Should Docs Recommend Smokeless Tobacco as Last Resort to Quit Smoking?

If people are unable to kick the smoking habit, are doctors justified in recommending smokeless tobacco such as Snus or other smokeless tobacco products? That is the question under debate in a recent article in the British Medical Journal.

More than 100,000 people a year in the UK die because of smoking, primarily from lung cancer, heart disease, and chronic obstructive pulmonary disease, says John Britton, Professor of Epidemiology at City Hospital, Nottingham. An estimated 77% of smokers want to stop smoking, and 78% have tried but failed because of nicotine addiction.

While the best course would be for health professionals to urge quitting all nicotine use, he suggests that switching to a medicinal nicotine product is the logical option for those who want to quit but repeatedly fail.

Dr. Britton suggests that if all else fails, doctors may want to recommend a smokeless tobacco product, such as Snus. He maintains that Snus would be acceptable as a measure of last resort. But it first needs to be tested, he says.

Meanwhile, Alexander Macara, President of the National Heart Forum, while allowing that smokeless tobacco is less addictive than smoked tobacco, quotes studies that show smokeless tobacco to be carcinogenic, with an increased risk of oral and pancreatic cancers and heart attacks. In addition, he says, 60% of people who use Snus become chronic Snus users.

Action on Smoking and Health and the Royal College of Physicians of London have reviewed safer sources of nicotine as a means of reducing the harm caused by smoking, but Macara is concerned that if products such as Snus are recommended as a means to quit smoking, its use may be adopted by more people, particularly young people, who might never have smoked in the first place.

Source: British Medical Journal (BMJ Volume 336 pp 358-9

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