one of these products rather than smoking reduces the risks by about 99%.
Quitwithsnuff.com focuses on nasal snuff as the most promising way to give up cigarettes with the lowest negative impact on health, but according to tobaccoharmreduction.org at Alberta University, if you are a smoker and switch to any of these products, the benefits are almost as good as the benefits from quitting entirely.

Isn't harm reduction a controversial idea?

Anti-tobacco advocates think that it is, but this is simply not true. Most all of public health, and a large part of medical care, is devoted to harm reduction.
The term "harm reduction" is most often used in controversial contexts, like encouraging condom use and other safe sex practices, or providing heroin users with clean needles or methadone. Calling it "harm reduction" reminds us that people would be at less risk of disease if they avoided sex or gave up narcotics entirely, but we cannot expect that to happen.
But harm reduction is also our policy in most matters of health. Driving and other transport is a dangerous activity, but we do not suggest that people give it up. We do not even tell them to limit it to "necessary" trips, avoiding vacations or trips to the video store. Instead, we have rules of the road that make it safer, encourage (or mandate) seatbelt use, and build cars with safety features. Similarly, we do not tell people they have to give up playing hockey, bicycling, or other sports, even though there is some risk, but we do try to encourage the use of protective equipment.
When physicians or public health practitioners try to get you to change your cholesterol, eat less meat, or exercise more, the target is to improve your health but seldom do they insist that you have only one choice: Do the best possible thing or forget it. Taking most health advice will reduce your health risks but not get them to the lowest possible level.
When it comes to diet, exercise, sex, transportation, sports, and even heroin use, public health experts generally agree that scolding people to do the healthiest thing possible is just not practical or reasonable (indeed, it would be downright cruel in most cases). Instead we realize that people will decide that the benefits of certain behaviors are worth some risks, so we try to help them reduce their risks. Of all the things people do, nicotine use is about the only one where health officials do not promote harm reduction, and think they have a right to just demand you do what they want; and will even lie to you to keep you from learning about reduced harm alternatives.

Can't I be 100% safe?

If you find yourself dealing with someone who seems to be insisting that comparative risk does not matter - that a lot better is not perfect and therefore not worth pursuing - try having this conversation (exact details might vary, but we would bet not by much):
You: Do you think it is good to tell people to eat more fruits and vegetables? If so, why?
Ostensible Public Health Expert: Yes, certainly. Eating more fruits and vegetables reduces the risk of digestive system cancers (stomach and colon cancers) and is beneficial in many other ways.
You: So you are saying that someone who eats lots of fruits and vegetables will never get colon cancer.
Expert: No, of course not. We cannot eliminate all the risk, but the benefits are still very impressive.
You: Ah, well, at least you can tell me that absolutely no one has ever died from eating lots of fruits and vegetables, right?
Expert: Strictly speaking, no. There are a fair number of cases of foodborne disease that are traced to plant foods, some of which are fatal. People die from allergies, including allergies to fruits. Fruits and vegetables contain pesticides (some naturally occurring, some added by humans) and other organic chemicals, heavy metals (calcium, lead), and even radioactive isotopes that probably sometimes cause cancers and other diseases. On net, on average, you are much better off eating more fruits and vegetables rather than less, but it is not perfect. Don't be distracted by the fact that it is not perfect. It is still very good.
You: So eating fruits and vegetables does not entirely eliminate the risk of any disease, and is not perfectly safe but is still a great idea. That sounds kind of familiar.

Can tobacco harm reduction really work?

The male population of Sweden is living proof that tobacco harm reduction can work. Smokeless tobacco has a long history in Sweden and, though it was largely replaced by cigarettes when they became popular in the early 20th century, it made a comeback. Over the last few decades, men in Sweden have smoked less and used more "snus" (the Swedish word for moist snuff) instead.

This was not caused by any public health campaign or government meddling. It was a normal social process of people changing their tastes. But the result was a huge public health triumph. Swedish men have a very low rate of lung cancer and other smoking related diseases, as we would expect from a population that quit smoking. The scientific evidence shows that the widespread use of smokeless tobacco is not causing any substantial disease risk. (Swedish women, unfortunately, continue to smoke at the higher rates typical of other countries, and their rates of smoking-related diseases remain high).
Could the Swedish experience be repeated elsewhere? It might be spontaneously happening in Norway right now, where smokeless tobacco is also culturally popular. But to duplicate it in other cultures will require some effort on the part of health promoters to educate people and persuade them of the advantages of harm reduction. That is what we are attempting to do.

How to Use Nasal Snuff

Snuff is a form of finely ground smokeless tobacco predominantly enjoyed by the English aristocracy of the 18th century. It is an arguably healthier alternative to smoking for the user, and undeniably healthier for those in your company as you are not subjecting them to second-hand smoke while snuffing. Here is how to properly take (and enjoy) nasal snuff!

Warnings

• Snuff is still a form of tobacco and therefore contains nicotine and is thus addictive. And while it is generally accepted as less harmful than smoking (and obviously less harmful to those around you than smoking) there may be carcinogenic (cancer) risks. Snuff is healthier than smoking, but it is by no means a risk-free alternative and not something you should do if you intend to live forever.

Nicotine and Addiction

You keep talking about providing a less harmful source of nicotine. But isn't nicotine itself very bad for you?

No. The effects of nicotine itself are very similar to that other popular drug, caffeine. There is no reason to believe that nicotine causes any substantial risk for cancer, and evidence shows that the risk for cardiovascular disease is minimal. Much of the confusion about nicotine comes from anti-smoking activists talking about nicotine and smoking as if they were the same (just as they confuse tobacco and smoking). It is true that people smoke mostly because of nicotine; but nicotine users die mostly because of the smoke.

Neither nicotine nor coffee are completely benign (in particular, both cause a short-term increase in your blood pressure and pulse rate when you use them, which could affect your health). A lot of evidence shows that coffee drinking causes very little health risk. Studying nicotine is a bit harder, because most nicotine users smoke, and the smoking is quite bad for you. But we do have some good evidence: If nicotine were very bad for you then smokeless tobacco, which provides nicotine, would be very bad for you. As we've shown above, that is not the case.

Though nicotine is relatively safe for most individuals, it may have a negative effect on fetal development and as such should be avoided during pregnancy.

But isn't nicotine addictive?

That question is a bit tricky to answer, since there is not actually a scientifically accepted definition of addiction. We know that some people try hard to give up nicotine and keep going back to it, which probably meets most people's definition of addiction. Indeed, that is a large part of why we think harm reduction is such an important idea – if everyone who used nicotine could just take it or leave it, then some anti-tobacco advocates' goal of getting everyone to just quit would not be so absurd.

Many people can take it or leave it, so nicotine is clearly not such a strong draw for some people. Many tobacco users have not had too much trouble quitting, and many others use it sometimes, but feel no need to use it regularly. Some of the researchers who produced this website use smokeless tobacco sometimes – we feel it is our professional responsibility to be thoroughly familiar with the products we are writing and talking about – but feel no urge to use it more often. It seems that some people get substantial benefits that keep them using nicotine, while others do not.

Some advocates seem to think that addiction is a terrible disease in itself (despite them not even having a good definition for it). If you are addicted to something, these people think you should give it up, even if it is doing you more good than harm. They apparently would have you suffer the pain of quitting, and possibly ongoing unpleasantness of wanting something you cannot have – just because you are "addicted". We think this is absurd, and even downright cruel. We agree that when someone is obsessed with something and neglects the rest of their life, or is compelled to do something that hurts them, then helping them quit is a worthy goal. But when someone has a habit that is not hurting them much, then why should we make their lives miserable and insist that they give it up. Of course, smoking does hurt people a lot, but nicotine does not have to.

It is sad and frustrating that some people are so obsessed with ending addiction to nicotine, rather than reducing the heath impact of using nicotine, that they tell all tobacco users that they must quit entirely, and if they do not quit, they might as well smoke and die from it. In addition to insisting that people endure the unpleasantness of quitting, this has terrible health consequences. Since many people who try to quit smoking fail, this attitude dooms millions of people to die unnecessarily from their nicotine habit.

Does nicotine have any benefits?

Yes, for many people. For quite a few people, nicotine provides the benefits that some people get from caffeine or Ritalin: it helps them focus and be more productive, overcoming attention-deficit-type problems. For some people, nicotine provides relief from stress, anxiety, or panic. For people suffering from some severe mental illnesses, nicotine seems to provide great relief, which probably explains why a very large fraction of psychiatric patients smoke.

Nicotine is also suspected as the reason as why there is a lower incidence of Parkinson's Disease among smokers. And for those who have Parkinson's, nicotine appears to reduce the associated symptoms. Unfortunately, because nicotine is so politically incorrect, there is less information about it than we might want, so we do not have good scientific evidence on all of its possible benefits.

At the risk of being even more politically incorrect, we will state the obvious: Benefits are a good thing. Many people recognize that they get immediate psychological benefits from nicotine – anything from being able to focus in school to not feeling severe distress – and, not surprisingly, keep using it. Think about this: Most everyone in Western society tries nicotine sometime during their childhood or adolescence, but relatively few of them adopt it as a habit. Why is it so hard to realize that those who kept using felt substantial benefits from it, while those of us who chose not to bother with it did not? (We might even speculate that the effective campaigns to reduce youth smoking might partially explain the increase in prescriptions for alternative attention-deficit drugs – not that this would be a reason to want children to smoke, of course.)

One of us had a friend in graduate school who had forced himself to quit smoking because of the health risks. He believed that if anyone ever found a way to provide nicotine without large health risks, then everyone in school would use it. If they wanted to stay competitive, he thought, they would need the increased clear thinking and productivity that nicotine gave him. He did not know that there was, in fact, a way to get nicotine without a huge health risk (none of us did). More interestingly, he did not realize that most of us do not get the same benefit from nicotine that he did – he assumed that everyone was like him. Tobacco policy seems to be made by people who have not experienced any benefits from tobacco, and assume that everyone is like them.

People who get the most benefit from smoking are the ones who are likely to keep smoking (be "addicted") despite high taxes, non-smoking buildings, and all the messages telling them to quit. So, by making smoking more and more unpleasant, while also trying to hide the fact that there are much less risky sources of nicotine, anti-tobacco advocates are just hurting people who get relief from psychological difficulties by using nicotine. Laws against smoking in public places are often praised by anti-smoking advocates for making it easier for smokers to quit. But when you start pretending that smoking has no benefits, it becomes clear that making quitting "easier" really means making smokers' lives so unpleasant that the costs exceed the benefits, even when the benefits were high.

We are not suggesting that we know whether the benefits of using nicotine outweigh the possible costs (the financial costs of buying it, the effort that goes into using it, and the possible very small health costs) for any particular person. This is a decision that people must make for themselves, and should do so based on mature judgment, a complete understanding of the costs (the true costs, not the shameless anti-nicotine propaganda), and knowledge of their own personal benefits.

Advocates should keep in mind that some nicotine users are getting benefits that make them willing to accept the huge costs from smoking. The obvious humane response to this is to try to lower the high costs of nicotine use, by providing a substitute for smoking. The opposite strategy, continuing to increase the costs until they exceed the benefits, making people so miserable that they quit, is puritanical and cruel.

But isn't nicotine...?

But isn't nicotine used as an insecticide? But isn't pure nicotine highly toxic? But isn't the nicotine in a pack of cigarettes a lethal dose? Yes, yes, and yes. But so what?

A lot of anti-nicotine advocates try to scare people by saying things that while scientifically accurate, are just designed to confuse. Nicotine is produced by the tobacco plant as a natural insecticide, and people have discovered that they can concentrate it and use it as an artificial insecticide. This should not come as a shock – many of the chemicals in plants that we like are part of the plants' defense mechanisms. Pretty much every plant we eat or do anything else with contains natural insecticides. We would not expect the plants to be making chemicals for our benefit. It just happens that this chemical, which sometimes poisons insects, sometimes also provides an effect that some people like.

It is also true that a drop of pure nicotine can be deadly, and that if you concentrated the nicotine from a pack of cigarettes (or a can of snuff, or a box of pharmaceutical nicotine products) and put it into your body all at once, it would likely be fatal. But, again, so what? Nicotine users do not consumer these quantities all at once and are never exposed to pure nicotine. If you took an entire meal's worth of food and stuffed it in your mouth all at once, that would probably kill you too, even though it would be harmless if you took twenty minutes to eat it. That may seem like a silly thing to say, but it is no more silly than pointing out that a huge dose of nicotine, delivered all at once, would be deadly. Neither one says anything about the safety of normal consumption.

Keep in mind the truism in toxicology: "The dose makes the poison." Enough of anything, delivered fast enough, is deadly (including food or water). For many medicines you have on your shelf, ingesting the entire bottle at once would be deadly.

In any case, it is always most useful to go back to the scientific evidence. Long term users of nicotine who do not smoke (smokeless tobacco users) suffer very little ill effect from their habits, as we describe above. If nicotine were deadly, we would expect to see a lot of these people die prematurely. We do not see that.

Does smokeless tobacco act as a "gateway", causing people to start smoking?

There is no real evidence that anyone who would not have otherwise smoked takes it up because of smokeless tobacco use. But to the extent that people do switch, the best thing we could do is tell them the truth. This is a case where the anti-tobacco literature actually encourages some people to smoke.

Some anti-smokeless-tobacco advocates have realized that they have no legitimate scientific basis for arguing that there are major health impacts associated with smokeless tobacco use. But instead of seeing that as a reason to devote their attention to more dangerous exposures, they just decided to search for other arguments. One that became popular is the "gateway" hypothesis, that the use of smokeless tobacco leads people to later take up smoking.

Whether true or not, this claim is not relevant to harm reduction, which is aimed at people who are already smoking. But it is also pretty clearly not true. It is no surprise that many people who like to use one tobacco product will like to use another, in particular because they like nicotine. The evidence shows that many people use one product and then switch to the other. This does not mean that the first product caused them to use the second (i.e., that if the first product did not exist, they never would have tried the second). Quite likely they would have tried the second product in the first place. The gateway argument assumes that some people never would have thought to try cigarettes were it not for smokeless tobacco, which seems rather unlikely in a society where cigarettes are so common.

In any case, if the gateway claim were true, we would have to eliminate smokeless tobacco entirely to keep it from happening, which would be a terrible option, leaving tobacco users without a good reduced-harm alternative. No one is talking about doing that.

Most important, if there is a gateway effect, the harm reduction message is actually the best way to do something about it. The dominant misinformation, that smokeless tobacco is about as unhealthy as smoking, tells smokeless tobacco users, "you might as well smoke". This terribly irresponsible message translates to something along the lines of"if you use nicotine, and you like cigarettes a bit more than smokeless tobacco, then go ahead and smoke". Many people try both products and settle on cigarettes. If people are going to use one product or the other, we want them to settle on smokeless tobacco.

Anti-tobacco advocates tend to treat tobacco users as if they are complete idiots – helpless children who cannot make a rational decision and need to be manipulated. We think otherwise. We think that many tobacco users will choose a product that is 99% less harmful, as soon as someone can break through the propaganda and let them know about that comparative risk. The "gateway", then, will be an exit, not an entrance to smoking.

Are you trying to encourage people to use snuff?

We are not encouraging anyone who does not currently use nicotine to try it or use it (in any form). Nicotine products cost you money and time, and even smokeless products (smokeless tobacco and pharmaceutical nicotine products) are probably a little bit bad for your health.

On the other hand, we are not too worried that we are going to cause non-users to try nicotine. We are not so naive (as many anti-tobacco activists seem to be) to think that there are many people in our readership who have never tried nicotine, and that somehow the message that smokers would benefit from switching to smokeless tobacco or other  tobacco products which are not burned might cause non-users to take up nicotine. (Sounds pretty silly when we put it like that, doesn't it?) Most people who try nicotine do not like it enough to become regular users. Many who do become regular users at some later point find that smoking no longer suits them, and quit. But some people keep using nicotine. These are the people we are trying to reach.

For the minority of nicotine users who choose smokeless tobacco rather than smoking, we want to make sure they do not switch to smoking. Anti-tobacco activists frequently claim that all tobacco products pose similar health risks, which is the same as telling smokeless tobacco users "you might as well smoke". For the majority of nicotine users who choose smoking, and keep smoking, we want them to realize there is an alternative besides "quitting or dying".

Does this mean if our message is successful that fewer cigarettes and more smokeless tobacco will be sold? Of course it does. But so what? When public health experts suggest that people eat more vegetables and whole grains, and less meat, some products sell better and some worse (assuming anyone takes the advice). Health advice is very often advice about consumption (and thus about purchases). The only big change is the huge potential health benefit.