This intriguing and equally baffling comment was made by a Swedish MEP outside the European Parliament in Brussels, to a campaigner fighting the proposed e-cigarette regulations in the Tobacco Products Directive.
I have been a Swedish resident for 11 years. I am also a vaper, and I see tobacco harm reduction in action via snus and e-cigarettes every day – both personally, and by witnessing first hand the experiences of others. The comment shocked me. What I hear is either: “Snus is bad enough, but there would be riots if we ban it” or: “We’ve got some harm reduction already; we don’t want any more!” It is deeply saddening to hear someone suggest that the harm reduction product snus (which many countries fail to embrace) is a reason not to embrace a product that is proving itself to be a formidable harm reduction tool elsewhere.
Sweden has a long history of hysterical over-reaction to common pleasures. Home to one of the most swivel-eyed temperance movements to have graced our planet (still going strong today), it’s often at the forefront of random and often comical prohibitions.
When skateboarding first took off around the globe, Sweden’s first instinct was to ban it. An obscure piece of scaremongering research from the USA was further exaggerated in translation, leading to the quite astonishing conclusion that skateboarding “is probably the most dangerous activity known to man”. So for the sake of The Children it was was banned.
Coffee is another everyday human pleasure that has suffered national bans (6 times in fact, for a total of 17 years). Although in this instance it was banned in retaliation, as part of a political battle between farmers and the elite Burghers. The Burghers had previously penalized farmers for having the temerity to brew & distill their own alcohol – a battle that continues to this day (it’s still illegal for a cider farm, for example, to sell…erm…cider to the public).
So it should come as no surprise that Sweden is trying its hardest to ban ecigs, citing a mixture of junk science, scaremongering studies from the USA, and of course the prohibitionists’ killer app – The Children. When Swedish eliquid “poisoning” cases (a mixture of phone enquiries, mild stomach aches & some dizziness) “skyrocketed” from 3 in 2012 to 29 in 2013, you’d have been forgiven for thinking that Ebola was sweeping the Baltic, such was the hysterical reaction of the Tobacco Control industry, politicians & the ever-willing media.
The sale of eliquids & ecigs containing nicotine is still in limbo, as the court ruling that declared nicotine eliquid to be an illegal medicine continues to bounce around the appeal courts. In this legal vacuum, vaping is still a relatively underground activity, with just a few shops and a few more online vendors. Their future is in the hands of the Swedish legal system, as is the natural spread of ecig take-up among smokers that we have seen in other countries.
So what can we make of the MEP’s comment?
Some in the Swedish establishment are still rightly proud of snus, and accept and/or support its continued use. However it would appear that many Swedish politicians, egged on by anti-tobacco campaigners, are convinced that with smoking rates down to around 12-13% (although Euromonitor puts this figure at around 16%), now is not the time to “dither around with harm reduction any more” (a statement from a presentation at the recent ECToH Conference), but to stamp out cigarettes, snus and e-cigarettes as quickly and efficiently as possible.
I understand that some members of the Tobacco Control industry might agree that this is a noble goal. But let’s be honest, for everyone else outside that community and a growing number within, it is neither realistic, nor pragmatic. And if snus and e-cigarettes aren’t both seen as part of the solution, then harm reduction automatically becomes part of your problem. And therein lies a huge risk to public health.
I believe that the inability to accept snus and its role in ongoing tobacco harm reduction has caused, and will continue to cause harm. I worry that the campaign to prohibit e-cigarettes (or at the very least to restrict them to the bland, ineffective, cessation-based world of medicinal regulation) here in Sweden will cause harm – since smokers would be denied a personalised consumer experience that is widely acknowledged to be at least 95% and probably >99% safer.
A bit about snus
Snus plays a unique role in Swedish culture. A mix of finely ground tobacco, water, salt, flavourings and sodium carbonate (to regulate the pH value), it’s been around since the 1600s – either as a loose tobacco product that is rolled up into a small ‘dose’, and more recently also in small, rectangular pouches like tiny teabags, with perforations to allow the contents to deliver their flavour and nicotine to the user.
Like many tobacco products, its popular use has shifted between social classes as times and fashions change – in recent times it has become an almost iconic working-class product, fiercely cherished and defended by manual workers and farmers as a proud Swedish tradition. But its position in society took on an entirely new role in the late 20th Century, as more became known about the dangers of smoking lit tobacco. Suddenly snus was being championed as a product at the forefront of a new way of thinking – tobacco harm reduction.
The crucial impact it made was twin-pronged – people began to switch to snus either to quit smoking entirely or to cut down, but also many young people chose snus in preference to smoking, as a less harmful (and more socially acceptable) alternative, particularly as the anti-smoking and anti-smoker movements took hold.
A taxing issue
There was a recent proposal to raise the tax on snus, which for many snus users would actually raise the price of their daily use above the average daily cost of a smoker. What sort of a message does that send out? In one particularly chilling and ill-thought-out interview, a Government Minister defended this paradox by saying: “Well if we raise the tax on cigarettes it will increase smuggling.” The fact that snus consumed in Sweden is mostly produced in Sweden (and therefore less likely to be susceptible to smuggling) is true; that someone could accept that making snus more expensive than smoking isn’t a potential public health disaster is nothing short of disgraceful.
The amount of people you meet in Sweden who have never smoked, but use snus everyday, is quite remarkable – and around 20% of the adult male population uses snus on a daily basis. There are also a significant number of people who we might consider to be smokers, who due to their knowledge and awareness of the differences in effects of the two products are essentially predominantly snus users – they might have the odd cigarette here and there and maybe a few more in social situations.
The overall, population-level effects, as I’m sure many of you are well aware, are astonishing. I’m sure that the Swedish MEP feels very proud of the general health of the population.
But there is an elephant in the room.
Out of a population of around 9m, there are still 1 million smokers. And I was one of them. And I’m certain that a great many of those 1 million smokers felt exactly like me. I’d used snus on many occasions over my 11 years in Sweden, and I still use it today – it’s handy, especially for flights and other smoke-free environments where you can’t pop out when you fancy a smoke.
However, I could never really say that it would appeal to me as a complete replacement for smoking cigarettes – for one thing I had no strong desire to quit smoking. And I loved smoking – there is simply no way that placing a little pouch of tobacco under my lip was going to replace the joy, the utterly pleasant sensation I felt when I smoked.
I quit by accident – E-cigarettes have become my particular, personal choice of effective tobacco harm reduction. Snus works for some (as well as preventing the uptake of smoking on a population level), NRT works for others, and let’s not forget that cold turkey is still by far the best cessation method for those who are interested in and determined enough to want to quit smoking altogether.
Snus plays a vital role in tobacco harm reduction – both as a consumer product that causes less harm on uptake, an alternative for existing smokers who wish to reduce harm but don’t see a need to quit using nicotine, and as a non-medical, self-titrating and personal approach to first smoking, then nicotine cessation. But nothing works for everyone – we are all unique in our relationships with – and use of – tobacco. So why would our reaction to different forms of harm reduction and cessation be any different?
The Quit, Die or Snus approach fails too many Swedes
When I log in to the Swedish ecig forums, I read about people in their 30s, 40s, 50s, 60s, 70s and 80s who have logged on to meet other vapers to share experiences, tips, advice – but also to share their story. I’m not ashamed to admit that it often brings a tear to my eye to read about a 50-year smoker who lives out in the middle of nowhere in rural Sweden, who has found something “magical” – and no longer smokes. These are people who have smoked for years – despite trying NRT, hypnotherapy, cold turkey, and yes, even snus. They have found what works for them.
But what galls me most – what really makes my blood boil and froth is this: snus use is and has always been predominantly used by men, and the rates of smoking amongst young women in Sweden is actually rising. According to the Swedish national statistics service, smoking rates in this group increased from 10% in 2009 to 13% in 2013. Recent figures shown at a youth smoking conference confirm that around 40% of young people start either smoking or using snus as they reach 18 – and since a far greater number of the male students choose snus, it’s clear to see how the harm reduction potential of snus helps young men to a much greater extent than it does young women.
So young women are still taking up smoking, and at a faster rate than they have done for years. And just like with previous generations of Swedish women, they are choosing to smoke despite the fact that snus is freely & widely available. At what is probably the most stressful time in their lives, these young women have chosen to do something which has a widely known and observable stress-relieving chemical and psychological effect. They have enough on their plate without being hounded by tobacco controllers, teachers & parents – particularly when they may be the source of some of the stress that they relieve by smoking.
By prohibiting the sale, availability or effectiveness of e-cigarettes, Sweden is missing out on the possibility of a genuine & immediate health intervention. Every one of those young adults who has recently become a smoker, who might have switched to e-cigarettes (or even by-passed cigarettes altogether and just used e-cigarettes, as many snus users do), will be denied the right to try a product that is clearly having a positive harm reduction impact on millions around the globe.
While many in positions of power and influence in Sweden are less openly proud to admit it these days, snus has clearly worked. And it continues to work, by enabling a huge proportion of the population to either switch from cigarettes, reduce the amount of cigarettes they smoke, or simply to take up a habit that allows them to enjoy the effects of nicotine with an essentially imperceptible risk. Snus should be freely available worldwide. But it would work even better as part of a harm reduction strategy that includes the wide availability of e-cigarettes as consumer products.
So to the Swedish MEP, the rest of the Swedish politicians, public health officials and anti-smoking/snus/e-cigarette extremists, I will say this:
“You do need e-cigs – because not everybody likes snus.”
(To which I would add “or cares to bother trying your medical “help” again”)
Tobacco, Snus & Cigarette use in Sweden (As with most tobacco statistics, smoking rate figures in Sweden often vary wildly, but it is the ratio of snus/cigarette use that is most relevant here)
Men / Women
Total use of tobacco 31% 18%
Snus 20% 3%
Cigarettes 13% 15%
Gymnasiet Year 2 Students (17-18 y.o.)
Trying/Starting 40% 38%
Daily tobacco use 20% 13%
Source: CAN(2012) Drug use in Sweden 2011.
If you haven’t already done so, I would urge you to visit these outstanding blogs, where you’ll find comprehensive details on the scientific research and politics concerning snus, ecigs and tobacco harm reduction: