Snus

Snus (/snuːs/ SNOOSS, Swedish: [ˈsnʉːs] ^ⓘ) is a Swedish tobacco product (in Scandinavia). It is consumed by placing a pouch of powdered tobacco leaves under the lip for nicotine to be absorbed through the oral mucosa.^[1] Snus, not to be confused with nicotine pouches, consists of ground up tobacco leaves, salt, an alkalizer (e.g. Sodium Carbonate, Sodium Bicarbonate) and (optionally) flavorings. The final product is sold as both loose tobacco, and in portions with the tobacco mixture contained in a small teabag-like pouch.

The manufacturing process of snus differs from that of other oral tobacco products. Snus tobacco is heated and pasteurized rather than cured or fermented, resulting in a less harmful product which contains a lower concentration of TSNA carcinogens in comparison to other traditional tobacco products.^[2] Though research on the connection between snus and disease such as cancer is not conclusive, no associations between snus consumption and an increased risk of cancer have been found.^[3]

The warning text "causes cancer" was removed from snus packaging in Sweden and other countries because current scientific evidence indicates that the cancer risk associated with snus is significantly lower than that of smoking. The shift in labeling aims to provide accurate information while still cautioning consumers about potential health concerns.

Nicotine products in general have been linked to reproductive harms such as stillbirth, premature birth, and low birth weight.^[4] Conversely, non-tobacco based nicotine pouches (also known as "nic pouches") are classified as non-carcinogenic^[5][6][7] since nicotine itself is not a carcinogen. However, they are still harmful to cardiovascular health due to their nicotine content, and are associated with moderately higher risk of cardiovascular disease, stroke, and reproductive harms.^[8][9] The main causes for mortality from smoking including cardiovascular disease from the effects of smoke on vascular coagulation and blood vessel walls are not caused primarily by nicotine and hence not to be considered equal to the moderate cardiovascular health risks from nicotine pouches.^[10]

The sale of tobacco-based snus is illegal in several countries, including Australia, New Zealand and all European Union (EU) countries except for Sweden.^[12] Non-tobacco nicotine pouches are presently not regulated at EU-level. It is the most common type of tobacco product in Sweden^[13] and Norway^[14] and is also available in Switzerland. Some European countries, such as the United Kingdom,^[15] Ireland^[16] and Estonia,^[17] allow the sale of non-tobacco based snus. Snus is also available in the United States.