European Tobacco Harm Reduction Advocates
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The Dutch government are proposing to extend their ban on the use of tobacco products in public places to include the use of snus (see here for the notification detail for the draft act). The consultation period ended on 31 December 2019.
Bengt Wiberg, the co-founder of ETHRA partner EUforSnus, wrote to the Swedish government to urge them to respond to the proposal. We summarise the letter below.
The Dutch government is proposing to ban the use of cigarettes and e-cigarettes as well as snus and other smokeless products in all public places. In Sweden, there has been a ban on the use of cigarettes and e-cigarettes in public places since December 2018 but snus is not included. In Sweden, 17% of the electorate uses snus. Snus has been used in Sweden for over 200 years and is thus by far the oldest harm reduction product (compared to smoking) in the world.
We urge the Swedish government to respond to the consultation on the Dutch proposal.
If the Dutch bill goes through, unopposed by the Swedish government, other EU governments are likely to conclude that snus is as dangerous as smoking. However, thanks to snus, Sweden has by far the lowest proportion of tobacco mortality and tobacco-related diseases in the EU and also the lowest smoking prevalence. This is because Swedes use snus instead of smoking. Research has shown that 86-87% of Swedish snus users are former smokers who stopped smoking for good.1
The potential impact on public health, for the 100 million daily smokers in the European Union is extremely worrying.2 Annually approximately 700,000 die prematurely from smoking-related diseases in the EU.3 However, nobody has been proven to have died from snus. Snus is not a health product but must be considered in relation to the dangers of smoking. Swedish snus, and tobacco-free snus, can be excellent tools to quit smoking. There is no ban on the sale of tobacco-free snus in the EU, and it is often manufactured by Swedish companies and sold to EU countries.
The epidemiological wonder of Sweden’s low smoking prevalence is often referred to as “The Swedish Experience”. On October 22, 2019, the US Federal Authority (FDA) decided to grant Swedish snus - the first product in FDA history - with approval as a "modified risk tobacco product" (MRTP) and approval to market eight Swedish snus products as being less harmful than smoking.4
Snus should not be a political issue at all. It is rather a public health issue. We in Sweden should be proud to have the lowest proportion of smokers in the entire EU (and probably the western world) as well as the lowest tobacco mortality and prevalence of tobacco-related diseases. In September 2017, the world's largest so-called meta-data study, comprising 26 years of published scientific research, concluded that Swedish snus does not increase the relative risk of any disease at all when using snus compared to non-snus users.5
Read the full letter here.
Footnotes
1.Patterns of Smoking and Snus Use in Sweden: Implications for Public Health, https://www.ncbi.nlm.nih.gov/pubmed/27834883
2. Flash Eurobarometer No 253 Survey on Tobacco. Analytical report. Hungary: The Gallup Organisation, 2009. http://ec.europa.eu/public_opinion/flash/fl_253_en.pdf (accessed 16 January 2020).
3. "Overview - Public Health - European Commission", Public Health - European Commission, 2020 https://ec.europa.eu/health/tobacco/overview_en [Accessed 16 January 2020].
4."Spotlight On Science - Winter 2020", U.S. Food And Drug Administration, 2020 https://www.fda.gov/tobacco-products/ctp-newsroom/spotlight-science-winter-2020 [Accessed 16 January 2020].
5.Skademinimering« är ett omdiskuterat alternativ för dem som inte kan sluta röka, (Harm reduction is a well-debated alternative for those who cannot quit smoking) Stefan Willers, Läkartidningen, http://www.lakartidningen.se/Klinik-och-vetenskap/Klinisk-oversikt/2018/10/Skademinimering-ar-ett-omdiskuterat-alternativ-for-dem-som-inte-kan-sluta-roka/
EU for Snus is an advocacy group campaigning to give everyone access to nicotine replacement products with an onus on the right to enjoy smokeless tobacco products such as snus. EU for Snus’ Facebook group has several thousand members from about 100 countries, including all countries in the EU. The members are adult men and women, almost all of whom have stopped smoking with the help of snus. You can find out more about EU for Snus on their Facebook page.
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ETHRA founder partner, the New Nicotine Alliance in the UK, is calling on European Harm Reduction Advocates to prepare for worrying developments in the new year.
In an article just before Christmas, they urged vapers, especially, to “prepare for battle” in the coming year. The European Union is currently gathering evidence for a review of the Tobacco Products Directive and meetings have already been planned to discuss how misinformation emanating from the US can be used to close down the sensible regulations Europe has enjoyed since 2014.
As the NNA put it: “The war on harm reduction in the EU is starting again. Much sooner than you realise, minds will be closed, and positions taken. By the time any of us are asked for comment on this, policy proposals will already have been made. We are expecting the first significant discussions to start in the European Parliament as soon as the end of January 2020.”
It is important that all partners take this threat seriously. Harm reduction in Europe is under imminent threat and we will have to mobilise consumers as we did for the last iteration of the TPD. Five years ago, it took a lot of pressure from vapers to educate the EU as to how important vaping products were and to head off counterproductive regulations which would affect the choices of European smokers wishing to quit.
2020 will see major threats to the sensible regulations that we fought so hard for under TPD2, but it would appear that the EU wishes to erase them and introduce the same damaging proposals that they were forced to abandon before.
We must all resist this by reminding the EU that the most important voice on this subject in Europe is that of those of us who have derived tangible and life-changing benefits from harm reduction. ETHRA is committed to galvanising the consumer voice in our region and will be asking for your help in a major campaign in 2020 to remind the EU why they prohibit reduced risk products at their peril. They would prefer we stay silent and be rule-takers, we must make them realise that we will not sit idly by as they dismantle what we know is working.
We cannot just let ill-informed bureaucrats play games with our lives, please be prepared to mobilise all European consumers in 2020.
Notes:
New Nicotine Alliance UK is a registered charity which raises awareness about tobacco harm reduction. The Board of NNA and Associates include ex-smokers, most of whom have succeeded in giving up smoking through the use of other nicotine delivery systems. NNA can be contacted here.
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ETHRA is pleased to welcome some promising news from Norway.
The Norwegian government has declared that it will lift its ban on e-cigarettes with nicotine and replace it with an authorisation system as it belatedly moves to implement the EU’s Tobacco Products Directive (TPD). Manufacturers of e-cigarettes and new tobacco products will have to apply for authorisation at least six months before they intend to put their product on the market, as the TPD requires. The government is also planning to allow e-cigarettes and refill containers to be advertised at the point of sale and be presented online neutrally, unlike cigarettes.
The Norwegian Directorate of Health, which will evaluate the applications, will look at “whether the product will contribute to tobacco harm reduction;” whether it appeals to youngsters; whether it will lead to the initiation and re-normalisation of tobacco use; and whether it’s addictive, according to draft rules sent to notify the European Commission at the end of November.
The directorate will then decide whether the e-cigarette or novel tobacco product is defined as a nicotine or smokeless tobacco product, or a tobacco product for smoking, and which regulations should apply to it. This measure goes beyond the scope of the TPD.
“Legalising vaping in Norway is a welcoming development and we congratulate our government for aligning with the EU’s TPD,”, says Trond Meier, of Norsk Dampselskap/Norwegian Union of Vapers, a consumer-led association which advocates for vaping in Norway, “however, there is still much negative publicity around vaping in the media and many details still to become clear so our welcome must be cautious for now. There is still more work for us and our ETHRA partners to do.”.
André Bendigtsen, of Nikan, the tobacco harm reduction consumer group, adds: “We understand that these proposals will be implemented during 2020 and we would suggest that the government includes consumers of reduced risk products in the process at every stage.”, André continues, “these products offer a lifeline to many former smokers and can lead to better outcomes for the public’s health in Norway in the future. Consumers are ready and available to offer our experience and knowledge to regulators in order to maximise the many benefits of safer nicotine use.”.
Notes
Nikan has written about the new proposals on their website here and welcome being contacted here: This email address is being protected from spambots. You need JavaScript enabled to view it.
Norsk Dampselskap / Norwegian Union of Vapers can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. and their website is here.
Norsk Dampselskap was established on 6 November 2011 and has over 4,000 members.
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The Norwegian Institute of Public Health has just published a new report on the use of Swedish Snus. However, instead of celebrating the remarkable impact that snus has had on smoking rates in Norway, the Institute has chosen to focus on minimal risks as if to deter use of one of the safest forms of nicotine in existence.
The report speculates on a host of “probable” and “possible” negative outcomes despite snus being definitely orders of magnitude safer than smoking which it is replacing. It also worries unnecessarily about the increase in Norwegian snus users who had not previously smoked, despite it being certain that many of those would have gone on to use the most harmful nicotine delivery system – cigarettes – if snus was not readily accessible.
The truth is that snus has delivered considerable success in Norway, with Government figures showing that smoking has almost disappeared among young Norwegian women, especially. In 2001 the smoking rate among females aged 16 to 24 was 30%. By 2017 that had collapsed to just 1%. Over the same period smoking among young Norwegian men fell from 29% to 3%.
https://www.ssb.no/en/statbank/table/05307/?rxid=fba52324-e745-43b1-8740-058b118535f6
These data illustrate the game-changing potential of reduced risk nicotine products to better the Norwegian population’s health, which could only bring further benefits now e-cigarettes have been legalised.
“The significant switch from smoking towards the use of snus in the past two decades has been an unmitigated success,”, says André Bendigtsen, of Nikan, a consumer-led association which advocates for tobacco harm reduction in Norway, “rather than exaggerating negligible health risks, the NIPH should be celebrating the fact that smoking prevalence has collapsed by smokers choosing to use safer products without any cost to taxpayers.”
“Why is the NIPH so intent on creating doubt about the indisputable role that snus played in improving the public’s health in our country and, instead, seems to want to scare the public into avoiding less harmful nicotine use?
“Rather than amplifying negative messages about snus, the NIPH should be recognising that harm reduction works, and should be embracing the use of other safer products such as e-cigarettes too.”, André Bendigtsen continues, “Banning vaping in public places sends the message that there is no benefit in switching to a safer option, this has to change. We would encourage government and policy-makers in Norway to talk to consumers such as us and hear our stories of how snus and vaping have transformed our lives for the better, and why authorities should rejoice in the positive change rather than trying to suppress it”.
Nikan can be contacted here: This email address is being protected from spambots. You need JavaScript enabled to view it.
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