Snus prohibition

This week I wrote an article for the Swedish newspaper Espressen about the EU prohibition on snus—which most Swedes find baffling (and with good reason). The whole story is recounted in my book The Art of Suppression. This is a very brief overview. Prohibition still kills. Won't someone tell the FDA?

Here is the unedited article in English...

For most of us, the word ‘prohibition’ brings to mind images of Al Capone, Elliot Ness, speakeasies and moonshine gin being distilled in bath tubs. It is widely acknowledged that America’s attempt to use manmade laws to defeat the laws of fermentation was a fiasco. Russia, Finland and Iceland also experimented with bans on alcohol in the 1920s with equally dismal results. Sweden narrowly escaped the same fate in 1922 when a referendum for national prohibition was defeated by the tightest of margins - 49% voted for and 51% voted against.

The violence, crime, ill health and drunkenness that invariably accompanied alcohol prohibition meant that it was repealed in every country that tried it. Finland’s ban was so unsuccessful that by the time it ended in 1934, the Swedish government was complaining about the amount of drink being smuggled in from its supposedly dry-as-dust neighbour.

Bootlegging, gangsterism and poisonings were unintended consequences of prohibition that no government could ignore, but the harmful consequences of criminalising products are not always so obvious. In the case of the European Union’s ban on Swedish snus, the damage remains unseen precisely because the prohibition has ‘worked’. It has ‘worked’ in the sense that few people outside Scandinavia use – or are even aware of – the product. As a means of limiting snus use in Europe, the ban has been a roaring success, but as a public health measure it has failed as grievously as any prohibition in the last two hundred years.

My country, the United Kingdom, must take some of the blame. In the 1980s, a smokeless tobacco company set up a headquarters in Scotland where they produced an oral tobacco product similar to snus called Skoal Bandits. Low in nicotine, sweetly flavoured and with a masked cowboy emblazoned on each container, Skoal Bandits were accused of being aimed at teenagers. The British have no history of using snus and, as a result, there was a loophole in the law that allowed its sale to children. Alarmed by this news, anti-smoking groups and the tabloid press led a brief moral panic which resulted in oral tobacco being banned outright in the UK and Ireland. In 1992, the European Commission complained that unilateral bans by member states undermined market harmonization and so decided to enforce a total ban on “new tobacco products for oral use.”

Few noticed and fewer cared about this legislation because hardly anybody in the EEC used these products. It was not until Sweden prepared to join what had become the EU in 1995 that it became a live issue. Aware that Sweden was a nation of snus-users, the European Commission temporarily abandoned its insistence on market harmonization and allowed it an exemption from the ban. The rest of Europe remained indifferent to this little piece of diplomacy, but that was about to change.

The public health basis for the EU’s ban was based on the twin assumptions that snus increased the risk of oral cancer and was a gateway to smoking. The first of these beliefs was plausible since it was well known that some smokeless tobacco products, especially those used in Africa and Asia, contain high levels of carcinogens. What was less well understood, however, was that Swedish snus is a fundamentally different product. Whereas the hazardous ‘tobacco-specific nitrosamines’ can be found in excess of 1,000 parts per million in some chewing tobaccos, levels in Swedish snus are as low as 2 parts per million. Very little was known about the effect of snus use on health when the EU introduced its ban, but when scientists conducted studies in the 1990s, they found no difference in cancer rates between users and non-users. This evidence was so compelling that, in 1999, the EU went to the unprecedented step of removing the ‘Causes Cancer’ warning on snus packaging.

As for the ‘gateway to smoking’ hypothesis, it has become clear in the last twenty years that snus is a gateway from smoking. The revival of snus use in Sweden since the 1970s has been accompanied by an exceptional decline in smoking prevalence. Today, Sweden has the lowest male smoking rate and the lowest lung cancer rate of any developed country. In the North of the country, where snus consumption is at its highest, the smoking rate is lower still. Any lingering fears that snus causes cancer are dispelled by the fact that Sweden also has the third lowest rate of oral cancer (and the fourth lowest rate of pancreatic cancer) of any EU nation.

As public health researchers pieced this picture together, it became clear that European smokers had been deprived of a product that could help them quit cigarettes. One study estimated that 200,000 lives could be saved if the whole EU emulated the ‘Swedish experience’. Britain’s Royal College of Physicians, Action on Smoking and Health, the American Association of Public Health Physicians, the European Respiratory Society, the Norwegian Directorate of Health and the Swedish government have all called for the EU ban to be overturned, but they face resistance from hard-liners in the anti-smoking movement who are anxious to maintain one of the world’s few prohibitions of a tobacco product. The manufacturers of nicotine gums and patches are also keen to maintain their monopoly on the smoking cessation market and have lobbied hard for the ban to remain in place.

This leaves snus in a peculiar position. Despite being a near-harmless substitute for smoking, it is treated like an illegal drug in the EU while cigarettes remain freely available to any adult who wants to buy them. Few Swedes appreciate the role that snus has played in improving the nation’s health and few people outside Scandinavia have even heard of it.

There are no Al Capones or Pablo Escobars smuggling snus into other member states. No one is making counterfeit General in their basements or running illicit bars for snus users. The curious ban on snus has created no mayhem in the streets and yet, by helping to keep nicotine users consuming the most deadly tobacco products, this little known prohibition may be costing more lives than all the poisoned moonshine drunk in 1920s America.

Other recent articles related to The Art of Suppression:

'We should stop panicking about Boozy Britain' (Independent)

'Prohibition fuels firestorm of new dangerous drugs' (City AM)

Patrick Hayes' review of The Art of Suppression (Spiked)

Tom Miers' review of The Art of Suppression (The Free Society)