Smokeless tobacco, often marketed as a safer alternative to smoking, has emerged as a subject of interest as public health campaigns and regulations continue to curb smoking rates worldwide. Products such as chewing tobacco, snuff, and more recent developments like snus and nicotine pouches have gained popularity, especially in areas with strict anti-smoking laws. Advocates argue that smokeless tobacco is a less harmful way to consume nicotine since it does not involve inhaling smoke and the associated toxins produced by combustion. This is appealing in harm reduction discussions, especially for long-time smokers who struggle to quit traditional cigarettes. Indeed, the absence of smoke reduces the risk of lung cancer and respiratory diseases, which are heavily associated with smoking. However, while smokeless tobacco might be less harmful in some respects, it is far from harmless. Research shows that smokeless products still carry significant health risks, particularly due to carcinogenic compounds called nitrosamines.

These compounds are formed during the curing and processing of tobacco, and their presence has been linked to an increased risk of cancers of the mouth, esophagus, and pancreas. Additionally, the high nicotine content in smokeless tobacco can lead to strong dependency, making it difficult for users to quit and potentially fostering long-term use. The cultural and social acceptance of smokeless tobacco also varies greatly by region. In Scandinavian countries, particularly Sweden, snus has a longstanding tradition and is often used as an alternative to smoking. Swedish smokeless tobacco product studies have suggested that widespread use of snus may correlate with lower smoking rates and fewer tobacco-related health problems overall. This has spurred some policymakers to consider whether smokeless tobacco products could play a role in harm reduction strategies globally. However, critics argue that promoting smokeless tobacco risks undermining anti-tobacco efforts and might attract new users who otherwise would have avoided tobacco products altogether.

This is particularly concerning for young people, who are susceptible to nicotine addiction and may perceive smokeless tobacco as a trendy, safer option. The growing market for nicotine pouches and similar non-combustible products that do not contain actual tobacco also complicates the landscape. These products, often flavored, are increasingly popular among youth, raising concerns that they serve as a gateway to nicotine dependency and possibly later use of other tobacco products. Public health experts are divided on whether smokeless tobacco should be included in tobacco harm reduction strategies or if it should be regulated as stringently as cigarettes. Some argue that if former smokers can use smokeless products as a bridge to cessation, the public health benefits could be considerable. Others emphasize that smokeless tobacco should be viewed with caution because it does not address the underlying issue of nicotine addiction and its associated risks. Furthermore, they argue that any promotion of smokeless tobacco may divert attention from nicotine-free cessation tools, such as nicotine replacement therapies and medications.