In Norway, people are emulating their Viking forefathers by living in the moment and letting things go – in particular, cigarette smoking. So much so that 98% of people under 25 today don’t smoke. This is thanks to the ubiquitous use of snus, an oral smokeless tobacco product, writes Chris Bateman for MedicalBrief.
Snus is usually placed behind the upper lip, either in a loose form or in portioned sachets. The health harms of snus are estimated at 5% or less of combustible tobacco, giving Norway the lowest cigarette-related mortality and morbidity figures in Europe, with the exception of Sweden next door, where snus has also transformed the health landscape.
Yet according to Dr Karl E Lund, a senior researcher at the Norwegian Institute of Public Health, their politicians are reluctant to trumpet this success.
He told the annual E-Cigarette Summit held in London and Washington DC last week that in a climate where ‘never smokers’ will soon be in the majority, the government is instead curbing snus use through tax hikes, display bans, plain packaging and anti-nicotine campaigns.
Lund said the nicotine industry in Norway finds itself in a Catch 22 situation; transfer manufacturing to low-risk products with the potential to eradicate smoking, but face regulators who argue that these harm reduction products have become redundant, and who are thus clamping down on them on legitimate health grounds.
Addressing the global virtual e-cigarette summit on 8 December, Lund’s description of Norway and its neighbouring outlying country had his audience fascinated by the almost unthinkable scenarios he sketched.
“My guess is that the authorities will eventually go for the free choice argument, while still curbing snus use,” he said.
With smoking about to be eradicated in Norway, snus and other non-combustible nicotine products “can’t really be presented as alternatives to cigarettes anymore. So, in my country there’s a new debate emerging; will there be a place for recreational use of low-risk nicotine products in a post-smoking era?
“Now I realise that in a world of 1.3 billion smokes and increasing cigarette consumption, this might appear somewhat absurd and even irrelevant. In our overall population the current smoking prevalence has crept below 10%.”
Lund said the use of snus gradually increased among people aged 16 to 29, between 1985 and 2020, with a sharp increase among men at the turn of the century and the same among women a few years later. This had created an almost reverse correlation, with smoking declining as snus use soared.
“We’re now observing the first generation going smoke free. It hasn’t always been like this. Twenty years ago, cigarettes made up 93% of the nicotine market and snus 7%. snus now has almost 50% of the market and overall sales of nicotine per capita have been reduced from two kilograms per capita to one,” he added.
Lund said that if the appetite for nicotine persisted and if the product range widened, “in an imaginary future we might perhaps end up with a multi-product low risk landscape where cigarettes have become a niche product. We’ve reduced morbidity and premature mortality and virtually eliminated smoking and the tobacco industry – in fact we’ve ticked all the boxes.”
He continued: “So, everybody should be happy, but in this landscape the low-risk products become more or less redundant to cure smoking, and their therapeutic functions are about to be negated. After product transformation, the industry will put addictive commodities on the market.
“So, why do we need them? The difference is they do not kill the customers. When you strip out the therapeutic function of these products, consumers will use them for pleasure, enjoyment, affection, passion, inspiration, relaxation, amusement, love, contentment, happiness, or just to create some kind of distinctive style and individuality,” he grinned.
In short, these alternative products would be used for recreation only – although some dismissed this conception on moral grounds as ‘excessive’ or ‘conspicuous’.
Lund stressed: “My objective is to approach recreational use detached from any moral judgement. We’re in the end game of smoking,”
He said an emerging argument among some of his colleagues was that there would be a long-term market for nicotine because the availability of low-risk products would keep cigarettes from a return.
His take was that addiction without harm was a moral, not a health issue. Nicotine was “innocuous”, and not associated with typical drug related problems like intoxication, accidents or injuries, while the gateway argument was not valid in a smoke free culture.
From a more ideological platform, liberalists were pro free choice, rejecting micro-management and paternalism while promoting acceptance and respect for one another’s values.
“Some people rank present pleasure higher than future health. Also, from a practical sense, harsh regulation will result in a black market and workarounds,” he added.
Lund emphasised that a robust infrastructure for tobacco control in Norway and the widespread availability of snus were responsible for the country’s – and Sweden’s – globally unique situation.
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