Prescribing doctors are continually
balancing the risks of their treatment versus the risk of not treating.
Untreated: A smoker
who continues to smoke faces a 1 in 2 cumulative risk of premature
disease. 4500 NZ smokers dying annually didn’t quit in time.
Prescribed
nicotine patches and gum for those wanting to quit, with advice:
·
20% stay quit for a year.
·
80% will relapse to smoking.
Risks of prescribing snuff
Cigarettes,
and most oral tobacco products world-wide, cause mouth cancer; but not
Swedish snuff:
·
Chewing tobacco raises the risk of mouth
cancer five –fold in India. (Znaor 2003)
·
Dry snuff used orally by southern US women caused
increased mouth cancer pre-1980. (US Surgeon General 1986)
·
Swedish moist snuff (snus) is
manufactured differently and does not cause mouth cancer. Sweden’s mouth
cancer rates are lower than for NZ, despite one million Swedes snuffing
daily. www.endsmoking.org.nz/mouthcancer.htm
·
Snuff has 10% of the total mortality
risk of smoking. (Levy 2004)
·
Nasal snuff has long been used by one
third of Lesotho women yet the Lesotho female naso-pharngeal cancer rate is <1 per 100,000 per
year. www.endsmoking.org.nz/tobaccocancers.htm
Suggested warning for tobacco snuff containers
This tobacco product may damage your health, and is
addictive.
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Effectiveness of snus as a stop smoking
aid
A large cross
sectional survey in Sweden shows that it was
2-4 times as effective in helping smokers quit smoking in their last
quit attempt, compared with nicotine patch or gum. http://www.endsmoking.org.nz/snusaidsquitting.htm
What
doctors can do
Tobacco is not approved as a medicine
for stopping smoking and therefore doctors should not prescribe it as
such.
Doctors may however wish to recommend
snus as a stop-smoking aid for those unwilling to quit tobacco.
NZ’s Smokefree Environments Act
·
Bans advertising any tobacco product
·
Permits nasal snuff to be imported and
sold.
·
Bans sale and distribution of oral snuff
but permits its import for personal use.
Conclusion
Doctors and their
practice organizations should
record smoking status of all patients and ensure that
·
The smokers are offered nicotine patch and gum.
·
Smokers unwilling or unable to quit smoking should
be accurately informed and assured that Swedish moist snuff is worth
considering as a stop-smoking aid.
Snuff contains
tobacco It is a lifestyle choice. Doctors do not prescribe it as it is
not a medicine. It has its own risks, but may be a lifesaver for highly
addicted smokers unable or unwilling to quit by other means.
Price
information on Swedish snuffs: http://www.northerner.com/html/snus.html
or http://www.buysnus.com NZ Customs says any quantity can be
imported, but only for personal use, and taxed.
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