With the marketing of Camel Snus and Electronic cigarettes, many of us are being asked about these. So here is what I usually say

           

Snus is a type of smokeless tobacco. In most US smokeless tobacco, the tobacco is fermented and this process causes the formation of carcinogens. Snus began in Sweden and is a smokeless that uses a different process that appears to dramatically reduce carcinogens. Although typical US smokeless has been associated with oral cancer, surprisingly snus has not.   Snus also appears to have few risks, but this is unclear. Many Swedes have used snus to stop smoking and there are currently trials of using snus for cessation, because it may produce higher levels of nicotine than nicotine replacement therapy.   Bottom line – smokeless tobacco of any type is safer than cigarettes and snus appears to be the safest form of smokeless; however, snus is likely to be more risky than nicotine replacement therapy, so I cannot see recommending snus unless someone has really failed all the current existing therapies.  

           

The e-cigarette is basically a tube in which nicotine is vaporized.   The data thus far say it produces low levels of nicotine, is not very good at relieving craving and withdrawal, and, more importantly, we really do not know what else this cigarette produces.   So, I cannot see a role for it with cessation. Bottom line - better to use the nicotine inhaler if you want something to handle..

           

Of course, snus and e-cigs are mostly promoted, not for cessation, but for use when one cannot smoke (i.e. during “temporary abstinence” periods). Some worry that using snus, ecigs or even nicotine medications during temporary abstinence periods would undermine the beneficial effects of smoking restrictions to prompt quit attempts. Others believe that, at least for nicotine medications, such use might familiarize smokers with the benefits of these medications and actually increase quit attempts. But unfortunately, we have no data on which of these (or neither) is true.   Bottom line – my clinical guess (and it’s a true guess) is that use of nicotine medications will not undermine cessation, but I am not confident enough to endorse such use.  

           

I look forward to other’s thoughts

 

John